DOI
https://doi.org/10.25772/WWQA-EH26
Author ORCID Identifier
https://orcid.org/0000-0002-9103-135X
Defense Date
2018
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Health Related Sciences
First Advisor
Chuck Biddle, PhD, CRNA
Second Advisor
Brad Verhulst, PhD
Third Advisor
Mary Ford, PhD, CRNA
Fourth Advisor
Brenda Wands, PhD, CRNA
Abstract
Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home
patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical.
Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity and mortality is on the horizon unless aggressive measures are taken at mitigating risk. Similarly, as the obesity epidemic expands, obesity-related comorbid conditions including obstructive sleep apnea (OSA) are likely to grow.
The purpose of this research was to explore the relationship between ambulatory orthopedic patient-reported activities (quality of life metrics) and diagnostic factors (physical and perioperative care data) in the immediate postoperative period that are predictive of arterial oxygen desaturation. Data was obtained using a novel patient journal exploring sleep, pain, nausea, tobacco use, alcohol use, and appetite in conjunction with a valid and reliable portable, wrist-worn pulse oximeter. Additional assessment data was taken from the preanesthetic assessment. All participants were scored according to the STOP-Bang questionnaire, an accepted survey of OSA risk.
Patients were recruited from a busy metropolitan ambulatory surgery center in Richmond, Virginia that sees approximately 500 cases monthly, and a 309-bed tertiary care hospital in West Burlington, Iowa. The target sample included 52 individual patients with data collected over the first two post-operative nights following discharge. Two patients were excluded.
Negative binomial regression, log10 transformation, and least-squares regression examined the relationships the STOP-Bang questionnaire, quality of life data, and physical perioperative data had on postoperative desaturation events. Results suggested the STOP-Bang score predicted desaturation events and that age and BMI were significant individual predictors. Opiate pain medication treatment, a happy mood, and home CPAP use were associated with decreased events.
This study provided a unique perspective in patient safety research, relating human behaviors and experiences with postoperative oxygen desaturation. Future research projects aligned with postoperative monitoring, pulse oximetry, patient safety, and obstructive sleep apnea are potential following the findings of this study.
Rights
© Charles Reginald Elam, IV
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
12-5-2018
Included in
Anesthesiology Commons, Other Medicine and Health Sciences Commons, Perioperative, Operating Room and Surgical Nursing Commons, Sleep Medicine Commons