Association of Sociodemographic Factors With Overtriage, Undertriage, and Value of Care After Major Surgery-Reference-Cited by-同舟云学术

Association of Sociodemographic Factors With Overtriage, Undertriage, and Value of Care After Major Surgery

Published:2024-05-01 Issue:2 Volume:5 Page:e429
ISSN:2691-3593
Container-title:Annals of Surgery Open
language:en
Short-container-title:

Author:

Loftus Tyler J.¹²,Ruppert Matthew M.¹³,Shickel Benjamin¹³,Ozrazgat-Baslanti Tezcan¹³,Balch Jeremy A.¹²⁴,Abbott Kenneth L.²,Hu Die¹²,Javed Adnan⁵,Madbak Firas⁶,Guirgis Faheem⁷,Skarupa David⁶,Efron Philip A.²,Tighe Patrick J.⁸,Hogan William R.⁹,Rashidi Parisa¹⁴,Upchurch Gilbert R.²,Bihorac Azra¹²³

Affiliation:

1. Intelligent Critical Care Center, University of Florida, Gainesville, FL

2. Department of Surgery, University of Florida Health, Gainesville, FL

3. Department of Medicine, University of Florida Health, Gainesville, FL

4. Departments of Biomedical Engineering, Computer and Information Science and Engineering, and Electrical and Computer Engineering, University of Florida, Gainesville, FL

5. Departments of Emergency Medicine & Critical Care Medicine, University of Florida College of Medicine, Jacksonville, FL

6. Department of Surgery, University of Florida College of Medicine, Jacksonville, FL

7. Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL

8. Departments of Anesthesiology, Orthopedics, and Information Systems/Operations Management, University of Florida Health, Gainesville, FL

9. Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL.

Abstract

Objective: To determine whether certain patients are vulnerable to errant triage decisions immediately after major surgery and whether there are unique sociodemographic phenotypes within overtriaged and undertriaged cohorts. Background: In a fair system, overtriage of low-acuity patients to intensive care units (ICUs) and undertriage of high-acuity patients to general wards would affect all sociodemographic subgroups equally. Methods: This multicenter, longitudinal cohort study of hospital admissions immediately after major surgery compared hospital mortality and value of care (risk-adjusted mortality/total costs) across 4 cohorts: overtriage (N = 660), risk-matched overtriage controls admitted to general wards (N = 3077), undertriage (N = 2335), and risk-matched undertriage controls admitted to ICUs (N = 4774). K-means clustering identified sociodemographic phenotypes within overtriage and undertriage cohorts. Results: Compared with controls, overtriaged admissions had a predominance of male patients (56.2% vs 43.1%, P < 0.001) and commercial insurance (6.4% vs 2.5%, P < 0.001); undertriaged admissions had a predominance of Black patients (28.4% vs 24.4%, P < 0.001) and greater socioeconomic deprivation. Overtriage was associated with increased total direct costs [$16.2K ($11.4K–$23.5K) vs $14.1K ($9.1K–$20.7K), P < 0.001] and low value of care; undertriage was associated with increased hospital mortality (1.5% vs 0.7%, P = 0.002) and hospice care (2.2% vs 0.6%, P < 0.001) and low value of care. Unique sociodemographic phenotypes within both overtriage and undertriage cohorts had similar outcomes and value of care, suggesting that triage decisions, rather than patient characteristics, drive outcomes and value of care. Conclusions: Postoperative triage decisions should ensure equality across sociodemographic groups by anchoring triage decisions to objective patient acuity assessments, circumventing cognitive shortcuts and mitigating bias.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference32 articles.

1. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes.;Weiser;Lancet,2015

2. Association of postoperative undertriage to hospital wards with mortality and morbidity.;Loftus;JAMA Netw Open,2021

3. Aligning patient acuity with resource intensity after major surgery: a scoping review.;Loftus;Ann Surg,2021

4. Postoperative overtriage to an intensive care unit is associated with low value of care.;Loftus;Ann Surg,2022

5. Reasons for refusal of admission to intensive care and impact on mortality.;Iapichino;Intensive Care Med,2010