Is No difference a good outcome? Equity evaluation of the general surgery prioritization tool.

Abstract

Background: The general surgery prioritization tool (GSPT) was implemented in 2018 to equitably prioritize non-cancer elective general surgery waitlists. It combines patient-reported Impact On Life (IOL) scores and clinician-reported values for a total score which determines access to the waitlist. In New Zealand there are inequities in surgical access and outcomes, particularly for Māori, and this study evaluates whether the GSPT may contribute.

Method: A retrospective review of general surgery prioritization events at Capital & Coast District Health Board, New Zealand, between May 2018 and August 2022 was conducted. The patient-reported IOL score (6-36), total score (0-100), waitlist access, and time to surgery in days were recorded and analyzed for ethnic, age and gender differences.

Results: 4527 events were included. Median IOL score and total score were 20 and 68. 4231 (90.8%) met the waitlist threshold with a median time to surgery of 99 days. Higher average IOL scores were associated with being female (P = 0.005), Pacific Peoples (P = 0.007) and Other Ethnicity (P = 0.006). The average total score for Māori was 1.13 points higher than Europeans (P = 0.013). There was no evidence of associations between the odds of surgery booking and patient age, ethnicity and gender when adjusted for deprivation and procedure type.

Conclusion: This study shows that despite differences in the IOL and total scores across ethnicity, no evidence of difference was found in the odds of surgical booking based on patient ethnicity, age or gender. Amendments to weighting of IOL scores and ethnicity score adjustment could be considered to remedy this.