Relationship of perioperative hyperglycemia and major infections in cardiac surgery patients
AuthorPear, Suzanne Marie
KeywordsHealth Sciences, Medicine and Surgery.
Health Sciences, Public Health.
Health Sciences, Health Care Management.
AdvisorLebowitz, Michael D.
MetadataShow full item record
PublisherThe University of Arizona.
RightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
AbstractTwo of the major infectious complications of cardiac surgery are pneumonia and surgical site infections of the sternum and graft harvest site. These postoperative adverse events significantly increase patient morbidity, mortality and cost associated with coronary artery bypass graft operations. Pre-existing diabetes mellitus is commonly considered one of the primary risk factors for development of these major infections. However, most of the previous cardiac surgery risk factor studies have not considered the role perioperative stress hyperglycemia may play in initiating these complications. The primary hypothesis of this retrospective descriptive cohort study was that perioperative stress hyperglycemia (defined as either perioperative serum glucose threshold ≥250 mg/dL or perioperative serum glucose change ≥50 mg/dL) is an independent risk factor for the composite outcome of postoperative infections, including pneumonia and surgical site infections of the sternum and harvest site. The relationship of stress hyperglycemia to the individual infection outcomes was also examined. The secondary study hypothesis was that stress hyperglycemia increases resource utilization as excess days of care. The setting was a tertiary care federal medical facility in the southwestern United States, and the study cohort involved 1285 male military veterans.
Degree ProgramGraduate College
Degree GrantorUniversity of Arizona
Showing items related by title, author, creator and subject.
Modeling the cost-effectiveness of a regional poison control center using decision analysisHarrison, Donald Lee, 1956- (The University of Arizona., 1996)Using decision analysis techniques, the cost-effectiveness of two alternatives for treating human poison exposures were modeled. The alternatives were the treatment of poisonings with the services of a regional poison control center versus without access to any poison control center. The relative cost-effectiveness was modeled based on two outcomes (morbidity and mortality) for each of four typical poison exposures: acetaminophen overdose, tricyclic antidepressant overdose, cleaning substance exposure in children, and cough/cold preparation overdose in children. Additionally, analyses were conducted to test the sensitivity of the cost-effectiveness ratio to outcome probability, average inpatient and emergency room charges, and proportion of poison exposures managed on site by the regional poison control center. This research was conducted from society's point of view.
Continuity of care for migrant farm workers utilizing computer disksBayham-Hicks, Shirley Louise (The University of Arizona., 2000)Not much has changed for the migrant farmworker in the last thirty years. In one of the wealthiest countries on earth, migrant farmworker health status remains comparable to that found in Third World countries because of poor sanitation, poor nutrition and exposure. Current estimates show that migrant clinics are serving less than 20% of this population, leaving about 2,000,000 farmworkers without medical care. The barriers to health care for this population are numerous. This study will focus on the barrier to care resulting from lack of continuity in care due to poor inter-clinic communication. In this study it has been shown that computer disks and a standard word-processing program can be used to create a portable medical health history for the migrant to improve inter-clinic communication. In the process of carrying out this study, it was also shown how other barriers to care for this vulnerable population might be removed as well.
Development of the Diabetes Resource Consumption Index and profiling quality of diabetes care in the Veterans Health AdministrationJoish, Vijay (The University of Arizona., 2003)The purpose of this study was to develop and validate a risk-adjustment index for one year healthcare resource use specific to diabetic patients, based on severity of illness measures; and to profile quality of diabetes care between outpatient clinics. The data for this study was collected from four outpatient clinics within the Southern Arizona Veterans Affairs Healthcare System, Tucson, AZ. The DRCI was developed using a sample size of 367 diabetic subjects that had complete information on diabetes-specific variables. Individual DRCI weights, based on the magnitude of one year healthcare resource use and socio-demographic characteristics, ranged from -471.5 to 3,081.2 for total healthcare costs, from -304.3 to 1,582.1 for outpatient costs, and -0.19 to 0.93 for risk of hospitalization. The DRCI was better than or equivalent to the Chronic Disease Score in predicting health care costs. Diabetics in the second cohort were predominantly elderly (mean = 66yrs ± 11.1), married (61%), white (73%), males (96%), had a high BMI (31 ± 6.3 kg/m²), and mean comorbidity score of 4.2 ± 1.8 conditions. Screening for HbA1c and microalbuminuria was frequently performed in all clinics. Overall, 61% and 36% of study patients did not have evidence of foot or eye examinations during the entire study period, respectively. Approximately, 27% (n = 408), 41% (n = 643), and 26% (n = 515) of the study patients had poor glycemic, renal function, and lipid control, respectively. Significant differences (p < .05) in HbA1c and creatinine clearance rates between the clinics were observed after adjusting for patient case-mix. However, differences between the clinics in cardiovascular outcome were not observed after adjusting for patient case-mix. This study demonstrated an association between diabetes severity with healthcare resource and costs. The DRCI, using laboratory data, is a diabetes-specific severity measure for prediction of one year healthcare resource use. Future studies are needed to validate this index in other settings. Finally, the results from this study emphasize the need to adjust for case-mix variable when comparing quality of diabetic care outcomes between outpatient clinics.