Case Questions: Answer the case questions, with research from your book, CDC, NI

Question

Case Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a paper, so your answer should not be numbered, but rather it should use titles and subtitles.
1. Which factors are supposedly related to CABG morality?
2. Which factors are the most strongly related to CABG mortality?  
3. How could one derive an expected mortality rate from the multivariate model?  

Explanation / Answer

Coronary artery bypass graft surgery (CABG) is a type of surgery that helps to improve blood flow to the heart, which is used to treat people who have severe coronary heart disease (CHD). CHD is a disease in which a waxy substance called plaque builds up inside the coronary arteries, arteries which supply oxygen-rich blood to your heart (National Heart, Lung, and Blood Institute, 2015). This buildup of plaque causes the inside of the arteries to become narrowed, limiting the supply of oxygen-rich blood to the heart muscle. CABG is a very delicate procedure that requires the heart must be stopped to allow the doctor to perform the surgery. When the heart has been stopped, the doctor will perform the bypass graft procedure by sewing one end of a section of vein over a tiny opening made in the aorta, and the other end over a tiny opening made in the coronary artery just below the blockage (Johns Hopkins Medicine, 2015). This paper will answer some questions related to CABG morality.

Questions Answered

Which factors are supposedly related to CABG morality?

In reviewing the case study, factors supposedly related to CABG morality include demographic factors, such as age and gender, hemodynamic state, comorbidities, severity of atherosclerotic process, ventricular function, and previous open heart operations are related to the risk of CABG mortality.

Which factors are the most strongly related to CABG mortality?

Factors that are the most strongly related to CABG mortality are hepatic failure. The odds ratio is a measure of the relative risk of mortality for patients with and without the characteristic. Patients with hepatic failure have about 21 times the odds of mortality compared to those without this comorbidity. Notice the dose-response relationship between ventricular function and mortality—the risk of dying increases as ejection fraction decreases.

How could one derive an expected mortality rate from the multivariate model?

One could derive an expected mortality rate from the multivariate model by using the model coefficients to calculate a “predicted value” for each patient, which can be transformed to a “probability of death.” If we sum the probabilities of death across each hospital or surgeon’s case load, we derive the total expected deaths for each hospital or surgeon. Dividing the expected deaths by the number of patients and multiplying by 100 would give an expected mortality rate (per 100).

CONCLUSION

In short, it is important to understand how mortality measures can be developed and used to describe and compare the burden of death across periods, population groups, or geographic areas and settings of care. The purpose of any of these measures is to make judgments regarding whether the “burden” of mortality is excessive (Fleming, 2008). CABG is the most common type of open-heart surgery performed in the United States and results from the surgery are usually good.

References

Coronary Artery Bypass Graft Surgery (CABG). (2015). Retrieved from Johns Hopkins Medicine:

Fleming, S. T. (2008). Managerial epidemiology: Concepts and cases (2nd ed.). Chicago, IL: Health Administration Press.

What Is Coronary Artery Bypass Grafting? (2015). Retrieved from National Heart, Lung, and Blood Institute

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