Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Ann M. Mayo, DNSc, RN, FAAN, Committee Member; Laurie Ecoff, PhD, RN, NEA-BC, Committee Member


anemia, cardiac surgery, readmission, condition based maintenance, readmission, value based purchasing


Background. In 2013 alone, more than 4% (3.9 million) of patients discharged from a hospital were readmitted. Anemia following a surgical procedure is associated with early hospital readmission.

Purpose/Aims. The following were specific aims of this dissertation:

  • Aim 1. To develop an operational definition of the term condition-based maintenance as applied to health care and discuss the applicability and effectiveness of condition-based maintenance within health care.
  • Aim 2. To identify the number of adult patients undergoing elective open-heart surgery with preoperative anemia.
  • Aim 3. To examine the relationship between preoperative anemia, sociodemographics, and 30-day hospital readmission rates among postoperative open-heart adult patients.
  • Aim 4. To explain the development and impact of the Hospital Readmissions Reduction Program (HRRP) and discuss the political, social, and economic implications of CABG as a newly targeted condition within the HRRP.

Approach. To address aim 1, the Walker and Avant model for concept analysis was used to review and analyze relevant literature, create a basic operational definition, and clarify related concepts. To address aims 2 and 3, a retrospective cross‐sectional study was conducted using the STS Database to identify 1,353 surgical cases between August 2014 and July 2018. Cross-tabs and multivariable logistic regression analysis were used to assess the prevalence of preoperative anemia and association with 30-day hospital readmission. To address aim 4, a policy analysis was performed in accordance with Bardach and Patashnik’s procedure.

Findings. From the concept analysis process, the notion of condition-based maintenance emerged, holding promise in advancing symptom science through development of personalized strategies to treat and prevent adverse symptoms of illness.

The prevalence of preoperative anemia was 43.7% (n = 591), and 177 (13%) had a 30-day hospital readmission. Patients with preoperative anemia had 1.88 (95% CI 1.36, 2.58) times higher odds of being readmitted. Through policy analysis, a correlation between insurance and 30-day hospital readmission following a CABG procedure was identified. Currently, penalty programs may be adjusted to better capture sociodemographic differences.

Implications. The findings from this study suggest preoperative anemia is associated with increased risk for 30-day hospital readmission. These results provide a basis for further risk reduction strategies and preoperative optimization.

Document Type

Dissertation: Open Access



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Creative Commons Attribution-Noncommercial 4.0 License
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