Association of Sociodemographic Factors With Overtriage, Undertriage, and Value of Care After Major Surgery
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 intens...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2024-06-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000429 |
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| author | Tyler J. Loftus, MD Matthew M. Ruppert, MS Benjamin Shickel, PhD Tezcan Ozrazgat-Baslanti, PhD Jeremy A. Balch, MD Kenneth L. Abbott, MD Die Hu, MS Adnan Javed, MD Firas Madbak, MD Faheem Guirgis, MD David Skarupa, MD Philip A. Efron, MD Patrick J. Tighe, MD William R. Hogan, MD Parisa Rashidi, PhD Gilbert R. Upchurch, Jr, MD Azra Bihorac, MD |
| author_facet | Tyler J. Loftus, MD Matthew M. Ruppert, MS Benjamin Shickel, PhD Tezcan Ozrazgat-Baslanti, PhD Jeremy A. Balch, MD Kenneth L. Abbott, MD Die Hu, MS Adnan Javed, MD Firas Madbak, MD Faheem Guirgis, MD David Skarupa, MD Philip A. Efron, MD Patrick J. Tighe, MD William R. Hogan, MD Parisa Rashidi, PhD Gilbert R. Upchurch, Jr, MD Azra Bihorac, MD |
| author_sort | Tyler J. Loftus, MD |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-d61e92eec95a4e538b624f9469e1d686 |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-06-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-d61e92eec95a4e538b624f9469e1d6862025-01-24T09:18:39ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-06-0152e42910.1097/AS9.0000000000000429202406000-00025Association of Sociodemographic Factors With Overtriage, Undertriage, and Value of Care After Major SurgeryTyler J. Loftus, MD0Matthew M. Ruppert, MS1Benjamin Shickel, PhD2Tezcan Ozrazgat-Baslanti, PhD3Jeremy A. Balch, MD4Kenneth L. Abbott, MD5Die Hu, MS6Adnan Javed, MD7Firas Madbak, MD8Faheem Guirgis, MD9David Skarupa, MD10Philip A. Efron, MD11Patrick J. Tighe, MD12William R. Hogan, MD13Parisa Rashidi, PhD14Gilbert R. Upchurch, Jr, MD15Azra Bihorac, MD16From the * Intelligent Critical Care Center, University of Florida, Gainesville, FLFrom the * Intelligent Critical Care Center, University of Florida, Gainesville, FLFrom the * Intelligent Critical Care Center, University of Florida, Gainesville, FLFrom the * Intelligent Critical Care Center, University of Florida, Gainesville, FLFrom the * Intelligent Critical Care Center, University of Florida, Gainesville, FL† Department of Surgery, University of Florida Health, Gainesville, FLFrom the * Intelligent Critical Care Center, University of Florida, Gainesville, FL∥ Departments of Emergency Medicine & Critical Care Medicine, University of Florida College of Medicine, Jacksonville, FL¶ Department of Surgery, University of Florida College of Medicine, Jacksonville, FL# Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL¶ Department of Surgery, University of Florida College of Medicine, Jacksonville, FL† Department of Surgery, University of Florida Health, Gainesville, FL** Departments of Anesthesiology, Orthopedics, and Information Systems/Operations Management, University of Florida Health, Gainesville, FL†† Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL.From the * Intelligent Critical Care Center, University of Florida, Gainesville, FL† Department of Surgery, University of Florida Health, Gainesville, FLFrom the * Intelligent Critical Care Center, University of Florida, Gainesville, FLObjective:. 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.http://journals.lww.com/10.1097/AS9.0000000000000429 |
| spellingShingle | Tyler J. Loftus, MD Matthew M. Ruppert, MS Benjamin Shickel, PhD Tezcan Ozrazgat-Baslanti, PhD Jeremy A. Balch, MD Kenneth L. Abbott, MD Die Hu, MS Adnan Javed, MD Firas Madbak, MD Faheem Guirgis, MD David Skarupa, MD Philip A. Efron, MD Patrick J. Tighe, MD William R. Hogan, MD Parisa Rashidi, PhD Gilbert R. Upchurch, Jr, MD Azra Bihorac, MD Association of Sociodemographic Factors With Overtriage, Undertriage, and Value of Care After Major Surgery Annals of Surgery Open |
| title | Association of Sociodemographic Factors With Overtriage, Undertriage, and Value of Care After Major Surgery |
| title_full | Association of Sociodemographic Factors With Overtriage, Undertriage, and Value of Care After Major Surgery |
| title_fullStr | Association of Sociodemographic Factors With Overtriage, Undertriage, and Value of Care After Major Surgery |
| title_full_unstemmed | Association of Sociodemographic Factors With Overtriage, Undertriage, and Value of Care After Major Surgery |
| title_short | Association of Sociodemographic Factors With Overtriage, Undertriage, and Value of Care After Major Surgery |
| title_sort | association of sociodemographic factors with overtriage undertriage and value of care after major surgery |
| url | http://journals.lww.com/10.1097/AS9.0000000000000429 |
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