Nutritional value, performance, carcass quality, visceral organ size, and blood clinical chemistry of broiler chicks fed 30% tannin-free fava bean diets.

Two experiments were conducted to evaluate the chemical and nutritional values of 5 tannin-free fava bean (FB) cultivars (FB9, FB10, FB13, FB17, and FB24) on growth, visceral organ size, and blood clinical chemistry of broiler chicks fed a corn-soybean meal 48 (SBM48) diet containing 30% tannin-free FB. In the first experiment, 49 Hy-line roosters, 55 wk of age, were individually precision-fed 30 g of each FB cultivar and soybean meal 44 (SBM44). Protein, methionine, and lysine contents of the FB seeds (0.005% tannin) were 27.7, 0.23, and 1.98% of DM, respectively. The AMEn of all FB cultivars was 2,839 kcal/kg and higher (P < 0.05) than SBM44. The true lysine digestibility of FB10 (94.1) was higher (P < 0.05) than FB9 (89.0%) and FB24 (89.2%), but comparable with the other fava beans. The FB cultivar's true methionine digestibilities were similar among each other and to SBM44. In a battery feeding trial, 6 corn-SBM48 diets containing 0 (control) or 30% of FB9, FB10, FB13, FB17, or FB24 seeds were each fed to Ross 308 1-wk-old male broiler chicks for 14 d. The determined FB nutrient values were used in formulating FB-containing diets. Birds fed FB-containing diets had better (P < 0.05) weight gain and feed conversion than those of the control. When compared with the control birds, relative weights of abdominal fat pad and liver were reduced (P < 0.05) by 30% inclusion of all dietary FB varieties, except for FB17 and FB13, respectively. Broiler chicks fed the FB13 diet had plasma thrombocyte and white blood cell (WBC) differential counts higher (P < 0.05) than those fed the FB10 diet and WBC count higher (P < 0.05) than the birds fed the FB17 diet. In conclusion, tannin-free FB was lower in protein, methionine, and lysine, but higher in AMEn, compared with SBM44. Moreover, FB seeds, especially FB10, can be included in a broiler chick diet with no adverse effects on performance, but FB13 increased WBC count.

Metabolizable energy and amino acid digestibility of decorticated extruded safflower meal.

An experiment was conducted to determine TME and amino acid digestibility of several dehulled extruded safflower meals. Finely ground partially dehulled extruded (ESM), partially dehulled solvent-extracted (SESM), extensively cleaned dehulled and extruded safflower meal (CSM), or soybean meal 44 (SBM 44) was intubated to 9 fasted mature roosters with 40 g per rooster and total excreta was collected.The concentrations of all essential amino acids in CSM were higher than those in ESM and SESM. Also, compared with SBM 44, CSM was deficient in lysine, slightly higher in TSAA and tryptophan, but much higher in arginine. The AME(n) and TME(n) of CSM were 2,413 and 2,832 kcal/kg, respectively, and were higher than those of SBM 44 (P < 0.01). The true lysine digestibilities of CSM and SBM 44 were similar but were higher than those of ESM and SESM (P < 0.05). However, ESM, SESM, and CSM had similar true tryptophan and threonine digestibilities that were lower than that of SBM 44 (P < 0.05). With respect to TSAA, all feed ingredients under investigation had similar apparent and true digestibilities. In conclusion, extensive hull removal of safflower seeds followed by cold extrusion produced a low-fiber CSM rich in both energy and protein that makes it a promising feed ingredient for poultry.

Effects of feeding ervil (Vicia ervilia) seeds soaked in water or acetic acid on performance and internal organ size of broilers and production and egg quality of laying hens.

Experiment 1 was conducted to study the effects of feeding 60% untreated ervil seeds (UE) or ervil soaked in water at room temperature (RTWE) or at 40 degrees C (40WE) for 72 h with water change every 12 h on the performance and internal organ size of broilers. Isocaloric and isonitrogenous corn-soybean meal diet (control) and diets containing 60% UE, RTWE, or 40WE were fed to battery caged broilers in 4 replicates with 8 birds per replicate, from 8 to 49 d. Broilers consuming UE from 8 to 28 d gained less weight, used feed less efficiently, and had heavier liver, pancreas, and gall bladder weights (%BW) than the other treatments (P < 0.05). Compared with control birds, broilers on 40WE had similar relative organ weights, except for kidney, but lower BW gain at 49 d (P < 0.05). In experiment 2, ervil seeds were soaked in 1% acetic acid at room temperature (RTAAE) or at 40 degrees C (40AAE) for 24 h. A conventional diet and diets containing 60% UE, 40WE, RTAAE, or 40AAE were fed to individually caged laying hens in 4 replicates per treatment with 5 hens per replicate for 42 d. Hens on UE had the poorest performance followed by RTAAE, 40WE, and then 40AAE (P < 0.05). Compared with the control, all treated ervil diets resulted in lower shell thickness values but higher Haugh unit scores (P < 0.05). In experiment 3, 30% dietary UE and 40AAE at 10, 20, and 30% were fed to layers for 56 d. The general performance of hens on 30% 40AAE was comparable with that of the control except for BW and feed conversion (P < 0.05). Compared with UE, the performance of broilers and layers was improved by 40WE and that of hens was further enhanced by 40AAE. In addition, diets containing up to 20% 40AAE had no adverse effects on feed conversion, egg production, or quality of hens.

Nutritive value of high-oil corn grown under semi-arid conditions and its impact on broiler performance and carcass composition.

A series of experiments was conducted to evaluate nutritive value of a high-oil corn (HOC) cultivar, grown under semiarid conditions, and its impact on performance and carcass characteristics of male broilers raised to market age. Conventional corn (CC) and HOC used in this research were produced under similar semi-arid conditions. By using a glucose containing reference diet in Experiment 1, the AMEn of CC, as determined on 11-d-old male broilers, was lower (P < 0.05) than that of HOC (3,541 vs. 3,669 kcal/kg DM). The TME, TMEn, and true amino acid availability of CC and HOC were determined in Experiment 2 through individual precision feeding of eight intact mature roosters per ingredient. The TMEn of HOC was significantly higher than that of CC (4,126 vs. 3,870 kcal/kg DM), but true availability of amino acids was comparable for both cultivars. By using the CP and TMEn values determined in Experiment 2, two corn soybean meal starter and grower diets, containing no added fat, were prepared in Experiment 3, in which HOC replaced CC. Diets were provided ad libitum in five replicates to 5-d-old male broilers with eight birds per replicate until market age. Broiler performance, carcass yield, and carcass composition were comparable between both corn cultivars. Birds on HOC diet, however, deposited more (P < 0.05) abdominal fat (0.695%) than those on CC diet (0.575%). The results indicated that the extra calories derived from HOC could have been funneled primarily toward abdominal fat pad deposition rather than increased growth.

The effect of enzyme predigestion on the nutritional quality of prepressed turkey feather meal.

Three experiments were conducted to determine the protein efficiency ratio (PER), pepsin digestibility, TMEn, and true amino acid availability (TAAA) of prepressed turkey feather meal (PFM), enzyme-digested PFM (EPFM), and commercial feather meal (CFM). Turkey feathers from a commercial processing plant were mechanically pressed alone or mechanically pressed, followed by treatment with a mixture of protease, lipase, and amylase prior to autoclaving. In the first study, feather meal diets containing 16,20, or 24% CP from PFM, EPFM, or CFM were fed to starter poults for 10 d. All diets resulted in negative or negligible growth. In a second study, PFM, EPFM, and CFM were again the primary sources of CP, but dietary protein levels were increased to 20, 24, and 28% CP, and all diets contained 20% corn and 10% soybean meal (PFMCS, EPFMCS, CFMCS), respectively, to allow for a basal level of growth. Performance and PER of the poults fed the diets with PFMCS, EPFMCS, and CFMCS were similar. The efficiency of use of the PFMCS diet was numerically lower (P < or = 0.1) when compared with the EPFMCS and CFMCS diets. Similarly, pepsin digestibilities of EPFM and CFM were higher than PFM. The TAAA of PFM (82.1%) and EPFM (80.6%) were not significantly higher than that of CFM (71.4%); however, the availabilities of lysine, threonine, aspartate, glutamate, proline, and histidine were significantly higher. Digestion of pressed turkey feathers with an enzyme mixture prior to autoclaving could have a positive impact on its protein and amino acid nutritional values.

Metabolizable energy values and amino acid availability of vetch (Vicia sativa) and ervil (Vicia ervilia) seeds soaked in water and acetic acid.

In two experiments we evaluated the effect of water and acetic acid soaking on ME, apparent amino acid (AA) availability, and true AA availability of vetch (V) and ervil (E) seeds. In Experiment 1, the feedstuffs were untreated (U) V or coarsely ground V soaked in water (1:10, wt/vol) at 40 C for 72 h with a water change every 12 h (40WV), vetch soaked in 1% acetic acid for 24 h at 40 C (40AAV) or at room temperature (RTAAV), or dehulled soybean meal (SBM). In Experiment 2, E seeds were subjected to the same soaking methods, and the ingredients were UE, 40WE, 40AAE, RTAAE, and SBM. Each feedstuff was precision-fed to five individually caged mature ISA Brown roosters. A group of five roosters was used to correct for metabolic and endogenous energy and amino acid losses. The AME, AMEn, TME, and TMEn of UV and UE (in parentheses) were 2,558 (2,663), 2,840 (3,098), 3,026 (3,154), and 2,934 (3,176) kcal/kg DM, respectively, and were, in general, higher than those of SBM. The TMEn of V increased as a result of soaking in water or acetic acid, whereas that of E decreased in 40WE and RTAAE by 492 and 920 kcal/kg DM, respectively (P < 0.05). The apparent availability of most essential amino acids in UV and UE was lower (P < 0.05) than that of SBM. Acetic acid soaking of V, irrespective of temperature, and E at 40 C resulted in apparent AA availability similar to that of SBM except for Met. The true AA availability of V treated or not, and that of E soaked at 40 C, were similar to that of SBM. Results indicated that UV and UE are energy rich ingredients but detrimental to amino acid availability. Soaking the seeds in acetic acid at room temperature and at 40 C improved the nutritional value of V and E, respectively.

Geographic variations in utilization rates in Veterans Affairs hospitals and clinics.

BACKGROUND: In the United States, geographic variation in hospital use is common. It is uncertain whether there are similar geographic variations in the health care system of the Department of Veterans Affairs (VA), which differs from the private sector because it predominantly serves men with annual incomes below $20,000, has a central system of administration, and uses salaried physicians. Thus, it might be less likely to have geographic variations. METHODS: We used VA data bases to obtain information on patients treated for eight diseases (chronic obstructive pulmonary disease, pneumonia, congestive heart failure, angina, diabetes, chronic renal failure, bipolar disorder, and major depression). We analyzed their use of hospital and outpatient services by assessing the risk-adjusted numbers of hospital days (the average number of days a patient spent in the hospital per 12 months of follow-up, regardless of the number of hospital stays), hospital-discharge rates, and clinic-visit rates from 1991 through 1995 for the entire system and within the 22 geographically based health care networks. RESULTS: We found substantial geographic variation in hospital use for all eight cohorts of patients and all the years studied. Variations in the numbers of hospital days per person-year among the networks were greatest among patients with chronic obstructive pulmonary disease (ranging from a factor of 2.7 to a factor of 3.1) during a given year and smallest among patients with angina (ranging from a factor of 1.5 to a factor of 2.1). Levels of hospital use were highest in the Northeast and lowest in the West. The variation in the rates of clinic visits for principal medical care among the networks ranged from a factor of approximately 1.6 to a factor of 4.0; variations in the rates were greatest among patients with chronic renal failure and smallest among patients with chronic obstructive pulmonary disease. There was no clear geographic pattern in the rates of outpatient-clinic use. CONCLUSIONS: There are significant geographic variations in the use of hospital and outpatient services in the VA health care system. Because VA physicians are unable to increase their income by changing their patterns of practice, our findings suggest that their practice styles are similar to those of other physicians in their geographic regions.

Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study.

BACKGROUND: The National Veterans Affairs Surgical Risk Study was designed to collect reliable, valid data on patient risk and outcomes for major surgery in the Veterans Health Administration and to report comparative risk-adjusted postoperative mortality rates for surgical services in Veterans Health Administration. STUDY DESIGN: This cohort study was conducted in 44 Veterans Affairs Medical Centers. Included were 87,078 major noncardiac operations performed under general, spinal, or epidural anesthesia between October 1, 1991, and December 31, 1993. The main outcomes measure was all-cause mortality within 30 days after the index procedure. Multivariable logistic regression risk-adjustment models for all operations and for eight surgical subspecialties were developed. Risk-adjusted surgical mortality rates were expressed as observed-to-expected ratios and were compared with unadjusted 30-day postoperative mortality rates. RESULTS: Patient risk factors predictive of postoperative mortality included serum albumin level, American Society of Anesthesia class, emergency operation, and 31 additional preoperative variables. Considerable variability in unadjusted mortality rates for all operations was observed across the 44 hospitals (1.2-5.4%). After risk adjustment, observed-to-expected ratios ranged from 0.49 to 1.53. Rank order correlation of the hospitals by unadjusted and risk-adjusted mortality rates for all operations was 0.64. Ninety-three percent of the hospitals changed rank after risk adjustment, 50% by more than 5 and 25% by more than 10. CONCLUSIONS: The Department of Veterans Affairs has successfully implemented a system for the prospective collection and comparative reporting of risk-adjusted postoperative mortality rates after major noncardiac operations. Risk adjustment had an appreciable impact on the rank ordering of the hospitals and provided a means for monitoring and potentially improving the quality of surgical care.

Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study.

BACKGROUND: The National Veterans Affairs Surgical Risk Study was designed to collect reliable, valid data on patient risk and outcomes for major surgery in the Veterans Health Administration and to report comparative risk-adjusted postoperative mortality and morbidity rates for surgical services in the Veterans Health Administration. STUDY DESIGN: This was a cohort study conducted at 44 Veterans Affairs Medical Centers closely affiliated with university medical centers. Included were 87,078 major noncardiac operations performed under general, spinal, or epidural anesthesia between October 1, 1991, and December 31, 1993. The main outcomes measures in this report are 21 postoperative adverse events (morbidities) occurring within 30 days after the index procedure. Multivariable logistic regression risk-adjustment models for all operations and for eight surgical subspecialties were developed. RESULTS: Patient risk factors predictive of postoperative morbidity included serum albumin level, American Society of Anesthesia class, the complexity of the operation, and 17 other preoperative risk variables. Wide variation in the unadjusted rates of one or more postoperative morbidities for all operations was observed across the 44 hospitals (7.4-28.4%). Risk-adjusted observed-to-expected ratios ranged from 0.49 to 1.46. The Spearman rank order correlation between the ranking of the hospitals based on unadjusted morbidity rates and risk-adjusted observed-to-expected ratios for all operations was 0.87. There was little or no correlation between the rank order of the hospitals by risk-adjusted morbidity and risk-adjusted mortality. CONCLUSIONS: The Department of Veterans Affairs has successfully implemented a system for the prospective collection and comparative reporting of postoperative mortality and morbidity rates after major noncardiac operations. Risk adjustment had only a modest effect on the rank order of the hospitals.

Quality improvement in the US Veterans Health Administration.

The Veterans Health Administration, the largest government-operated health-care system in the United States, has been actively engaged in quality improvement activities since 1990. These activities have been implemented on both a system-wide and facility-specific basis. Some quality improvement efforts have been targeted to specific clinical services; others relate to the overall process of providing patient care. This paper provides an overview of three quality improvement activities in the Veterans Health Administration and considers the research and managerial issues they raise.

Protein quality and calcium availability from extruded and autoclaved turkey hatchery residue.

The protein quality of an extruded mixture of hatchery by-product meal and soybean meal (EHSM) and the calcium availability of autoclaved hatchery by-product meal (AHBM) were determined. In Experiments 1 and 2, EHSM or soybean meal (SBM) were the only protein sources in diets formulated to contain 16, 20, or 24% CP. In both experiments, there were five or six replicate pens randomly allotted to each level of dietary protein and each pen contained five poults. In Experiment 1, there was a significant increase in the Protein Efficiency Ratio (PER; P < or = 0.005) in poults from a fast-growing line compared with poults from a slow-growing line selected for egg production but no significant differences between EHSM and SBM. In Experiment 2, PER was increased in poults fed EHSM (P < or = 0.002). In both studies, there was a large decline in PER in those poults fed the 16% SBM diet, and this resulted in a significant source by level interaction. There were no significant source or level of protein effects on the Net Protein Ratio (NPR) or Net Protein Utilization (NPU) in Experiment 2. In Experiment 3, AHBM, steamed bone meal and limestone were the primary sources of calcium in diets containing 0.6, 0.8, 1.0, and 1.2% calcium. There were four replicate pens per level and source of calcium. The length and width of the femur and tibia were measured along with fat-extracted bone weight and ash. Poults fed diets containing AHBM and limestone had improved feed efficiency (P < or = 0.008) compared with those fed bone meal. There were no significant diet effects on any bone measurements.

Contribution of locally and externally designed quality management activities to hospitals' efforts to improve patient care.

We examined the effects of quality management activities on efforts by hospitals to improve patient care. Our primary objective was to assess the relative contribution to these efforts of quality management activities designed by facility staff and those designed by external organizations. We asked chiefs of medicine, surgery, psychiatry, and ambulatory care at 47 randomly selected Department of Veterans Affairs hospitals to identify the 3 actions taken by their departments during the previous year that most improved patient care. The sources of information contributing to each action were subsequently identified through 2 independent procedures: a review of hospital documents and attributions by the department chiefs. Quality management activities contributed to 31% of 493 actions to improve care in the analysis of the department chiefs' attributions and to 26% of 446 actions in the analysis of the sources found in hospital documents. Four locally designed quality management activities contributed to more than twice as many actions to improve patient care as did 12 externally designed ones, suggesting that locally designed quality management activities have a greater effect on efforts to improve patient care than do externally designed ones.

Orange juice classification with a biologically based neural network.

Dystal, an artificial neural network, was used to classify orange juice products. Nine varieties of oranges collected from six geographical regions were processed into single-strength, reconstituted or frozen concentrated orange juice. The data set represented 240 authentic and 173 adulterated samples of juices; 16 variables [8 flavone and flavanone glycoside concentrations measured by high-performance liquid chromatography (HPLC) and 8 trace element concentrations measured by inductively coupled plasma spectroscopy] were selected to characterize each juice and were used as input to Dystal. Dystal correctly classified 89.8% of the juices as authentic or adulterated. Classification performance increased monotonically as the percentage of pulpwash in the sample increased. Dystal correctly identified 92.5% of the juices by variety (Valencia vs non-Valencia).

Comparative growth and development of Nicholas and hybrid toms from 16 to 82 days and effects of protein restriction from 0 to 59 days on growth of hybrid toms through 125 days of age.

The objective of this experiment was to study age and diet effects on serial growth of economically important carcass parts of Nicholas (NIC) and Hybrid (HYB) toms. At approximately 14-d intervals from 16 to 82 d, BW and the weight of selected carcass parts were compared in toms from both commercial strains. There were no overall strain differences in BW, although NIC toms were heavier from 31 to 72 d, which resulted in a significant strain by age interaction (P < or = 0.021). The absolute weight of the Pectoralis major (PMAJ; P < or = 0.022) and tibia plus associated muscles (Drum; P < or = 0.051) were increased in NIC toms. The relative weight of the PMAJ (P < or = 0.004) and abdominal fat (72 and 82 d; P < or = 0.023) also were heavier in NIC toms. The relative weight of the drum and Gastrocnemius muscle (GAS-TROC) was heavier in HYB toms, however (P < or = 0.001). A separate set of HYB poults was fed a diet deficient in protein or lysine (PD) from 0 to 8 wk and their growth and carcass development were compared with those fed a Control diet (NRC, 1984). Comparisons also were made at approximately 14-d intervals from 16 to 125 d. The PD diet from 0 to 8 wk significantly reduced BW and absolute breast muscle and leg portion weights. The relative weight of the PMAJ and Pectoralis minor (PMIN) were also reduced in toms fed the PD diets but the thigh and drum (125 d) were increased.

The Mayo block: an efficacious block for hallux and first metatarsal surgery.

The Mayo block is an extremely efficacious regional anesthetic technique used to provide anesthesia of the forefoot. Patients requiring surgical correction of hallux deformity, bunionectomy, and first metatarsal surgery may benefit from this technique. The Mayo block is a field block that anesthetizes the specific nerves of the forefoot that innervate the surgical field. This technique requires less local anesthesia than that required by direct local anesthetic infiltration and does not distort the surgical tissue planes. The Mayo block is effective. This technique has been used at one military hospital on more than 275 patients. The failure rate of the block is less than 1%. Learning this technique adds to the anesthetist's armamentarium of regional anesthesia, aids in rapid case turnover, and avoids the risks associated with major conduction and general anesthesia.

Characterization of carcass development from 14 to 145 days of age in turkey hens from two strains.

Body weight and carcass components were measured from 14 to 145 d in Nicholas (NIC) and Hybrid (HYB) strain turkey hens. At most ages, BW of HYB hens was greater than that of NIC and there were small but significant differences in the weight of the Pectoralis minor (PMIN). The relative weight of the PMIN increased in HYB hens from 98 to 145 d. No strain differences in either the absolute or relative weights of the Pectoralis major (PMAJ) were observed. The absolute and relative weights of the tibia plus associated muscles (DRUM) and femur plus associated muscles (THIGH) were significantly heavier in HYB hens. The same was true for the Gastrocnemius muscle (GASTROC). The relative weight of the abdominal fat pad (ABFAT) was significantly increased in NIC hens compared with HYB hens from 70 to 145 d. There was a linear relationship between the relative weight of the PMAJ and BW in hens from both strains (NIC, r2 = .69; HYB, r2 = .51). The relationship between the relative weight of the PMIN and BW was best described with a quadratic model but the r2 in both strains was considerably lower than that for the PMAJ (NIC, r2 = .26; HYB, r2 = .36). The linear relationship between BW and the relative weights of the THIGH and DRUM was negative and positive for ABFAT.

Removal of the alpha-galactosides of sucrose from soybean meal using either ethanol extraction or exogenous alpha-galactosidase and broiler performance.

Two studies using broiler chicks and one using adult White Leghorn roosters were conducted to determine the influence of stachyose and raffinose (alpha-galactosides of sucrose) present in soybean meal (SBM) on the nutritional value of the meal. In Experiment 1, the addition of four levels (0, .05, .10, or .20 g/kg) of alpha-galactosidase with and without 1 g/kg of invertase to a corn-SBM diet had no effect on weight gain, feed efficiency, protein digestibility, or the digestible energy value of the feed when fed to broiler chicks. However, both enzymes decreased (P < .001) dietary AMEn. In Experiment 2, ethanol extraction and incubation of SBM with alpha-galactosidase decreased the concentrations of the alpha-galactosides of sucrose in SBM from 6.59 to .81 and 1.43%, respectively. However, when broiler chicks were fed semi-purified diets containing SBM, ethanol-extracted SBM, water-incubated SBM, or water plus alpha-galactosidase-incubated SBM, no improvements in weight gain, feed efficiency, or apparent protein digestibility were observed. There was also no improvement in TMEn when the above meals were precision fed to adult White Leghorn roosters (Experiment 3). These results indicate that the removal of up to approximately 90% of the alpha-galactosides of sucrose has no beneficial effect on the nutritional value of SBM for chickens.

The effect of enzyme predigestion on the quality of poultry by-product meal from whole turkey mortality.

Enzyme predigested poultry by-product meal made from onfarm, whole turkey mortality (E-TBM) was compared with soybean meal (SBM) and commercial poultry by-product meal (CPBM) in each of three experiments. In Experiment 1, young poults were fed diets containing 16, 20, or 24% CP with either SBM or E-TBM as protein sources. A separate group of poults was fed a nitrogen-free diet. The E-TBM was higher than SBM in protein, fat, lysine, methionine, and total sulfur amino acids. Diets containing E-TBM resulted in increased BW, feed consumption, and a higher protein efficiency ratio (PER) and net protein ratio (NPR) compared with diets containing SBM. In Experiment 2, feeding nonenzyme-treated turkey by-product (TBM) or E-TBM resulted in significantly improved BW and feed efficiency compared with CPBM but this may have been due to decreased protein in diets containing CPBM. Protein source did not affect feed intake, PER, NPR, or net protein utilization (NPU). In Experiment 3, the TMEn content of CPBM was lower than both TBM and E-TBM but lysine and methionine digestibilities were greater.

The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care.

BACKGROUND: The use of surgical outcome in the comparative assessment of the quality of surgical care is predicted on the development of proper models that adjust for the severity of the preoperative risk factors of the patient. The National Veterans Administration Surgical Risk Study was designed to collect reliable, valid data about patient risk and outcome for major surgery in the Veterans Health Administration (VHA) and to report comparative risk-adjusted surgical morbidity and mortality rates for surgical services in VHA. This study describes the rationale and methods used in the Risk Study and reports on the frequency distribution of the data elements that will be used in the development of risk-adjusted reporting of surgical outcome. STUDY DESIGN: This study was a prospective observational study in which dedicated nurses collected preoperative, intraoperative, and outcome data on patients undergoing noncardiac operations using general, spinal, and epidural anesthesia in 44 Veterans Administration Medical Centers. Outcome measures included all cause mortality within the 30 days after the index procedure and 21 major morbidities. RESULTS: Eighty-three thousand nine hundred fifty-eight cases meeting inclusion criteria were entered in the study between October 1, 1991 and December 31, 1993. Ninety-seven percent of patients were men, with a mean age of 60.1 +/- 13.6 (standard deviation) years. The most common preoperative risk factors were smoking (40.7 percent) and hypertension (36.1 percent). Of the patients, 84.6 percent had one or more risk factors. The most common procedures were transurethral resection of the prostate gland (6.7 percent), total knee replacement (3.1 percent), thromboendarterectomy (2.4 percent), partial colectomy (2.2 percent), and total hip replacement (2 percent). The unadjusted mortality rate was 3.1 percent at 30 days. The most common postoperative morbidities were pneumonia (3.6 percent), urinary tract infection (3.5 percent), and failure to wean from the ventilator at 48 hours postoperatively (3.2 percent). Seventeen percent of the patients have one or more major complications. CONCLUSIONS: The Veterans Health Administration has successfully implemented an outcome reporting system for major surgery that prospectively collects patient risk and outcome information reliably and validly. Risk adjustment models and comparative hospital-specific rates of risk-adjusted outcomes are currently being developed.