Perioperative medicine & outcomes
Disparities in Preoperative Goals of Care Documentation in Veterans
Authors' conclusion
In this cross-sectional study, disparities in documentation rates within a VHA cohort persisted based on race, ethnicity, rurality of patient residence, history of mental health disability, and access to high-volume, high-complexity facilities.
Study context
- Population
- Veterans who underwent surgical procedures in the Veterans Healthcare Administration (VHA), January 1, 2017, to October 18, 2022
- Participants
- 229,737 veterans
- Exposure
- Preoperative life-sustaining treatment (LST) documentation by race, ethnicity, rurality, mental health disability history and facility complexity
- Outcome
- Preoperative life-sustaining treatment (LST) note documentation
- Follow-up
- Within 30 days prior to or on day of surgery
Methodological detailslogistic regression, covariate-adjusted
- Logistic regression
- Covariate-adjusted
Main finding
As reported in the abstract
Preoperative LST completion (covariate-adjusted)
Odds ratio (95% CI)P value
Black vs White
0.79(0.77–0.80)
P < 0.001Other race vs White
0.78(0.74–0.81)
P < 0.001Hispanic vs Non-Hispanic
0.78(0.76–0.81)
P < 0.001Rural vs Urban
0.91(0.90–0.93)
P < 0.001Mental health disability vs No mental health disability
0.93(0.92–0.94)
P = 0.001- Patients completing preoperative LST, overall
- 13 408 (5.8%)
Observational data: associations, not effects.
Further findings
Unadjusted characteristics, did not vs did complete preoperative LST
- Female, did not vs did complete
- 19 914 [9.2%] vs 700 [5.2%]
- Black, did not vs did complete
- 42 571 [19.7%] vs 2416 [18.0%]
- Hispanic, did not vs did complete
- 11 793 [5.5%] vs 631 [4.7%]
- Rural, did not vs did complete
- 75 637 [35.0%] vs 4273 [31.9%]
- Mental health disability history, did not vs did complete
- 65 974 [30.5%] vs 4053 [30.2%]
- Lowest-complexity (level 3) facilities, did not vs did complete
- 7849 [3.6%] vs 78 [0.6%]
Trend over time
- Preoperative LST completed increasingly more often over time, despite the COVID-19 pandemic
Original publication
Disparities in Preoperative Goals of Care Documentation in Veterans. JAMA Netw Open. Published 1 December 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →