{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:03:13Z","timestamp":1792134193242,"version":"4.4.0"},"reference-count":60,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"\n Importance<\/jats:title>\n Inguinal hernia repair (IHR) is one of the most commonly performed operations in the United States, with approximately 800\u202f000 performed each year. US veterans are a unique group that is predominantly male and tends to have higher rates of medical comorbidities and tobacco use, common risk factors for hernia development. With significant advancements in IHR technique in recent years, the majority of national database studies have focused on civilian populations.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine trends and the evolution of IHR within the Veterans Health Administration (VHA) over the past 20 years.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study examined national data retrospectively from all VHA institutions in the period 2002 to 2022. Participants were veterans who received IHR within the VHA were identified through the Corporate Data Warehouse using procedure and diagnosis codes. Data were analyzed from January to April 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Inguinal hernia repair.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Surgical volumes and trends in IHR surgical approach across the VHA were examined over time. Additional measures included procedural urgency and surgical setting.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 308\u202f876 veterans underwent IHR from 2002 to 2022. Patients were predominantly male (306\u202f905 [99.4%]; 1971 female patients [0.6%]), with a median (IQR) age of 65 (57-73) years. They had high rates of hypertension (198\u202f792 [64.4%]), depression (102\u202f880 [33.3%]), chronic obstructive pulmonary disease (82\u202f608 [26.7%]) and alcohol use disorder (68\u202f427 [22.2%]). A total of 60\u202f088 patients (19.5%) underwent minimally invasive (MIS) IHR while 246\u202f403 procedures (79.8%) were open. Most were outpatient (300\u202f400 [97.3%]); only 17\u202f352 (5.6%) were urgent or emergent. Compared with men, women were more likely to undergo MIS-IHR (452 women [22.9%] vs 59\u202f636 men [19.4%]) and urgent\/emergent procedures (218 women [11.1%] vs 17\u202f134 men [5.6%]). Annual IHR volume increased from 12\u202f086 in 2002 to 17\u202f897 in 2022, with an increase in MIS-IHR from 1102 (9.2%) to 7286 (41.0%). After a decline during COVID-19, IHR numbers have since recovered and surpassed pre-2020 volume. Throughout the study period, IHRs performed in the community were less likely to be urgent or emergent cases (1006 [3.0%] vs 16\u202f346 [5.9%] in Veterans Affairs [VA] facilities).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This study found that over the past 20 years, the volume of IHRs performed in the VHA system has increased, along with MIS approaches. Hernia repairs are a significant surgical burden within the veteran population, reflecting the evolving surgical practices and needs of this unique demographic.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.0307","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T15:30:25Z","timestamp":1773847825000},"page":"518","source":"Crossref","is-referenced-by-count":7,"title":["Evolving Inguinal Hernia Repair Practice at the Veterans Health Administration"],"prefix":"10.1001","volume":"161","author":[{"given":"Emma M.","family":"Bradley","sequence":"first","affiliation":[{"name":"Vanderbilt University Medical Center Department of Surgery, Nashville, Tennessee"},{"name":"Tennessee Valley Healthcare System VA Department of Surgery, Nashville"},{"name":"Tennessee Valley Healthcare System VA Geriatric Research Education and Clinical Care Service, Nashville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A.","family":"Schlosser","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Hospital, Plymouth, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Matheny","sequence":"additional","affiliation":[{"name":"Tennessee Valley Healthcare System VA Geriatric Research Education and Clinical Care Service, Nashville"},{"name":"Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Pierce","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center Department of Surgery, Nashville, Tennessee"},{"name":"Tennessee Valley Healthcare System VA Department of Surgery, Nashville"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"5","key":"soi260010r1","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1016\/S0039-6109(03)00132-4","article-title":"Demographic and socioeconomic aspects of hernia repair in the United States in 2003.","volume":"83","author":"Rutkow","year":"2003","journal-title":"Surg Clin North Am"},{"issue":"4","key":"soi260010r2","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1093\/ije\/25.4.835","article-title":"Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality.","volume":"25","author":"Primatesta","year":"1996","journal-title":"Int J Epidemiol"},{"issue":"3","key":"soi260010r3","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1001\/jamasurg.2019.5055","article-title":"Abdominal core health: a needed field in surgery.","volume":"155","author":"Poulose","year":"2020","journal-title":"JAMA Surg"},{"issue":"3","key":"soi260010r4","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1001\/jama.295.3.285","article-title":"Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial.","volume":"295","author":"Fitzgibbons","year":"2006","journal-title":"JAMA"},{"issue":"3","key":"soi260010r5","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1097\/SLA.0b013e3182a19725","article-title":"Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias.","volume":"258","author":"Fitzgibbons","year":"2013","journal-title":"Ann Surg"},{"issue":"18","key":"soi260010r6","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.1056\/NEJMoa040093","article-title":"Open mesh versus laparoscopic mesh repair of inguinal hernia.","volume":"350","author":"Neumayer","year":"2004","journal-title":"N Engl J Med"},{"issue":"4","key":"soi260010r7","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/j.jamcollsurg.2006.05.019","article-title":"Cost effectiveness of laparoscopic versus open mesh hernia operation: results of a Department of Veterans Affairs randomized clinical trial.","volume":"203","author":"Hynes","year":"2006","journal-title":"J Am Coll Surg"},{"issue":"12","key":"soi260010r8","doi-asserted-by":"publisher","first-page":"3026","DOI":"10.1007\/s00464-010-1079-x","article-title":"Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? results of more than 2800 patients in comparison to literature.","volume":"24","author":"Wauschkuhn","year":"2010","journal-title":"Surg Endosc"},{"issue":"4","key":"soi260010r9","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.1007\/s00464-017-5911-4","article-title":"Inguinal hernia repair: is there a benefit to using the robot?","volume":"32","author":"Charles","year":"2018","journal-title":"Surg Endosc"},{"issue":"1","key":"soi260010r10","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1097\/00000658-200301000-00019","article-title":"Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison.","volume":"237","author":"Liem","year":"2003","journal-title":"Ann Surg"},{"key":"soi260010r11","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1016\/j.jss.2021.02.041","article-title":"Healthcare resource utilization in inguinal hernia repair: a three-year cost evaluation of Truven Health Marketscan research databases.","volume":"264","author":"Rogers","year":"2021","journal-title":"J Surg Res"},{"issue":"3","key":"soi260010r12","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1007\/s10029-019-01968-y","article-title":"Review of inguinal hernia repair techniques within the Americas Hernia Society Quality Collaborative.","volume":"23","author":"AlMarzooqi","year":"2019","journal-title":"Hernia"},{"issue":"12","key":"soi260010r13","doi-asserted-by":"publisher","first-page":"7200","DOI":"10.1007\/s00464-020-08217-9","article-title":"Ten-year trends in minimally invasive hernia repair: a NSQIP database review.","volume":"35","author":"Madion","year":"2021","journal-title":"Surg Endosc"},{"issue":"3","key":"soi260010r14","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1007\/s10029-021-02419-3","article-title":"Trends and outcomes of open, laparoscopic, and robotic inguinal hernia repair in the veterans affairs system.","volume":"26","author":"Holleran","year":"2022","journal-title":"Hernia"},{"issue":"6","key":"soi260010r15","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1097\/MLR.0b013e31819432e5","article-title":"A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data.","volume":"47","author":"van Walraven","year":"2009","journal-title":"Med Care"},{"issue":"1","key":"soi260010r17","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1258\/shorts.2010.010071","article-title":"Frequency of abdominal wall hernias: is classical teaching out of date?","volume":"2","author":"Dabbas","year":"2011","journal-title":"JRSM Short Rep"},{"issue":"3","key":"soi260010r18","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1097\/JS9.0000000000000217","article-title":"The global, regional, and national burden and its trends of inguinal, femoral, and abdominal hernia from 1990 to 2019: findings from the 2019 Global Burden of Disease Study, a cross-sectional study.","volume":"109","author":"Ma","year":"2023","journal-title":"Int J Surg"},{"issue":"3","key":"soi260010r19","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1097\/01.sla.0000179644.02187.ea","article-title":"Proficiency of surgeons in inguinal hernia repair: effect of experience and age.","volume":"242","author":"Neumayer","year":"2005","journal-title":"Ann Surg"},{"issue":"5","key":"soi260010r20","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1001\/jamasurg.2022.7728","article-title":"Robotic general surgery trends in the Veterans Health Administration, community practice, and academic centers from 2013 to 2021.","volume":"158","author":"Mills","year":"2023","journal-title":"JAMA Surg"},{"issue":"4","key":"soi260010r21","doi-asserted-by":"publisher","first-page":"e835","DOI":"10.1097\/SLA.0000000000005794","article-title":"Comparative outcomes of groin hernia repair by sex among Medicare beneficiaries.","volume":"278","author":"Ehlers","year":"2023","journal-title":"Ann Surg"},{"issue":"1","key":"soi260010r23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10029-017-1668-x","article-title":"International guidelines for groin hernia management.","volume":"22","author":"HerniaSurge Group","year":"2018","journal-title":"Hernia"},{"issue":"3","key":"soi260010r24","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1001\/jamasurg.2014.1242","article-title":"Trends in emergent hernia repair in the United States.","volume":"150","author":"Beadles","year":"2015","journal-title":"JAMA Surg"},{"issue":"4","key":"soi260010r25","doi-asserted-by":"publisher","first-page":"e129","DOI":"10.1097\/SLA.0000000000004692","article-title":"Surgical procedures in Veterans Affairs hospitals during the COVID-19 pandemic.","volume":"273","author":"Rose","year":"2021","journal-title":"Ann Surg"},{"issue":"5","key":"soi260010r26","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1097\/SLA.0000000000005403","article-title":"A population-based analysis of the COVID-19 generated surgical backlog and associated emergency department presentations for inguinal hernias and gallstone disease.","volume":"275","author":"Gomez","year":"2022","journal-title":"Ann Surg"},{"key":"soi260010r27","doi-asserted-by":"publisher","first-page":"B10","DOI":"10.2337\/diacare.27.suppl_2.B10","article-title":"Who has diabetes? best estimates of diabetes prevalence in the Department of Veterans Affairs based on computerized patient data.","volume":"27","author":"Miller","year":"2004","journal-title":"Diabetes Care"},{"issue":"3","key":"soi260010r28","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1016\/j.amepre.2004.12.007","article-title":"Obesity prevalence among veterans at Veterans Affairs medical facilities.","volume":"28","author":"Das","year":"2005","journal-title":"Am J Prev Med"},{"issue":"5","key":"soi260010r29","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.amepre.2012.07.029","article-title":"Health and health behavior differences: U.S. military, veteran, and civilian men.","volume":"43","author":"Hoerster","year":"2012","journal-title":"Am J Prev Med"},{"issue":"4","key":"soi260010r30","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/S0749-3797(18)30453-7","article-title":"The association between veteran status and cigarette-smoking behaviors.","volume":"11","author":"Klevens","year":"1995","journal-title":"Am J Prev Med"},{"issue":"4","key":"soi260010r31","first-page":"13","article-title":"Current and projected characteristics and unique health care needs of the patient population served by the Department of Veterans Affairs.","volume":"5","author":"Eibner","year":"2016","journal-title":"Rand Health Q"},{"issue":"1","key":"soi260010r32","doi-asserted-by":"publisher","first-page":"7","DOI":"10.15585\/mmwr.mm6701a2","article-title":"Tobacco product use among military veterans - United States, 2010-2015.","volume":"67","author":"Odani","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"12","key":"soi260010r34","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1001\/jamasurg.2022.4978","article-title":"Expansion of the Veterans Health Administration network and surgical outcomes.","volume":"157","author":"Graham","year":"2022","journal-title":"JAMA Surg"},{"issue":"9","key":"soi260010r35","doi-asserted-by":"publisher","first-page":"2179","DOI":"10.1007\/s11606-023-08207-2","article-title":"Veterans Health Administration (VA) vs. non-VA healthcare quality: a systematic review.","volume":"38","author":"Apaydin","year":"2023","journal-title":"J Gen Intern Med"},{"issue":"2","key":"soi260010r36","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1097\/XCS.0000000000000720","article-title":"Comparing quality of surgical care between the US Department of Veterans Affairs and non-Veterans Affairs settings: a systematic review.","volume":"237","author":"Blegen","year":"2023","journal-title":"J Am Coll Surg"},{"issue":"3","key":"soi260010r37","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1001\/jamasurg.2021.6488","article-title":"Comparing Veterans Affairs and private sector perioperative outcomes after noncardiac surgery.","volume":"157","author":"George","year":"2022","journal-title":"JAMA Surg"},{"issue":"4","key":"soi260010r38","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1177\/106286060201700405","article-title":"Satisfaction with VA and non-VA outpatient care among veterans.","volume":"17","author":"Harada","year":"2002","journal-title":"Am J Med Qual"},{"issue":"10","key":"soi260010r39","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.1007\/s11606-018-4574-8","article-title":"Accessing care through the Veterans Choice program: the veteran experience.","volume":"33","author":"Sayre","year":"2018","journal-title":"J Gen Intern Med"},{"issue":"3","key":"soi260010r40","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1007\/s10029-016-1465-y","article-title":"Perioperative outcomes and costs of laparoscopic versus open inguinal hernia repair.","volume":"20","author":"Tadaki","year":"2016","journal-title":"Hernia"},{"issue":"3","key":"soi260010r41","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1007\/s10029-022-02573-2","article-title":"The European Hernia Society Prehabilitation Project: a systematic review of patient prehabilitation prior to ventral hernia surgery.","volume":"26","author":"Jensen","year":"2022","journal-title":"Hernia"},{"issue":"1","key":"soi260010r42","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s10029-025-03301-2","article-title":"Is the recurrence rate higher in obese patients undergoing inguinal hernia surgery?","volume":"29","author":"Li","year":"2025","journal-title":"Hernia"},{"issue":"3","key":"soi260010r43","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/j.amjsurg.2016.01.036","article-title":"Predictors of inguinodynia, recurrence, and metachronous hernias after inguinal herniorrhaphy in veteran patients.","volume":"212","author":"Huerta","year":"2016","journal-title":"Am J Surg"},{"issue":"4","key":"soi260010r44","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1007\/s10029-024-03049-1","article-title":"The impact of smoking on inguinal hernia repair outcomes: a meta-analysis of multivariable-adjusted studies.","volume":"28","author":"Marcolin","year":"2024","journal-title":"Hernia"},{"issue":"3","key":"soi260010r45","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1016\/j.surg.2020.09.003","article-title":"Postoperative outcomes of ventral hernia repair in veterans.","volume":"169","author":"Shahait","year":"2021","journal-title":"Surgery"},{"issue":"11","key":"soi260010r46","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.16330","article-title":"Costs associated with modifiable risk factors in ventral and incisional hernia repair.","volume":"2","author":"Howard","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"1","key":"soi260010r47","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1111\/jgs.70216","article-title":"Learning how preoperative communication relates to postoperative experiences for older veterans having inguinal hernia surgery.","volume":"74","author":"Thornton","year":"2026","journal-title":"J Am Geriatr Soc"},{"issue":"5","key":"soi260010r48","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0324002","article-title":"Effect of tailored, intensive prehabilitation for risky lifestyles before ventral hernia repair on postoperative outcomes, health, and costs: study protocol for a randomised controlled trial (STRONG-Hernia).","volume":"20","author":"Jensen","year":"2025","journal-title":"PLoS One"},{"issue":"3","key":"soi260010r49","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1001\/jamasurg.2016.4219","article-title":"Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days.","volume":"152","author":"Hall","year":"2017","journal-title":"JAMA Surg"},{"issue":"5","key":"soi260010r50","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1007\/s10029-021-02372-1","article-title":"Cost analysis of inguinal hernia repair: the influence of clinical and hernia-specific factors.","volume":"25","author":"Aydin","year":"2021","journal-title":"Hernia"},{"issue":"3","key":"soi260010r51","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1016\/j.amjsurg.2021.01.026","article-title":"Using local rather than general anesthesia for inguinal hernia repair may significantly reduce complications for frail veterans.","volume":"222","author":"Meier","year":"2021","journal-title":"Am J Surg"},{"issue":"8","key":"soi260010r52","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1056\/NEJMcp1404068","article-title":"Clinical practice: groin hernias in adults.","volume":"372","author":"Fitzgibbons","year":"2015","journal-title":"N Engl J Med"},{"issue":"9","key":"soi260010r53","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011517.pub2","article-title":"Mesh versus non-mesh for inguinal and femoral hernia repair.","volume":"9","author":"Lockhart","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"soi260010r54","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1097\/SLA.0000000000003219","article-title":"Long-term comparison of recurrence rates between different lightweight and heavyweight meshes in open anterior mesh inguinal hernia repair: a nationwide population-based register study.","volume":"273","author":"Melkemichel","year":"2021","journal-title":"Ann Surg"},{"issue":"3","key":"soi260010r55","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1016\/j.surg.2019.08.021","article-title":"Lightweight mesh is recommended in open inguinal (Lichtenstein) hernia repair: a systematic review and meta-analysis.","volume":"167","author":"Bakker","year":"2020","journal-title":"Surgery"},{"issue":"10","key":"soi260010r56","doi-asserted-by":"publisher","first-page":"2544","DOI":"10.1111\/ans.18028","article-title":"Telemedicine versus face-to-face follow up in general surgery: a randomized controlled trial.","volume":"92","author":"Fink","year":"2022","journal-title":"ANZ J Surg"},{"issue":"1","key":"soi260010r57","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1007\/s10029-025-03377-w","article-title":"Non-operative considerations in relation to groin and ventral hernia repair: local consensus recommendations from the Danish Hernia Database.","volume":"29","author":"Rosenberg","year":"2025","journal-title":"Hernia"},{"issue":"6","key":"soi260010r58","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1001\/jamasurg.2024.0233","article-title":"Year-over-year ventral hernia recurrence rates and risk factors.","volume":"159","author":"Bhardwaj","year":"2024","journal-title":"JAMA Surg"},{"issue":"9288","key":"soi260010r59","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1016\/S0140-6736(01)06251-1","article-title":"Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study.","volume":"358","author":"Bay-Nielsen","year":"2001","journal-title":"Lancet"},{"issue":"1","key":"soi260010r60","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1007\/s10029-019-02009-4","article-title":"Comparing routine administrative data with registry data for assessing quality of hospital care in patients with inguinal hernia.","volume":"24","author":"K\u00f6ckerling","year":"2020","journal-title":"Hernia"},{"key":"soi260010r16","unstructured":"Congress.gov. Sen. Isakson J [R G. S.2372 - 115th Congress (2017-2018): VA MISSION Act of 2018. June 6, 2018. Accessed May 20, 2025. https:\/\/www.congress.gov\/bill\/115th-congress\/senate-bill\/2372"},{"key":"soi260010r22","unstructured":"US Census Bureau. American Community Survey S2101: Veteran Status. Accessed August 22, 2025. https:\/\/data.census.gov\/table\/ACSST1Y2021.S2101?q=S2101"},{"key":"soi260010r33","unstructured":"Congress.gov. Rep. Rogers H [R K 5. H.R.3230 - 113th Congress (2013-2014): Veterans Access, Choice, and Accountability Act of 2014. August 7, 2014. Accessed May 20, 2025. https:\/\/www.congress.gov\/bill\/113th-congress\/house-bill\/3230"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2846796\/jamasurgery_bradley_2026_oi_260010_1784049388.32696.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:00:44Z","timestamp":1784127644000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2846796"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":60,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2026.0307","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5,1]]}}}