Abstract/Details

Physiologic Capacity as a Predictor of Postoperative Complications and Associated Costs in Three Types of Oncological Surgeries


2011 2011

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Abstract (summary)

An estimated 12 million individuals undergoing non-cardiac surgery in the United States each year will experience postoperative complications. The costs of complications are manifested in the growing healthcare economic burden and patients' reduced quality of life, future economic productivity, and shortened long-term survival. This research is grounded in a conceptual framework derived from literature in physiologic capacity and stress. The purpose of the study was to test the hypothesis that physiologic capacity is a predictor of postoperative complications and associated costs in three types of oncological surgery (esophagectomy, hepatectomy, and radical cystectomy). Data analysis strategies included forward step-wise binary logistic regression. Results showed a peak oxygen uptake (PVO2) of >20 mL/min/kg, plus a heart rate time (HRTIME) of <5 minutes (for the heart rate to fall at or below 100 bmp after stop test) as the multivariate predictive model (67% sensitivity and 92% specificity) for complications in the hepatectomy group. Conversely, an anaerobic threshold (AT) of >10 mL/min/kg was found to be the univariate predictive model (33% sensitivity and 91% specificity) for the radical cystectomy group. No predictor was found for the esophagectomy group. Each predictive model also predicted between 89%–100% of actual length of stay and hospital costs. Lastly, trends in complications showed esophagectomy with 60 events over 60 days, radical cystectomy with 21 events over 12 days, and hepatectomy with 36 events over 7 days. Implications for positive social change included a paradigm shift from subjective to objective phenotypic physiologic risk assessment affecting standards of care, policies, procedures, and decision-making changes in the healthcare industries and surgeon practice, resulting in better patient outcomes, fewer surgical complications, and increased quality of life.

Indexing (details)


Subject
Public health;
Surgery
Classification
0573: Public health
0576: Surgery
Identifier / keyword
Health and environmental sciences; Energy metabolism; Physiologic capacity; Postoperative outcomes
Title
Physiologic Capacity as a Predictor of Postoperative Complications and Associated Costs in Three Types of Oncological Surgeries
Author
Woodruff, Vicky D.
Number of pages
194
Publication year
2011
Degree date
2011
School code
0543
Source
DAI-B 73/04, Dissertation Abstracts International
Place of publication
Ann Arbor
Country of publication
United States
ISBN
9781267069689
Advisor
Snodgrass, Jeffery
Committee member
Agha, Mehdi; Jimenez, Richard
University/institution
Walden University
Department
Health Services
University location
United States -- Minnesota
Degree
Ph.D.
Source type
Dissertations & Theses
Language
English
Document type
Dissertation/Thesis
Dissertation/thesis number
3487546
ProQuest document ID
913393770
Copyright
Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works.
Document URL
http://search.proquest.com/docview/913393770
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