DOI
https://doi.org/10.25772/2DK0-SH03
Author ORCID Identifier
https://orcid.org/0000-0002-0343-1178
Defense Date
2018
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Health Related Sciences
First Advisor
Clarence J Biddle, PhD, CRNA
Second Advisor
Cecil B Drain, PhD, CRNA
Third Advisor
Mary E Fischer, MD
Fourth Advisor
William Jarnagin, MD
Fifth Advisor
Charles Moore, PhD, CRNA
Abstract
The Relationship Between Central Venous Catheter and Post-operative Complications in Patients Undergoing Hepatic Resection
David C. O’Connor, Ph.D., DNAP, CRNA
A dissertation submitted in partial fulfillment of the requirements for the degree of
Doctor of Philosophy at Virginia Commonwealth University
Virginia Commonwealth University, 2018
Dissertation Chair: Clarence J. Biddle, Ph.D., CRNA
Hepatic resection is indicated for primary and secondary malignancies. Use of a low central venous pressure technique is associated with decreased blood loss in these cases. This technique has evolved; central venous catheters and high dose morphine are no longer used, and patients are extubated earlier. The purpose of this study is to assess a relationship between these changes and outcomes.
Central venous pressure has fallen out of favor as an accurate fluid measurement. Central venous catheters are associated with many complications. Outcomes in patients undergoing hepatic resection have improved over 20 years at one high volume institution.
Guided by Donabedian’s theory of measuring outcomes, a non-randomized, non-experimental, retrospective, cohort design was conducted.
The independent variables were intraoperative insertion of a central venous catheter, use of morphine, and time of extubation. The dependent variables were superficial and deep wound infections, number and severity of complications. The population sample is patients who submitted to partial hepatectomy at Memorial Sloan Kettering Cancer Center from 2007-2016.
Data was obtained from hepatobiliary and anesthesia databases at Memorial Sloan Kettering Cancer Center.
Data of 2518 from a possible 3903 patients were analyzed with chi square, univariate, Poisson and multivariate regressions. Univariate analysis for presence of CVC was significant for 90-day mortality (p 0.013). Use of morphine was significant for superficial wound infection (p 0.035), and a decrease in complications (p <.001). Amount of morphine was associated with fewer severe complications (p <.001). Incidental findings included a relationship between gender, total amount of fluids and number of segments resected.
The significance of CVC with 90-day mortality was eliminated with stepwise multivariate regression. The findings support the change in anesthetic practice with clinical significance. Incidental findings regarding fluids and segments are supported in the literature. Future research should include goal directed fluid therapy and investigation of the relationship between gender and outcomes.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
4-13-2018