Onkolojik kolorektal cerrahilerde postoperatif riskleri öngörmede hangisi daha değerli? asa skorlaması, prognostik nutrisyonel indeks, mini nutrisyonel değerlendirme, kırılganlık ölçeği
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Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışmamızda elektif laparaskopik onkolojik kolorektal cerrahi planan, 65 yaş ve üzeri hastaları,
preoperatif olarak ASA, FRAIL, MNA-SF, PNI skorları ile kırılganlık ve malnütrisyon değerlendirmesi yaparak,
postoperatif komplikasyon, mortalite, hastane ve ybü yatış sürecine etkisini saptamayı amaçladık.
Yöntem: Çalışmamıza elektif onkolojik kolorektal operasyon planan, 65 yaş ve üzeri 100 hasta dahil edildi.
Hastalara preoperatif dönemde onam alınarak, ASA (Amerikan Anestezi Derneği Fiziksel Sınıflandırma skoru),
FRAİL Kırılganlık Ölçeği ve Mini Nutrisyonel Değerlendirme Testi- Kısa Formu (MNA-SF) uygulandı.
Operasyon öncesindeki albümin ve lenfosit değerleri kaydedilerek, PNI (Prognostik Nutrisyonel Index) skoru
hesaplandı. Postoperatif 30 günlük süre içinde postoperatif komplikasyon gelişimi, mortalite, hastane ve yoğun
bakım yatış süresi, hastane tekrar başvurusu incelendi ve kaydedildi.
Bulgular: Çalışmamızda kırılganlık (FRAIL) ve malnütrisyon (MNA-SF ve PNI) düzeyleri artan hastalarda;
postoperatif komplikasyonlar, postoperatif ybü ihtiyacı, uzamış ybü süresi, uzamış hastane yatış süresi, tekrar
hastane başvurusu ve mortalitede artış istatistiksel olarak anlamlı ve fazlaydı (p<0,05). ASA skorlamamız ise
postoperatif ybü ihtiyacı (p<0,05) belirlemede anlamlı iken diğer incelemelerimizde istatistiksel olarak anlamsızdı
(p>0,05). Postoperatif komplikasyonlar ve mortalite için skorlarlamalar arasında yapılan regresyon testinde
FRAIL kırılganlık skoru malnütrisyon skorlarına göre daha anlamlı görüldü. Uzamış hastane ve ybü yatış süresini
öngörmede yapılan korelasyon testlerinde, FRAIL ve MNA-SF, PNI’a göre daha belirleyici olduğu görüldü.
Postoperatif komplikasyonları öngörmede, çalışmamızda belirlediğimiz PNI cut-off değerimiz ise 49,5 olarak
hesaplandı.
Sonuç: Çalışma sonucunda kırılgan ve malnütre hastalarda postoperatif morbidite, mortalite ve yatış süreleri çok
daha fazla oranda gözlenmiş ve istatiksel olarak anlamlı bulunmuştur. Özellikle geriatrik ve onkolojik hasta
grubunda, preoperatif dönemde kırılganlık ve malnütrisyon durumunun rutin olarak değerlendirilmesi ve gerekli
hazırlıkların yapılması, operasyon sonrası tedavi sürecinde oldukça elzem ve faydalı olduğu ortaya koyulmuştur.
Kırılganlık ve malnütrisyon değerlendirmelerinin, preoperatif değerlendirme için ASA sınıflandırmasının
öngörücü doğruluğunu önemli ölçüde artıracağını ve kombinasyonlarının tek başına ASA sınıflandırmasından
istatistiksel olarak anlamlı derecede üstün olacağını düşünüyoruz
Objective: In our study, we aimed to evaluate frailty and malnutrition with FRAIL, MNA-SF, PNI scores preoperatively in patients aged 65 and over, who were planned for elective laparoscopic oncological colorectal surgery, and to determine its effect on postoperative complications, mortality, hospital and ICU admission process. Method: 100 patients aged 65 and over who were planned for elective oncological colorectal surgery were included in our study. ASA (American Society of Anesthesiologists Physical Classification score), FRAIL Frailty Scale and Mini Nutritional Assessment Test-Short Form (MNA-SF) were applied to the patients, after obtaining informed consent in the preoperative period. Preoperative albumin and lymphocyte values were recorded and the PNI (Prognostic Nutritional Index) score was calculated. During the 30-day postoperative period, postoperative complication development, mortality, length of hospital and ICU stay, and hospital re-admission were examined and recorded. Results: In our study, in patients with increased frailty (FRAIL) and malnutrition (MNA-SF and PNI) levels were statistically significant and high with the increase in postoperative complications, postoperative ICU need, prolonged ICU time, prolonged hospital stay, rehospital admission and mortality (p<0,05). While our ASA scoring was significant in determining postoperative ICU need (p<0.05), it was statistically insignificant in our other examinations (p>0,05). In the regression test performed between scoring for postoperative complications and mortality, the FRAIL frailty score was found to be more significant than the malnutrition scores. In correlation tests performed to predict prolonged hospital and ICU stay, FRAIL and MNA-SF were found to be more predictive than PNI.Our PNI cut-off value, which we determined in our study to predict postoperative complications, was calculated as 49.5. Conclusion: As a result of the study, postoperative morbidity, mortality and length of stay were observed to be much higher in frail and malnourished patients and were found to be statistically significant. It has been revealed that routine evaluation of frailty and malnutrition status in the preoperative period and making the necessary preparations, especially in the geriatric and oncological patient group, are very essential and beneficial in the postoperative treatment process. We think that frailty and malnutrition assessments will significantly increase the predictive accuracy of ASA classification for preoperative evaluation and that their combination will be statistically significantly superior to ASA classification alone.
Objective: In our study, we aimed to evaluate frailty and malnutrition with FRAIL, MNA-SF, PNI scores preoperatively in patients aged 65 and over, who were planned for elective laparoscopic oncological colorectal surgery, and to determine its effect on postoperative complications, mortality, hospital and ICU admission process. Method: 100 patients aged 65 and over who were planned for elective oncological colorectal surgery were included in our study. ASA (American Society of Anesthesiologists Physical Classification score), FRAIL Frailty Scale and Mini Nutritional Assessment Test-Short Form (MNA-SF) were applied to the patients, after obtaining informed consent in the preoperative period. Preoperative albumin and lymphocyte values were recorded and the PNI (Prognostic Nutritional Index) score was calculated. During the 30-day postoperative period, postoperative complication development, mortality, length of hospital and ICU stay, and hospital re-admission were examined and recorded. Results: In our study, in patients with increased frailty (FRAIL) and malnutrition (MNA-SF and PNI) levels were statistically significant and high with the increase in postoperative complications, postoperative ICU need, prolonged ICU time, prolonged hospital stay, rehospital admission and mortality (p<0,05). While our ASA scoring was significant in determining postoperative ICU need (p<0.05), it was statistically insignificant in our other examinations (p>0,05). In the regression test performed between scoring for postoperative complications and mortality, the FRAIL frailty score was found to be more significant than the malnutrition scores. In correlation tests performed to predict prolonged hospital and ICU stay, FRAIL and MNA-SF were found to be more predictive than PNI.Our PNI cut-off value, which we determined in our study to predict postoperative complications, was calculated as 49.5. Conclusion: As a result of the study, postoperative morbidity, mortality and length of stay were observed to be much higher in frail and malnourished patients and were found to be statistically significant. It has been revealed that routine evaluation of frailty and malnutrition status in the preoperative period and making the necessary preparations, especially in the geriatric and oncological patient group, are very essential and beneficial in the postoperative treatment process. We think that frailty and malnutrition assessments will significantly increase the predictive accuracy of ASA classification for preoperative evaluation and that their combination will be statistically significantly superior to ASA classification alone.
Açıklama
Anahtar Kelimeler
Geriatrik hasta, Geriatric patient, onkolojik cerrahi, oncological surgery, Kırılganlık, frailty, malnütrisyon, malnutrition, komplikasyon, complication, mortalite, mortality, yatış süreci, hospitalization process
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Sayılmaz, U. (2024). Onkolojik kolorektal cerrahilerde postoperatif riskleri öngörmede hangisi daha değerli? asa skorlaması, prognostik nutrisyonel indeks, mini nutrisyonel değerlendirme, kırılganlık ölçeği. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Anesteziyoloji ve Reanimasyon Anabilim Dalı, Konya.
