Adult Postoperative Open-Heart Patients: Anemia and 30-Day Hospital Readmission

<p><strong>Background.</strong> In 2013 alone, more than 4% (3.9 million) of patients discharged from a hospital were readmitted. Anemia following a surgical procedure is associated with early hospital readmission.</p> <p><strong>Purpose/Aims. </strong> The following were specific aims of this dissertation:</p> <ul> <li>Aim 1. To develop an operational definition of the term <em>condition-based maintenance</em> as applied to health care and discuss the applicability and effectiveness of condition-based maintenance within health care.</li> <li>Aim 2. To identify the number of adult patients undergoing elective open-heart surgery with preoperative anemia.</li> <li>Aim 3. To examine the relationship between preoperative anemia, sociodemographics, and 30-day hospital readmission rates among postoperative open-heart adult patients.</li> <li>Aim 4. To explain the development and impact of the Hospital Readmissions Reduction Program (HRRP) and discuss the political, social, and economic implications of CABG as a newly targeted condition within the HRRP.</li> </ul> <p><strong>Approach. </strong>To address aim 1, the Walker and Avant model for concept analysis was used to review and analyze relevant literature, create a basic operational definition, and clarify related concepts. To address aims 2 and 3, a retrospective cross‐sectional study was conducted using the STS Database to identify 1,353 surgical cases between August 2014 and July 2018. Cross-tabs and multivariable logistic regression analysis were used to assess the prevalence of preoperative anemia and association with 30-day hospital readmission. To address aim 4, a policy analysis was performed in accordance with Bardach and Patashnik’s procedure.</p> <p><strong>Findings.</strong> From the concept analysis process, the notion of condition-based maintenance emerged, holding promise in advancing symptom science through development of personalized strategies to treat and prevent adverse symptoms of illness.</p> <p>The prevalence of preoperative anemia was 43.7% (<em>n</em> = 591), and 177 (13%) had a 30-day hospital readmission. Patients with preoperative anemia had 1.88 (95% CI 1.36, 2.58) times higher odds of being readmitted. Through policy analysis, a correlation between insurance and 30-day hospital readmission following a CABG procedure was identified. Currently, penalty programs may be adjusted to better capture sociodemographic differences.</p> <p><strong>Implications. </strong>The findings from this study suggest preoperative anemia is associated with increased risk for 30-day hospital readmission. These results provide a basis for further risk reduction strategies and preoperative optimization.</p>

Name thesis:degree_name

PhD Nursing

Level thesis:degree_level

Dissertation: Open Access

Discipline thesis:degree_discipline

Nursing

Year dc:date.available

2019

Author dc:creator

• Ryan, Lindsey

• anemia
• cardiac surgery
• readmission
• condition based maintenance
• value based purchasing
• Nursing

Repository record dc:identifier

https://digital.sandiego.edu/dissertations/143

OAI identifier oai:identifier

oai:digital.sandiego.edu:dissertations-1144