Factors Perpetuating Racial Disparities in Veterans Completing Preoperative Goals of Care Documentation (TH115A)

• Published in: Journal of pain and symptom management 2023-05, Vol.65 (5), p.e517-e517
• Main Authors: Wu, Adela, MD, Giannitrapani, Karleen, PhD MPH, Garcia, Ariadna, MS, Bozkurt, Selen, PhD, Boothroyd, Derek, PhD, Adams, Alyce, PhD, Shreve, Scott, DO, Lorenz, Karl, MD MSHS
• Format: Article
• Language: English
• Subjects: Anesthesia; Pain Medicine
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2023.02.016

Outcomes1. Describe the importance of life-sustaining treatment preferences documentation for surgical patients. 2. Identify disparities in completion of preoperative goals of care planning and life-sustaining treatment documentation. BackgroundPreoperative goals of care discussion and documentation are important for patients undergoing surgery, a major healthcare stressor that incurs risk. We aim to assess disparities in preoperative goals of care planning and other factors implicated in access. MethodsWe retrospectively analyzed 250,212 veterans who underwent surgeries between January 1, 2017, and September 28, 2022, at the Veterans Healthcare Administration (VHA). Our primary outcome was preoperative life-sustaining treatment (LST) documentation within 30 days prior to day of surgery. We aimed to assess impact of race (white/Black/other) and ethnicity (Hispanic/non-Hispanic) on preoperative LST completion and use binomial logistic regression, adjusted for patient and surgical characteristics. Preliminary results7,633 (3.8%) patients completed preoperative LST, and 192,560 (96.2%) did not. White (78.5%), male (94.2%), and non-Hispanic (92.9%) patients tended to complete LST before surgery. Patients from urban residences (66.0%) also had preoperative LST documentation more often. In addition, patients with Care Needs Assessment score ≥80 (1.6%), indicating high risk of hospitalization or death, or Charlson Comorbidity Index ≥4 (49.7%), indicating high risk of death, tended to complete preoperative LST. ConclusionsA minority of surgical patients completed preoperative LST, with pervasive disparities in documentation rates based on race, ethnicity, and rurality of patient residence within a VHA cohort. ImplicationsAs preoperative discussion and documentation of patient preferences is a quality standard, racial and socioeconomic disparities should be addressed for surgical patients.