Dataset Information

Postoperative Overtriage to an Intensive Care Unit Is Associated With Low Value of Care.

ABSTRACT:

Objective

We test the hypothesis that for low-acuity surgical patients, postoperative intensive care unit (ICU) admission is associated with lower value of care compared with ward admission.

Background

Overtriaging low-acuity patients to ICU consumes valuable resources and may not confer better patient outcomes. Associations among postoperative overtriage, patient outcomes, costs, and value of care have not been previously reported.

Methods

In this longitudinal cohort study, postoperative ICU admissions were classified as overtriaged or appropriately triaged according to machine learning-based patient acuity assessments and requirements for immediate postoperative mechanical ventilation or vasopressor support. The nearest neighbors algorithm identified risk-matched control ward admissions. The primary outcome was value of care, calculated as inverse observed-to-expected mortality ratios divided by total costs.

Results

Acuity assessments had an area under the receiver operating characteristic curve of 0.92 in generating predictions for triage classifications. Of 8592 postoperative ICU admissions, 423 (4.9%) were overtriaged. These were matched with 2155 control ward admissions with similar comorbidities, incidence of emergent surgery, immediate postoperative vital signs, and do not resuscitate order placement and rescindment patterns. Compared with controls, overtraiged admissions did not have a lower incidence of any measured complications. Total costs for admission were $16.4K for overtriage and $15.9K for controls ( P =0.03). Value of care was lower for overtriaged admissions [2.9 (2.0-4.0)] compared with controls [24.2 (14.1-34.5), P <0.001].

Conclusions

Low-acuity postoperative patients who were overtriaged to ICUs had increased total costs, no improvements in outcomes, and received low-value care.

SUBMITTER: Loftus TJ

PROVIDER: S-EPMC9817331 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Publications

Postoperative Overtriage to an Intensive Care Unit Is Associated With Low Value of Care.

Loftus Tyler J TJ Ruppert Matthew M MM Ozrazgat-Baslanti Tezcan T Balch Jeremy A JA Shickel Benjamin B Hu Die D Efron Philip A PA Tighe Patrick J PJ Hogan William R WR Rashidi Parisa P Upchurch Gilbert R GR Bihorac Azra A

Annals of surgery 20220706 2

<h4>Objective</h4>We test the hypothesis that for low-acuity surgical patients, postoperative intensive care unit (ICU) admission is associated with lower value of care compared with ward admission.<h4>Background</h4>Overtriaging low-acuity patients to ICU consumes valuable resources and may not confer better patient outcomes. Associations among postoperative overtriage, patient outcomes, costs, and value of care have not been previously reported.<h4>Methods</h4>In this longitudinal cohort study ...[more]

PMID: 35797553

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Dataset Information

Postoperative Overtriage to an Intensive Care Unit Is Associated With Low Value of Care.

Objective

Background

Methods

Results

Conclusions

Publications

Postoperative Overtriage to an Intensive Care Unit Is Associated With Low Value of Care.

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