Key result
Postoperative ward undertriage occurs in ~11% of patients and is linked to higher mortality.
May warrant caution with ward triage for high-risk postoperative patients; leaves open whether targeted ICU allocation improves outcomes.
It is critical in health care to neither overuse nor underuse resources. One of the key decisions in surgical treatment is to determine whether a patient can safely undergo an ambulatory procedure or requires hospital admission and observation. Patients admitted after a procedure undergo further stratification by admission status: to observation, inpatient ward, high-dependency unit, or intensive care unit (ICU). It is essential to accurately determine the optimal location for a patient after surgical treatment, balancing resource allocation with perioperative risks. A dynamic tension exists between overtriage to higher levels of care when not necessary, given that this is costly and is not associated with meaningful changes in perioperative outcomes, and conversely undertriage, which can also be associated with increased costs but may additionally be associated with worse perioperative outcomes. The Goldilocks admission dilemma of too hot, too cold, or just right has not yet been optimized. In this longitudinal, cross-sectional study, Loftus and associates 1 developed a machine-learning model to identify undertriage to hospital wards among patients after surgical procedures. They defined patients who were undertriaged as those who were sent to the floor but found to be in the top quartile of hospital mortality risk and who subsequently required a prolonged ICU stay of more than 48 hours. Out of more than 12000 postoperative ward admissions during the 6-year study period, 10.6% of admissions were identified as undertriaged. By using this model, the authors found that, compared with risk-matched ICU admissions, undertriaged postoperative admissions had an increased risk of mortality and morbidity, namely unplanned intubation, acute kidney injury, and longer hospital length of stay. Existing models for postoperative triage have been primarily based on high-risk surgical procedures, as defined by estimated mortality rates
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Ko et al. (2021) conducted an editorial in Postoperative surgical patients (n=12,000). Undertriage to hospital wards vs. Risk-matched ICU admissions was evaluated on Mortality and morbidity (unplanned intubation, acute kidney injury, and longer hospital length of stay). Undertriage to hospital wards occurred in 10.6% of postoperative admissions and was associated with increased mortality and morbidity compared with risk-matched ICU admissions.
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