Temporal Trends of Common Cardiac Surgical Procedures at Veterans Affairs Medical Centers

Importance: Characterizing the quality of cardiac surgery care provided by Department of Veterans Affairs (VA) hospitals is necessary to inform patient referral and resource allocation after clinical advances and programmatic changes, such as implementation of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act. Objective: To explore cardiac surgery volume, trends, and outcomes within VA hospitals. Design, Setting, and Participants: This retrospective cohort study was conducted among all patients who underwent cardiac surgery at VA medical centers (VAMCs) across the US from January 1, 2005, through September 30, 2024. Patients were identified using the VA Surgical Quality Improvement Program (VASQIP) cardiac surgery database. Data analysis was conducted from November 1, 2024, through November 7, 2025. Exposure: Cardiac surgery performed at VAMCs. Main Outcomes and Measures: Cardiac surgery case volume and trends for all cases performed at VAMCs nationwide. Operative mortality was determined for 12 procedures indexed by the Society of Thoracic Surgeons: coronary artery bypass graft (CABG), CABG with aortic valve replacement (AVR), CABG with mitral valve (MV) replacement (MVR), CABG with MV repair, CABG with AVR and MVR or MV repair, AVR, AVR with MVR or MV repair, MVR, MV repair, tricuspid valve (TV) replacement (TVR), TV repair, and aortic aneurysm surgery. All outcomes were explored over 5-year intervals between 2005 and 2024. Adjusted mortalities were determined using the Age-Adjusted Charlson Comorbidity Index (ACCI). Results: A total of 94 694 patients (mean [SD] age at procedure, 67.0 [9.1] years; 1410 [1.5%] female) at 43 VAMCs were identified, with 30 053 patients in the 2005-2009 cohort, 26 641 patients in the 2010-2014 cohort, 23 438 patients in the 2015-2019 cohort, and 14 562 patients in the 2020-2024 cohort. Age, diversity in self-reported race and ethnicity, and ACCI increased significantly over the 20-year period. Cardiac surgery volumes were highest in 2006, with a dip in volume after 2019 and subsequent stabilization. Adjusted 30-day mortalities in 2020 to 2024 were as follows: CABG, 0.8% (95% CI, 0%-99.9%); CABG with AVR, 4.3% (95% CI, 2.4%-7.5%); CABG with MVR, 3.0% (95% CI, 0.8%-10.2%); CABG with MV repair, 0% (95% CI, 0%-1.0%); CABG with AVR and MVR or MV repair, 11.8% (95% CI, 1.4%-56.4%); AVR, 1.6% (95% CI, 0.8%-3.0%); AVR with MVR or MV repair, 6.9% (95% CI, 1.7%-24.7%); MVR, 3.0% (95% CI, 1.1%-7.9%); MV repair, 0% (95% CI, 0%-100%); TVR, 0% (95% CI, 0%-100%); TV repair, 0% (95% CI, not applicable owing to no mortality across the years); and aortic aneurysm surgery, 0% (95% CI, 0%-100%). Conclusions and Relevance: Cardiac surgery outcomes at VA hospitals remained consistent over time, demonstrating high-quality care, despite increasing ACCI and shifting procedural volumes.