Emergency surgery in geriatrics: A retrospective evaluation in a single center

BACKGROUND: As life expectancy increases in humans, surgical procedures applied to the elderly people are also increasing in parallel with the developments in surgery and postoperative care. A significant number of studies investigating the morbidity-mortality of geriatric patients are related to patients who are undergoing emergency operations. The present study aims to investigate the factors affecting mortality and morbidity after emergency surgery in elderly people.
METHODS: The data of 200 patients aged 65 years and over who were operated under emergency conditions in the University of Health Sciences Kartal Dr. Lütfi Kýrdar Training and Research Hospital between January and December 2018 were evaluated retrospectively.
RESULTS: Patient’s demographic information, including age, gender, ASA physical status, comorbidities, functional dependency or non-dependency of patients, types of operation, anesthesia technique, duration of operation, intraoperative blood transfusion, the changes of hematocrit levels (during the perioperative period), the outcome after surgery (intensive care admission or ward transfer), were recorded. The risk prediction of short-term mortality has been estimated using CCI and APACHE II scoring systems.
CONCLUSION: The mean age of the patients was 74.8±6.7 and the number of females (n=134, 67%) outweighed the males. Higher ASA physical status scores, dependent living conditions, long operation time, general anesthesia, intraoperative blood transfusion, low Htc values (<25%), high APACHE II scores and lower scores of 10-years survival by CCI were the factors that affected the acceptance into ICU.

Geriatrik hastada acil cerrahi: Tek merkezde geriye dönük deðerlendirme

AMAÇ: Ýnsanlarda yaþam beklentisi arttýkça, yaþlý insanlara uygulanan cerrahi prosedürler cerrahi ve ameliyat sonrasý bakýmdaki geliþmelere paralel olarak artmaktadýr. Geriatrik hastalarýn morbidite-mortalitesini araþtýran önemli sayýda çalýþma acil ameliyat geçirenlerle ilgilidir. Bu çalýþmanýn amacý yaþlýlarda acil cerrahi sonrasý mortalite ve morbiditeyi etkileyen faktörleri araþtýrmaktýr.
GEREÇ VE YÖNTEM: Ocak–Aralýk 2018 tarihleri arasýnda Saðlýk Bilimleri Üniversitesi Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi’nde acil þartlarda ameliyat edilen 65 yaþ ve üstü 200 hastanýn verileri geriye dönük olarak deðerlendirildi.
BULGULAR: Hastalarýn demografik özellikleri yaþ, cinsiyet, ASA fiziksel durumlarý, komorbiditeleri, fonksiyonel olarak baðýmlý olup olmadýklarý, ameliyat tipleri, anestezi tekniði, ameliyat süresi, intraoperatif kan transfüzyonu, hematokrit düzeyindeki deðiþiklikler (perioperatif dönemde) cerrahi sonrasý sonuç (yoðun bakým ya da servise transfer) kaydedildi. Kýsa vadeli ölümlerin risk tahmini, Charlson Comorbidity Ýndeks (CCÝ) ve APACHE II puanlama sistemleri kullanýlarak tahmin edildi.
TARTIÞMA: Hastalarýn yaþ ortalamasý 74.8±6.7 idi ve kadýn sayýsý (n=134, %67) erkeklerden daha yüksekti. Yüksek ASA fiziksel durum skorlarý, baðýmlý yaþam koþullarý, uzun ameliyat süresi, genel anestezi, intraoperatif kan transfüzyonu, düþük Htc deðerleri (<%25), yüksek APACHE II skorlarý ve 10 yýllýk sað kalým skorlarýnýn CCÝ’ye göre daha düþük olmasý yoðun bakým ünitesine kabulü etkileyen faktörlerdir.