{"id":"https://openalex.org/W128039253","doi":null,"title":"The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care.","display_name":"The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care.","publication_year":1995,"publication_date":"1995-05-01","ids":{"openalex":"https://openalex.org/W128039253","mag":"128039253","pmid":"https://pubmed.ncbi.nlm.nih.gov/7749526"},"language":"en","primary_location":{"id":"pmid:7749526","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/7749526","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the American College of Surgeons","raw_type":"Comparative Study"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5110270947","display_name":"Shukri F. Khuri","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1322918889","display_name":"United States Department of Veterans Affairs","ror":"https://ror.org/05rsv9s98","country_code":"US","type":"government","lineage":["https://openalex.org/I1322918889"]},{"id":"https://openalex.org/I2799886695","display_name":"Veterans Health Administration","ror":"https://ror.org/05eq41471","country_code":"US","type":"government","lineage":["https://openalex.org/I1322918889","https://openalex.org/I2799886695"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"S F Khuri","raw_affiliation_strings":["Veterans Administration Medical Center, West Roxbury, MA 02132, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Veterans Administration Medical Center, West Roxbury, MA 02132, USA","institution_ids":["https://openalex.org/I1322918889","https://openalex.org/I2799886695"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5081317933","display_name":"Jennifer Daley","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"J Daley","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5055893435","display_name":"William Henderson","orcid":"https://orcid.org/0000-0001-5355-606X","observed_orcids":["https://orcid.org/0000-0001-5355-606X"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"W Henderson","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":null,"display_name":"G Barbour","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"G Barbour","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":null,"display_name":"P Lowry","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"P Lowry","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5080729503","display_name":"George L. Irvin","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"G Irvin","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5066001364","display_name":"James O. Gibbs","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"J Gibbs","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":null,"display_name":"F Grover","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"F Grover","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":null,"display_name":"K Hammermeister","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"K Hammermeister","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5077793480","display_name":"John F. Stremple","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"J F Stremple","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":4.5599,"has_fulltext":false,"cited_by_count":421,"citation_normalized_percentile":{"value":0.94659664,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":89,"max":100},"biblio":{"volume":"180","issue":"5","first_page":"519","last_page":"31"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11930","display_name":"Cardiac, Anesthesia and Surgical Outcomes","score":0.9340999722480774,"subfield":{"id":"https://openalex.org/subfields/2705","display_name":"Cardiology and Cardiovascular Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11930","display_name":"Cardiac, Anesthesia and Surgical Outcomes","score":0.9340999722480774,"subfield":{"id":"https://openalex.org/subfields/2705","display_name":"Cardiology and Cardiovascular Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12871","display_name":"Healthcare Quality and Management","score":0.05689999833703041,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11722","display_name":"Patient Satisfaction in Healthcare","score":0.002300000051036477,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/surgical-outcomes","display_name":"surgical outcomes","score":0.5680000185966492},{"id":"https://openalex.org/keywords/surgical-quality","display_name":"surgical quality","score":0.8970000147819519},{"id":"https://openalex.org/keywords/postoperative-morbidity","display_name":"postoperative morbidity","score":0.6589999794960022},{"id":"https://openalex.org/keywords/postoperative-mortality","display_name":"postoperative mortality","score":0.9039999842643738},{"id":"https://openalex.org/keywords/preoperative-risk-factors","display_name":"preoperative risk factors","score":0.8659999966621399},{"id":"https://openalex.org/keywords/veterans","display_name":"veterans","score":0.5249999761581421},{"id":"https://openalex.org/keywords/veterans-health-administration","display_name":"Veterans Health Administration","score":0.7730000019073486},{"id":"https://openalex.org/keywords/noncardiac-surgery","display_name":"non-cardiac surgery","score":0.7369999885559082}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9742200374603271},{"id":"https://openalex.org/C23131810","wikidata":"https://www.wikidata.org/wiki/Q818574","display_name":"Observational study","level":2,"score":0.5797159671783447},{"id":"https://openalex.org/C12174686","wikidata":"https://www.wikidata.org/wiki/Q1058438","display_name":"Risk assessment","level":2,"score":0.4687127470970154},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.4081496000289917},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.3714781403541565},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.17535552382469177},{"id":"https://openalex.org/C38652104","wikidata":"https://www.wikidata.org/wiki/Q3510521","display_name":"Computer security","level":1,"score":0.0},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.0}],"mesh":[{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D003627","descriptor_name":"Data Interpretation, Statistical","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006787","descriptor_name":"Hospitals, Veterans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008875","descriptor_name":"Middle Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008962","descriptor_name":"Models, Theoretical","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D009017","descriptor_name":"Morbidity","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010043","descriptor_name":"Outcome and Process Assessment, Health Care","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D011300","descriptor_name":"Preoperative Care","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011446","descriptor_name":"Prospective Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011787","descriptor_name":"Quality of Health Care","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D012307","descriptor_name":"Risk Factors","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D013514","descriptor_name":"Surgical Procedures, Operative","qualifier_ui":"Q000401","qualifier_name":"mortality","is_major_topic":true},{"descriptor_ui":"D014481","descriptor_name":"United States","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D014493","descriptor_name":"United States Department of Veterans Affairs","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D014768","descriptor_name":"Virginia","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017052","descriptor_name":"Hospital Mortality","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D018570","descriptor_name":"Risk Assessment","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":1,"locations":[{"id":"pmid:7749526","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/7749526","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of the American College of Surgeons","raw_type":"Comparative Study"}],"best_oa_location":null,"sustainable_development_goals":[{"display_name":"Good health and well-being","score":1.0,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W4300501142","https://openalex.org/W4248671093","https://openalex.org/W2131815800","https://openalex.org/W4231233676","https://openalex.org/W87919420","https://openalex.org/W2126856135","https://openalex.org/W2112540265","https://openalex.org/W4235393755","https://openalex.org/W2109768496","https://openalex.org/W3130163807"],"abstract_inverted_index":{"BACKGROUND:":[0],"The":[1,37,209,234,265,275,314],"use":[2],"of":[3,10,13,21,29,34,98,109,112,194,202,241,304,346],"surgical":[4,14,70,76,113],"outcome":[5,55,132,322,334],"in":[6,59,78,88,106,124,145,181],"the":[7,11,19,27,30,35,60,83,89,95,99,107,158,162,182,224,242,294,305],"comparative":[8,68,343],"assessment":[9],"quality":[12],"care":[15],"is":[16],"predicted":[17],"on":[18,94,134],"development":[20,108],"proper":[22],"models":[23,341],"that":[24,102,328],"adjust":[25],"for":[26,56,75,325],"severity":[28],"preoperative":[31,212],"risk":[32,53,213,232,332],"factors":[33,214],"patient.":[36],"National":[38],"Veterans":[39,61,147,315],"Administration":[40,63,148,317],"Surgical":[41],"Risk":[42,90,339],"Study":[43,91],"was":[44,119,269],"designed":[45],"to":[46,66,291],"collect":[47],"reliable,":[48],"valid":[49],"data":[50,100,133],"about":[51],"patient":[52,331],"and":[54,65,72,85,92,131,142,165,188,219,259,289,333,337,342],"major":[57,167,311,326],"surgery":[58,327],"Health":[62,316],"(VHA)":[64],"report":[67],"risk-adjusted":[69,110,347],"morbidity":[71],"mortality":[73,156,267],"rates":[74,345],"services":[77],"VHA.":[79],"This":[80,117],"study":[81,118,123,183],"describes":[82],"rationale":[84],"methods":[86],"used":[87,105],"reports":[93],"frequency":[96],"distribution":[97],"elements":[101],"will":[103],"be":[104],"reporting":[111,323],"outcome.":[114],"STUDY":[115],"DESIGN:":[116],"a":[120,199],"prospective":[121],"observational":[122],"which":[125],"dedicated":[126],"nurses":[127],"collected":[128],"preoperative,":[129],"intraoperative,":[130],"patients":[135,195,306],"undergoing":[136],"noncardiac":[137],"operations":[138],"using":[139],"general,":[140],"spinal,":[141],"epidural":[143],"anesthesia":[144],"44":[146],"Medical":[149],"Centers.":[150],"Outcome":[151],"measures":[152],"included":[153],"all":[154],"cause":[155],"within":[157],"30":[159,273],"days":[160],"after":[161],"index":[163],"procedure":[164],"21":[166],"morbidities.":[168],"RESULTS:":[169],"Eighty-three":[170],"thousand":[171],"nine":[172],"hundred":[173],"fifty-eight":[174],"cases":[175],"meeting":[176],"inclusion":[177],"criteria":[178],"were":[179,196,215,238,280],"entered":[180],"between":[184],"October":[185],"1,":[186],"1991":[187],"December":[189],"31,":[190],"1993.":[191],"Ninety-seven":[192],"percent":[193,227,271,303],"men,":[197],"with":[198],"mean":[200],"age":[201],"60.1":[203],"+/-":[204],"13.6":[205],"(standard":[206],"deviation)":[207],"years.":[208],"most":[210,235,276],"common":[211,236,277],"smoking":[216],"(40.7":[217],"percent)":[218],"hypertension":[220],"(36.1":[221],"percent).":[222,264,301],"Of":[223],"patients,":[225],"84.6":[226],"had":[228],"one":[229,308],"or":[230,309],"more":[231,310],"factors.":[233],"procedures":[237],"transurethral":[239],"resection":[240],"prostate":[243],"gland":[244],"(6.7":[245],"percent),":[246,251,254,258,283,288],"total":[247,260],"knee":[248],"replacement":[249,262],"(3.1":[250],"thromboendarterectomy":[252],"(2.4":[253],"partial":[255],"colectomy":[256],"(2.2":[257],"hip":[261],"(2":[263],"unadjusted":[266],"rate":[268],"3.1":[270],"at":[272,296],"days.":[274],"postoperative":[278],"morbidities":[279],"pneumonia":[281],"(3.6":[282],"urinary":[284],"tract":[285],"infection":[286],"(3.5":[287],"failure":[290],"wean":[292],"from":[293],"ventilator":[295],"48":[297],"hours":[298],"postoperatively":[299],"(3.2":[300],"Seventeen":[302],"have":[307],"complications.":[312],"CONCLUSIONS:":[313],"has":[318],"successfully":[319],"implemented":[320],"an":[321],"system":[324],"prospectively":[329],"collects":[330],"information":[335],"reliably":[336],"validly.":[338],"adjustment":[340],"hospital-specific":[344],"outcomes":[348],"are":[349],"currently":[350],"being":[351],"developed.":[352]},"counts_by_year":[{"year":2025,"cited_by_count":1},{"year":2024,"cited_by_count":9},{"year":2023,"cited_by_count":3},{"year":2022,"cited_by_count":9},{"year":2021,"cited_by_count":8},{"year":2020,"cited_by_count":9},{"year":2019,"cited_by_count":15},{"year":2018,"cited_by_count":19},{"year":2017,"cited_by_count":20},{"year":2016,"cited_by_count":20},{"year":2015,"cited_by_count":20},{"year":2014,"cited_by_count":24},{"year":2013,"cited_by_count":25},{"year":2012,"cited_by_count":27}],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2025-10-10T00:00:00"}