- Email: [email protected]
Condition Critical: The Story of a Nurse Continues
FEBRUARY 1995. VOL 61. NO 2
1992, two surgeons scheduled 684 patients for elective LC as treatment for symptomatic cholelithiasis. The multivariate nature of the data analysis used in this study excluded 56 of these patients for whom data were incomplete, leaving 628 patients in the study. To determine risk factors for conversion of LC to OC, the investigators recorded preoperative and intraoperative data and six-week follow-up data on these patients. Surgical outcomes were graded according to a published classification system (minor complications, complications requiring extensive intervention, complications associated with residual disability, complications leading to postoperative mortality). Data analysis determined that both patient and surgeon factors predicted conversion rates. Preoperative patient factors leading to conversion included a history of 10 or more episodes of acute cholecystitis (p < .0l ), I a history of biliary colic (p < .01), and age of 65 years or greater (p < .01).
Additional preoperative risk factors included obesity, concomitant systemic disorders, diabetes mellitus, and leukocytosis greater than 12,000 cells per mL in the presence of cholelithiasis. Data analysis also revealed that the number of laparoscopic procedures performed by the surgeons was an important variable in assessing risk. Examination of the conversion rate revealed that the first SO laparoscopic procedures attempted by each of the two surgeons resulted in 11 conversions (ie, I I o/o conversion rate). After that time, as the surgeons’ skill increased, the conversion rate decreased to one to three cases per
50 cases for each surgeon through the remainder of the study. Outcome measurements, analyzed using odds ratios, revealed six key intraoperative risk indicators for conversion. In decreasing order of significance, adhesions or unclear anatomy, bleeding, choledocholithiasis, cystic duct stone, trocar injury, and hypotension were indicators for conversion to open procedures.
cal and personal experiences of Heron in the coronary care unit and emergency department, as well as in her private life. The book reads easily and well and evokes a spectrum of emotions. I laughed and cried with her; however, I was left with a sense of continuing frustration that the public once again will see nurses as victims of hostile nurse/physician relationships and hospital administraPerioperative nursing impllca- tions that are cold, calculating tlons. This study demonstrates the money machines. I would have preimportance of conducting outferred that she transpose her experiences into fiction as does Robin comes research and particularly Cook rather than imply that the emphasizes prediction of final “truth” about the entire health care health outcomes. Studies of this industry is that it is dominated by type can be used to identify interdisciplinary turf fights. whether a health care technology As the wife of a surgeon, I or procedure affects patient survival or morbidity, improves believe I know more about real quality of life, or justifies the cost nurse/physician relationships than most people. I am a critical care of providing the technology. Surgeons may use knowledge nurse; Heron’s experiences are not obtained from such studies to my own. Although the author does a good job of conveying the caring schedule the most appropriate component of what we do, nurses procedures and select cases for presented in the book come across resident training. Perioperative as mostly whiny women who are nurses and surgeons may use this victimized by men. This is not the knowledge to plan intraoperative image 1want the public to have of patient care. MARGARET F. FAY my profession. It is exactly the RN, PnD opposite of what the majority of NURSINQ RESEARCH COMMIITEE my colleagues and I are working to achieve with all members of the BOOK REVIEWS health care industry. I know that we would welcome Heron’s obvious talents in helping us achieve CONDITION CRITICAL: THE STORY an environment in which everyOF A NURSE CONTINUES one’s talents are recognized, used, By Echo Heron and appreciated. 1994,414~~ This book is available from Bal$22 hardcover lantine Fawcett Books, Random House, Inc, Order Dept, 400 Hahn ondition Critical: The Story Rd, Westminster, MD 21 157. of a Nurse Continues is the KAREN CARTER LYON continuing saga of critical RN, PHD,CNAA, C care nurse Echo Heron. Set in the PRESIDENT hallways of Redwood Memorial CARLYON Hospital in California, the story is & Co HEALTHCARE CONSULTANTS a series of vignettes relating cliniEL PASO, TEX
c
426 AORN JOURNAL
1992, two surgeons scheduled 684 patients for elective LC as treatment for symptomatic cholelithiasis. The multivariate nature of the data analysis used in this study excluded 56 of these patients for whom data were incomplete, leaving 628 patients in the study. To determine risk factors for conversion of LC to OC, the investigators recorded preoperative and intraoperative data and six-week follow-up data on these patients. Surgical outcomes were graded according to a published classification system (minor complications, complications requiring extensive intervention, complications associated with residual disability, complications leading to postoperative mortality). Data analysis determined that both patient and surgeon factors predicted conversion rates. Preoperative patient factors leading to conversion included a history of 10 or more episodes of acute cholecystitis (p < .0l ), I a history of biliary colic (p < .01), and age of 65 years or greater (p < .01).
Additional preoperative risk factors included obesity, concomitant systemic disorders, diabetes mellitus, and leukocytosis greater than 12,000 cells per mL in the presence of cholelithiasis. Data analysis also revealed that the number of laparoscopic procedures performed by the surgeons was an important variable in assessing risk. Examination of the conversion rate revealed that the first SO laparoscopic procedures attempted by each of the two surgeons resulted in 11 conversions (ie, I I o/o conversion rate). After that time, as the surgeons’ skill increased, the conversion rate decreased to one to three cases per
50 cases for each surgeon through the remainder of the study. Outcome measurements, analyzed using odds ratios, revealed six key intraoperative risk indicators for conversion. In decreasing order of significance, adhesions or unclear anatomy, bleeding, choledocholithiasis, cystic duct stone, trocar injury, and hypotension were indicators for conversion to open procedures.
cal and personal experiences of Heron in the coronary care unit and emergency department, as well as in her private life. The book reads easily and well and evokes a spectrum of emotions. I laughed and cried with her; however, I was left with a sense of continuing frustration that the public once again will see nurses as victims of hostile nurse/physician relationships and hospital administraPerioperative nursing impllca- tions that are cold, calculating tlons. This study demonstrates the money machines. I would have preimportance of conducting outferred that she transpose her experiences into fiction as does Robin comes research and particularly Cook rather than imply that the emphasizes prediction of final “truth” about the entire health care health outcomes. Studies of this industry is that it is dominated by type can be used to identify interdisciplinary turf fights. whether a health care technology As the wife of a surgeon, I or procedure affects patient survival or morbidity, improves believe I know more about real quality of life, or justifies the cost nurse/physician relationships than most people. I am a critical care of providing the technology. Surgeons may use knowledge nurse; Heron’s experiences are not obtained from such studies to my own. Although the author does a good job of conveying the caring schedule the most appropriate component of what we do, nurses procedures and select cases for presented in the book come across resident training. Perioperative as mostly whiny women who are nurses and surgeons may use this victimized by men. This is not the knowledge to plan intraoperative image 1want the public to have of patient care. MARGARET F. FAY my profession. It is exactly the RN, PnD opposite of what the majority of NURSINQ RESEARCH COMMIITEE my colleagues and I are working to achieve with all members of the BOOK REVIEWS health care industry. I know that we would welcome Heron’s obvious talents in helping us achieve CONDITION CRITICAL: THE STORY an environment in which everyOF A NURSE CONTINUES one’s talents are recognized, used, By Echo Heron and appreciated. 1994,414~~ This book is available from Bal$22 hardcover lantine Fawcett Books, Random House, Inc, Order Dept, 400 Hahn ondition Critical: The Story Rd, Westminster, MD 21 157. of a Nurse Continues is the KAREN CARTER LYON continuing saga of critical RN, PHD,CNAA, C care nurse Echo Heron. Set in the PRESIDENT hallways of Redwood Memorial CARLYON Hospital in California, the story is & Co HEALTHCARE CONSULTANTS a series of vignettes relating cliniEL PASO, TEX
c
426 AORN JOURNAL