Association of low-value operative management with mortality, length of stay and complications
Bibliographic record
Abstract
BACKGROUND: Significant inter-hospital variation in potentially low-value operative management of blunt solid organ injuries (SOI) has been observed but data on the impact on patient outcomes is lacking. Our primary objective was to estimate the association between potentially low-value operative management of blunt SOI and hospital mortality, complications, and length of stay (LOS). A secondary objective was to identify determinants, independent of patients' health status on arrival. METHODS: We conducted a retrospective cohort study using the National Trauma Data Bank (2016-2019). We included adults admitted with blunt SOI eligible for nonoperative management (grade I-IV spleen/liver and grade I-III kidney, hemodynamically stable, no blood products within 6 hours). We used propensity scores to generate adjusted odds ratios (OR) of mortality and complications and geometric mean ratios (GMR) of LOS. RESULTS: We included 62,601 adults, of whom 1,683 (2.7%) had potentially low-value operative management. Adjusted ORs were 1.92 (95% CI 1.25-2.96) for mortality and 2.39 (1.99-2.87) for complications. The adjusted GMR was 1.52 (1.38-1.68) for LOS. Low-value operative management was more frequent in males, White non-Hispanics versus African Americans, Medicaid versus private insurance, and American College of Surgeons (ACS) level II/III and state-designated hospitals versus ACS level I. CONCLUSIONS: In this retrospective cohort study, potentially low-value operative management of SOI was infrequent but was associated with increased mortality, complications, and LOS and was influenced by sex, race and ethnicity and insurance status. Results suggest that interventions designed to reduce low-value operative management may improve patient outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".