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Biomedical subjects

W J Fanning

Publications and source records attributed to W J Fanning.

11 recordsLinked to original sources
PubMed1998

What is the marginal cost for marginal risk in cardiac surgery?

BACKGROUND: It has been shown that postoperative length of stay (LOS) correlates highly with mortality risk for cardiac surgical procedures. Similar correlations have been found for charges with LOS and costs with risk. METHODS: Postoperative LOS and risk scores were obtained, tabulated, and compiled into the five original Parsonnet risk groups for 2,589 patients who underwent cardiac operations from 1992 through 1996 at one hospital. The correlation of the group mean LOS with the group mean risk was tested. RESULTS: The correlation coefficient was 0.9827; 96.58% of the variance was removed using risk to predict LOS. A calculation of the difference in cost for difference in risk for cohorts of patients is developed. CONCLUSIONS: The high correlation of mean LOS with mean risk permits calculation of marginal cost for marginal risk based on clinical data. The marginal cost is equal to the difference in variable costs for cohorts.

Aged↗
PubMed1994

Can we afford to do cardiac operations in 1996? A risk-reward curve for cardiac surgery.

Parsonnet risk estimates and postoperative lengths of stay were studied for two cohorts of cardiac surgical patients. The first cohort consisted of 287 patients and was taken from 1984, the first full year of this cardiac surgical program. The second cohort consisted of all 1,167 patients operated on in the calendar years 1989 to 1991. We found that the mean risk for the patients had nearly doubled in this interval and that the risk distribution changed significantly from one skewed toward good-risk patients to a nearly uniform distribution through all risk categories. A high correlation was identified (0.9761) between the postoperative length of stay and the mean risk estimates for the 1989 to 1991 cohort of patients. This permits a regression equation to be calculated showing that the length of stay could be estimated at 7.06 days + 0.21 times the mean risk for a patient or cohort of patients. This relationship is then used to develop a relationship between the net income for a given case or cohort of patients and the length of stay or risk. These data suggest that, in most hospitals, hospital fixed costs are a major determinant, even more so than daily charges, of the relationship between the hospital's finances and the mean risks of patients undertaken in the cardiac surgical program. The consequences of this are discussed.

Algorithms↗
PubMed1993

Reoperative coronary artery bypass grafting without cardiopulmonary bypass.

Between June 1979 and January 1992, 46 men and 13 women aged 35 to 81 years (mean, 58 years) underwent reoperative coronary artery bypass grafting without cardiopulmonary bypass. Isolated reoperative circumflex bypass was performed through a left thoracotomy, and reoperative bypass to the right coronary artery and left anterior descending coronary systems was through a median sternotomy. Complete revascularization was the goal in all patients. Saphenous vein grafts were placed to the right coronary artery (n = 21), circumflex artery (n = 11), and left anterior descending artery (n = 24), and 14 internal thoracic artery to left anterior descending artery bypass grafts were performed. The overall mortality rate was 3.4% (2 deaths). Postoperative morbidity included myocardial infarction in 1 patient and pleuropulmonary complications in 6. No patient was reexplored for hemorrhage, and 19 patients required no blood products. Twenty patients underwent repeat coronary angiography, and 18 of 20 grafts placed without cardiopulmonary bypass were patent. At a mean follow-up interval of 42.2 months 35 of 50 evaluable patients were in functional class I or II. In selected patients, reoperative coronary artery bypass grafting can be performed without cardiopulmonary bypass with a low perioperative morbidity and mortality rate, satisfactory graft patency rates, and good long-term symptomatic improvement.

Adult↗
PubMed1991

Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting.

Ninety-nine consecutive consenting patients were prospectively entered into a randomized, double-blind, placebo-controlled trial to determine the efficacy of postoperative magnesium therapy on the incidence of cardiac arrhythmias after elective coronary artery bypass grafting. No patient had documented or suspected arrhythmias preoperatively. Forty-nine patients received 178 mEq of magnesium given over the first 4 postoperative days, and 50 patients received only placebo. The clinical characteristics of both groups were similar. The preoperative mean serum magnesium concentration was similar in both study (1.90 mEq/L) and placebo (1.90 mEq/L) groups. The mean postoperative serum magnesium concentration in study patients was significantly elevated over postoperative days 1 through 4 when compared with preoperative levels (p less than 0.001). The postoperative mean serum magnesium concentration in control patients declined and remained significantly depressed through postoperative day 3 (p less than 0.001), but increased to preoperative levels by postoperative day 4. The mean serum magnesium concentration was significantly greater in the study patients as compared with the control patients over postoperative days 1 through 4 (p less than 0.001). Although there was no significant difference between groups with respect to episodes of ventricular arrhythmias, there was a significant decrease in the number of episodes of atrial fibrillation in the group receiving magnesium therapy (p less than 0.02). There were no recognized adverse effects of magnesium therapy. Prophylactic magnesium administration seems to lessen the incidence and severity of atrial fibrillation after coronary artery bypass grafting.

Adult↗
PubMed1990

Donor management and matching.

Medical management of the multiorgan donor is an essential component of the success of heart transplantation. Appropriate management demands an understanding of the progressively changing pathophysiology of brain death such that rapid diagnostic and therapeutic intervention may be accomplished. Specific problems such as hypovolemia, diabetes insipidus, neurogenic pulmonary edema, electrolyte imbalance, and loss of temperature regulation require aggressive treatment. Early potential donor recognition, expedient diagnosis of brain death, careful maintenance of satisfactory end-organ function, and appropriate donor-recipient matching are important aspects in the management of the multiorgan donor that will maximize successful application of transplantation to the highest number of qualified recipients.

Age Factors↗
PubMed1988

Eliminating the dog-ear in modified radical mastectomy.

Inadequate attention has been paid to optimal closure of the postmastectomy incision in patients not desirous of breast reconstruction. Herein, we describe the use of a basic plastic surgical technique at the time of mastectomy to eliminate the dog-ear deformity at the axillary end of the incision. The technique is conceptually simple and expedient, and gives an excellent cosmetic result.

Humans↗
PubMed1987

Delayed sternal closure after cardiac surgery.

Fifty-seven patients undergoing various cardiac operations were managed with delayed sternal closure because of ongoing mediastinal hemorrhage or extreme cardiac dilatation. This strategy facilitated rapid access to the mediastinum for evacuation of clot when the risk of tamponade from hemorrhage was deemed great. When sternal closure over a dilated and edematous heart caused hemodynamically significant cardiac compression, wound closure without sternal reapproximation facilitated hemodynamic stability. Postoperative correction of hemodynamic and hemostatic functions allowed delayed sternal closure to be done a mean of 2.8 days later. Thirty-eight patients survived to leave the hospital. Recognized complications of delayed sternal closure included superficial wound infection (3 patients), sternal osteomyelitis (1 patient), and fatal mediastinal infection (1 patient). Delayed sternal closure may be beneficial in selected patients. Morbidity and mortality related to this technique have proved acceptable in this high-risk group.

Adult↗
PubMed1986

The role of echocardiography in patients with acute peripheral arterial embolization.

Forty-seven patients with acute arterial embolism requiring urgent embolectomy had postoperative echocardiography (36 2-D, 11 M-mode) in an attempt to identify a cardiac source of emboli. On the basis of history, physical examination, electrocardiogram, and chest roentgenogram, 37 patients were believed to have an apparent cardiac source. All histories and physical examinations in this group reaffirmed significant underlying cardiac disease. Nine of the 47 patients had no discernible source based on clinical data, and one had an arterioarterial embolus. In the presence of a clinically obvious source, although echocardiography (26 2-D, 11 M-mode) helped to clearly define evident cardiac disease in these patients, it failed to demonstrate a cardiac embolic source in those without clinical evidence of cardiac disease or to influence subsequent management. The continued use of echocardiography for the sole purpose of identifying a potential cardiac embolic source should be reconsidered.

Adult↗