Aligning Patient Acuity With Resource Intensity After Major Surgery: A Scoping Review. Issue 2 (February 2022)

• Record Type: Journal Article
• Authors: Loftus, Tyler J.; Balch, Jeremy A.; Ruppert, Matthew M.; Tighe, Patrick J.; Hogan, William R.; Rashidi, Parisa; Upchurch, Gilbert R.; Bihorac, Azra
• Is Part Of: Annals of surgery. Volume 275:Issue 2(2022)
• Publication Date: 2022-02
• Subjects: ICU -- illness severity -- level-of-care -- monitoring -- mortality -- postoperative; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000005079
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: Develop unifying definitions and paradigms for data-driven methods to augment postoperative resource intensity decisions. Summary Background Data: Postoperative level-of-care assignments and frequency of vital sign and laboratory measurements (ie, resource intensity) should align with patient acuity. Effective, data-driven decision-support platforms could improve value of care for millions of patients annually, but their development is hindered by the lack of salient definitions and paradigms. Methods: Embase, PubMed, and Web of Science were searched for articles describing patient acuity and resource intensity after inpatient surgery. Study quality was assessed using validated tools. Thirty-five studies were included and assimilated according to PRISMA guidelines. Results: Perioperative patient acuity is accurately represented by combinations of demographic, physiologic, and hospital-system variables as input features in models that capture complex, non-linear relationships. Intraoperative physiologic data enriche these representations. Triaging high-acuity patients to low-intensity care is associated with increased risk for mortality; triaging low-acuity patients to intensive care units (ICUs) has low value and imparts harm when other, valid requests for ICU admission are denied due to resource limitations, increasing their risk for unrecognized decompensation and failure-to-rescue. Providing high-intensity care for low-acuity patients may also confer harm through unnecessary testing and subsequent treatment of incidental findings, but there is insufficient evidence to evaluate this hypothesis. Compared with data-driven models, clinicians exhibit volatile performance in predicting complications and making postoperative resource intensity decisions. Conclusion: To optimize value, postoperative resource intensity decisions should align with precise, data-driven patient acuity assessments augmented by models that accurately represent complex, non-linear relationships among risk factors. Abstract : Supplemental Digital Content is available in the text