Kolon tümör nedeni ile cerrahi planlanan yaşlı hastalarda preoperatif demir eksikliği anemisinin Edmonton kırılganlık skoruna etkisinin değerlendirilmesi
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kırılganlık, yaşam boyunca f3zyoloj3k s3stem rezerv ve 3şlevlerde kümülat3f b3r azalma sonucu endojen
veya ekzojen stres faktörler3ne karşı savunmasızlık durumu olarak tanımlanab3l3r. Kırılganlık, b3r hastanın
cerrah3 b3r prosedürün stres3ne karşı savunmasızlığının ve artan postoperat3f kompl3kasyon gel3şme r3sk3 ve
daha uzun hastanede kalış süres3 de dah3l olmak üzere, postoperat3f advers olayların 3y3 b3l3nen b3r öngörücüsü
olarak düşünüleb3l3r. Çalışmamız kolon tümör neden3yle cerrah3 operasyon geç3recek olan, 65 yaş üstü
hastalarda dem3r eks3kl3ğ3 anem3s3n3n Edmonton Kırılganlık Skoruna etk3s3n3 araştırmayı amaçlamaktadır.
Yöntem: Çalışmamıza elekt3f laporoskop3k kolon tümör cerrah3s3 planan, 65 yaş üzer3 120 hasta dah3l ed3ld3.
Hastalarımızın preoperat3f dönemde ASA skorlaması ve demograf3k ver3ler3 kayded3ld3. Hastalarımızın tamamı
anem3 açısından değerlend3r3ld3 ve hemoglob3n değer3 13 altında olanlar anem3k olarak kabul ed3ld3. Hastalar
2 gruba (60 anem3s3 olan 60 anem3s3 olmayan) ayrıldı. Dem3r eks3kl3ğ3n3n serum göstergeler3; düşük dem3r
sev3yes3, düşük ferr3t3n düzey3, artmış dem3r bağlama kapas3tes3, artmış transferr3n satürasyon değerler3
aranarak dem3r eks3kl3ğ3 anem3s3 tesp3t3 yapıldı. Hastalarımızın tamamı preoperat3f değerlend3rme esnasında
Edmonton Kırılganlık Ölçeğ3ne tab3 tutuldu. Hastalarımıza 0,01 mg/kg 3v m3dazolam 3le premed3kasyon
uygulandı ve non 3nvaz3v (Ekg, SpO2, KB, NMT) mon3tör3zasyon yapıldıktan sonra 3v 1 mg/kg propofol ve 0.6
mg/kg rokuronyum 3le anestez3 3ndüks3yonu yapıldı. İdamede 3se 3v 0.1-0.3 μg/kg/dk rem3fentan3l ve 0.5-1
MAK desflurane 3nhalasyonu amel3yat önces3 v3tal değerler3n (KH, SAB ve OAB) %20-30 3ç3nde tutulmasına
özen göster3lerek uygulandı. Hastalara aynı cerrah3 ek3p tarafından laparoskop3k kolon tümör cerrah3s3 yapıldı.
Hastaların bazal, 3ndüks3yon sonrası, entübasyon 5. Dak3kası, cerrah3 5.,30. ve 60. dak3ka aralıklı, ekstübasyon
sonrası ve PACU 15. dak3kadak3 v3tal değerler3 (KH, SAB, DAB OAB) kayıt ed3ld3. PACU’de Mod3f3ye
Aldrete skoru hesaplandı. Hastalarımız per3operat3f dönemde ayrıca; operasyon süres3, 3notrop3k ajan 3ht3yacı,
kanama m3ktarı, kan ve kan ürünler3 transfüzyon gereks3n3m3, yoğun bakımda-hastanede yatış süres3, PACU’da
Mod3f3ye Aldrete Skoru ve 30 günlük mortal3te açısından 3ncelend3.
Bulgular: Çalışmamızda preoperat3f dönemde dem3r eks3kl3ğ3 anem3s3 olan grubunun yaş ortalaması(p=0,017),
ek hastalıkları, yoğun bakım ün3tes3nde yatış günü (p=0,01), total hastane yatış günü (p=0,016) ve Edmonton
Kırılganlık Ölçeğ3 (p<0,001) değerler3 genel hasta popülasyonuna göre daha yüksekt3. Yoğun Bakım Ün3tes3ne
yatış süreler3nde Edmonton Kırılganlık Ölçeğ3 3le poz3t3f yönde (p<0,001), Mod3f3ye Aldrete Skorları 3le
negat3f yönde b3r korelasyon 3l3şk3s3 vardı (p<0,001). Ayrıca postoperat3f 1 aylık mortal3te değerlend3r3lmes3nde
3stat3ksel olarak anlamlı farklılık yoktu. Dem3r eks3kl3ğ3 anem3s3 olan ve yüksek kırılganlık skoruna sah3p
grupta solunumsal (p=0,047), kard3yak (p=0,047) ve nörops3kojen3k (p=0,046) kompl3kasyon ve 3notrop3k ajan
kullanımı daha yüksekt3 (p<0,001). Anem3s3 olan hastaların PACU’da daha düşük Mod3f3ye Aldrete Skoruna
(p<0,001) sah3pt3; ayrıca Edmonton Kırılganlık Ölçeğ3 3le Mod3f3ye Aldrete Skorları arasında negat3f b3r
korelasyon 3l3şk3s3 vardı (p<0,001). Ayrıca Edmonton Kırılganlık Ölçeğ3 3le 3ndüks3yon sonrası SAB (p=0,003),
DAB (p=0,001), OAB (p=0,001) arasında negat3f (ters) yönde orta düzeyde b3r korelasyon 3l3şk3s3 görülmüştür.
Sonuç: Bu prospekt3f gözlemsel kl3n3k çalışmada; dem3r eks3kl3ğ3 anem3s3 olan ger3atr3k hastaların daha
yüksek kırılganlık skoruna sah3p olduğunu gördük. Ayrıca bu kırılgan hastalarda; 3ntraoperat3f 3notrop3k ajan
3ht3yacı, yoğun bakım ve hastanede kalış süreler3, postoperat3f kompl3kasyonlar daha fazla görülmüş ve
Mod3f3ye Aldreye Skoru 3se daha düşük tesp3t ed3lm3ş ve 3stat3ksel olarak anlamlı bulunmuştur. Ancak mortal3te
ve kan transfüzyonu açısından anlamlı farklılık saptanmamıştır. Özell3kle ger3atr3k onkoloj3k hasta grubunun
preoperat3f değerlend3r3lmes3nde kırılganlığın ASA skorunun öngörücü doğruluğunu artırdığını düşünüyoruz.
Edmonton Kırılganlık Skoru’nun Ayrıca hem kırılganlığın düzelt3leb3l3r r3sk faktörler3n3n (anem3,
malnutr3syon, pol3farmas3 vb.) tesp3t3 ve tedav3s3, hem de oluşab3lecek postoperat3f kompl3kasyonları
değerlend3reb3lmek 3ç3n rut3n olarak kullanılması gerekt3ğ3n3 düşünüyoruz.
Purpose: Fra3lty can be def3ned as a state of vulnerab3l3ty to endogenous or exogenous stressors as a result of a cumulat3ve reduct3on 3n phys3olog3c system reserves and funct3ons throughout l3fe. Fra3lty can be cons3dered as a well-known pred3ctor of a pat3ent's vulnerab3l3ty to the stress of a surg3cal procedure and postoperat3ve adverse events, 3nclud3ng 3ncreased r3sk of develop3ng postoperat3ve compl3cat3ons and longer hosp3tal stay. Our study a3ms to 3nvest3gate the effect of 3ron def3c3ency anem3a on Edmonton Fra3lty Score 3n pat3ents over 65 years of age undergo3ng surgery for colon tumor. Method: Our study 3ncluded 120 pat3ents over 65 years of age who were planned for elect3ve laporoscop3c colon tumor surgery. Preoperat3ve ASA scor3ng and demograph3c data of our pat3ents were recorded. All of our pat3ents were evaluated for anem3a and those w3th a hemoglob3n value below 13 were cons3dered anem3c. Pat3ents were d3v3ded 3nto 2 groups (60 w3th anem3a and 60 w3thout anem3a). Serum 3nd3cators of 3ron def3c3ency; low 3ron level, low ferr3t3n level, 3ncreased 3ron b3nd3ng capac3ty, 3ncreased transferr3n saturat3on values were searched for 3ron def3c3ency anem3a. All of our pat3ents were subjected to Edmonton Fra3lty Scale dur3ng preoperat3ve evaluat3on. Our pat3ents were premed3cated w3th 0.01 mg/kg 3v m3dazolam and anesthes3a 3nduct3on was performed w3th 3v 1 mg/kg propofol and 0.6 mg/kg rocuron3um after non-3nvas3ve (ECG, SpO2, BP, NMT) mon3tor3ng. On ma3ntenance, IV rem3fentan3l 0.1-0.3 μg/kg/m3n and 0.5-1 MAK desflurane 3nhalat3on were adm3n3stered w3th care to keep w3th3n 20% of preoperat3ve v3tal values (HR, SAB and OAB). Laparoscop3c colon tumor surgery was performed by the same surg3cal team. The pat3ents' v3tal values (HR, SAB, DAB, GAB OAB) at basel3ne, after 3nduct3on, at the 5th m3nute of 3ntubat3on, at the 5th, 30th and 60th m3nute 3ntervals after surgery, after extubat3on and at the 15th m3nute of PACU were recorded. Mod3f3ed Aldrete score was calculated 3n PACU. In the per3operat3ve per3od, our pat3ents were also analyzed 3n terms of durat3on of operat3on, need for 3notrop3c agents, amount of bleed3ng, need for blood and blood products transfus3on, durat3on of hosp3tal3zat3on 3n 3ntens3ve care un3t-hosp3tal, Mod3f3ed Aldrete Score 3n PACU and 30-day mortal3ty. Results: In our study, the mean age (p=0.017), comorbidities, days of hospitalization in the intensive care unit (p=0.01), total hospitalization days (p=0.016) and Edmonton Frailty Scale (p<0.001) values of the group with iron deficiency anemia were higher than the general patient population. There was a positive correlation with Edmonton Frailty Scale (p<0.001) and a negative correlation with Modified Aldrete Scores (p<0.001) in the duration of ICU hospitalization. In addition, there was no statistically significant difference in the evaluation of 1-month postoperative mortality. Respiratory (p=0.047), cardiac (p=0.047) and neuropsychogenic (p=0.046) complications and inotropic agent use were higher in the group with iron deficiency anemia and high frailty score (p<0.001). Patients with anemia had a lower Modified Aldrete Score in the PACU (p<0.001); there was also a negative correlation between the Edmonton Frailty Scale and Modified Aldrete Scores (p<0.001). There was also a moderate negative (inverse) correlation between the Edmonton Frailty Scale and post-induction SAB (p=0.003), DAB (p=0.001), and OAB (p=0.001). ConclusKon: In th3s prospect3ve observat3onal cl3n3cal study, we found that ger3atr3c pat3ents w3th 3ron def3c3ency anem3a had a h3gher fra3lty score. In add3t3on, the need for 3ntraoperat3ve 3notrop3c agents, durat3on of 3ntens3ve care and hosp3tal3zat3on, and postoperat3ve compl3cat3ons were h3gher 3n these fra3l pat3ents, and the Mod3f3ed Aldreye Score was lower and stat3st3cally s3gn3f3cant. However, no s3gn3f3cant d3fference was found 3n terms of mortal3ty and blood transfus3on. We th3nk that fra3lty 3ncreases the pred3ct3ve accuracy of ASA score espec3ally 3n the preoperat3ve evaluat3on of ger3atr3c oncolog3c pat3ent group. We also bel3eve that Edmonton Fra3lty Score should be used rout3nely to 3dent3fy and treat mod3f3able r3sk factors for fra3lty (anem3a, malnutr3t3on, polypharmacy, etc) and evaluate poss3ble postoperat3ve compl3cat3ons.
Purpose: Fra3lty can be def3ned as a state of vulnerab3l3ty to endogenous or exogenous stressors as a result of a cumulat3ve reduct3on 3n phys3olog3c system reserves and funct3ons throughout l3fe. Fra3lty can be cons3dered as a well-known pred3ctor of a pat3ent's vulnerab3l3ty to the stress of a surg3cal procedure and postoperat3ve adverse events, 3nclud3ng 3ncreased r3sk of develop3ng postoperat3ve compl3cat3ons and longer hosp3tal stay. Our study a3ms to 3nvest3gate the effect of 3ron def3c3ency anem3a on Edmonton Fra3lty Score 3n pat3ents over 65 years of age undergo3ng surgery for colon tumor. Method: Our study 3ncluded 120 pat3ents over 65 years of age who were planned for elect3ve laporoscop3c colon tumor surgery. Preoperat3ve ASA scor3ng and demograph3c data of our pat3ents were recorded. All of our pat3ents were evaluated for anem3a and those w3th a hemoglob3n value below 13 were cons3dered anem3c. Pat3ents were d3v3ded 3nto 2 groups (60 w3th anem3a and 60 w3thout anem3a). Serum 3nd3cators of 3ron def3c3ency; low 3ron level, low ferr3t3n level, 3ncreased 3ron b3nd3ng capac3ty, 3ncreased transferr3n saturat3on values were searched for 3ron def3c3ency anem3a. All of our pat3ents were subjected to Edmonton Fra3lty Scale dur3ng preoperat3ve evaluat3on. Our pat3ents were premed3cated w3th 0.01 mg/kg 3v m3dazolam and anesthes3a 3nduct3on was performed w3th 3v 1 mg/kg propofol and 0.6 mg/kg rocuron3um after non-3nvas3ve (ECG, SpO2, BP, NMT) mon3tor3ng. On ma3ntenance, IV rem3fentan3l 0.1-0.3 μg/kg/m3n and 0.5-1 MAK desflurane 3nhalat3on were adm3n3stered w3th care to keep w3th3n 20% of preoperat3ve v3tal values (HR, SAB and OAB). Laparoscop3c colon tumor surgery was performed by the same surg3cal team. The pat3ents' v3tal values (HR, SAB, DAB, GAB OAB) at basel3ne, after 3nduct3on, at the 5th m3nute of 3ntubat3on, at the 5th, 30th and 60th m3nute 3ntervals after surgery, after extubat3on and at the 15th m3nute of PACU were recorded. Mod3f3ed Aldrete score was calculated 3n PACU. In the per3operat3ve per3od, our pat3ents were also analyzed 3n terms of durat3on of operat3on, need for 3notrop3c agents, amount of bleed3ng, need for blood and blood products transfus3on, durat3on of hosp3tal3zat3on 3n 3ntens3ve care un3t-hosp3tal, Mod3f3ed Aldrete Score 3n PACU and 30-day mortal3ty. Results: In our study, the mean age (p=0.017), comorbidities, days of hospitalization in the intensive care unit (p=0.01), total hospitalization days (p=0.016) and Edmonton Frailty Scale (p<0.001) values of the group with iron deficiency anemia were higher than the general patient population. There was a positive correlation with Edmonton Frailty Scale (p<0.001) and a negative correlation with Modified Aldrete Scores (p<0.001) in the duration of ICU hospitalization. In addition, there was no statistically significant difference in the evaluation of 1-month postoperative mortality. Respiratory (p=0.047), cardiac (p=0.047) and neuropsychogenic (p=0.046) complications and inotropic agent use were higher in the group with iron deficiency anemia and high frailty score (p<0.001). Patients with anemia had a lower Modified Aldrete Score in the PACU (p<0.001); there was also a negative correlation between the Edmonton Frailty Scale and Modified Aldrete Scores (p<0.001). There was also a moderate negative (inverse) correlation between the Edmonton Frailty Scale and post-induction SAB (p=0.003), DAB (p=0.001), and OAB (p=0.001). ConclusKon: In th3s prospect3ve observat3onal cl3n3cal study, we found that ger3atr3c pat3ents w3th 3ron def3c3ency anem3a had a h3gher fra3lty score. In add3t3on, the need for 3ntraoperat3ve 3notrop3c agents, durat3on of 3ntens3ve care and hosp3tal3zat3on, and postoperat3ve compl3cat3ons were h3gher 3n these fra3l pat3ents, and the Mod3f3ed Aldreye Score was lower and stat3st3cally s3gn3f3cant. However, no s3gn3f3cant d3fference was found 3n terms of mortal3ty and blood transfus3on. We th3nk that fra3lty 3ncreases the pred3ct3ve accuracy of ASA score espec3ally 3n the preoperat3ve evaluat3on of ger3atr3c oncolog3c pat3ent group. We also bel3eve that Edmonton Fra3lty Score should be used rout3nely to 3dent3fy and treat mod3f3able r3sk factors for fra3lty (anem3a, malnutr3t3on, polypharmacy, etc) and evaluate poss3ble postoperat3ve compl3cat3ons.
Açıklama
Anahtar Kelimeler
Ger3atr3k hasta, GerKatrKc patKent, anem3, anemKa, dem3r eks3l3ğ3 anem3s3, Kron defKcKency anemKa, dem3r, kolorektal kanser, kırılganlık, kompl3kasyon, taburculuk sürec3, Kron, colorectal cancer, fraKlty, complKcatKon, dKscharge process
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kaya, A. Ö. (2024). Kolon tümör nedeni ile cerrahi planlanan yaşlı hastalarda preoperatif demir eksikliği anemisinin Edmonton kırılganlık skoruna etkisinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Anesteziyoloji ve Reanimasyon Anabilim Dalı, Konya
