Date of Conferral
2011
Date of Award
2011
Degree
Ph.D.
School
Health Services
Advisor
Jeffery Snodgrass
Abstract
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 (PVO 2 ) of >20 mL/min/kg, plus a heart rate time (HRTIME) of(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.
