Altmýþ beþ yaþ üstü hastalarda, preoperatif dönemde yoðun bakým ünitesi ihtiyacýný öngörmede kýlavuza ihtiyaç var mý? ASA, LUSS, CACI, SORT indekslerinin karþýlaþtýrýlmasý

AMAÇ: Altmýþ beþ yaþ üstü cerrahi uygulanan hastalarýn, pre-intra ve postoperatif deðiþkenlerinin tümü postoperatif yoðun bakým ünitesi (YBÜ) takip gerekliliðini belirler. Ameliyat öncesi hem cerrahi hem anesteziyi ilgilendiren, kolay ve hýzlý þekilde gerçekleþtirilecek ideal skorlama sistemleri ile postoperatif YBÜ endikasyonu belirlenerek yüksek riskli hastalarda morbidite ve mortalite geliþimi engellenebilir. Çalýþmamýzda, YBÜ endikas-yonunu belirlemede Amerikan Anesteziyolojistler Derneði (ASA) skoru, Akciðer Ultrason skoru (LUSS), Charlson Yaþ Ekli Komorbidite Ýndeksi (CACI), Cerrahi Sonuç Risk Aracý (SORT) skorunun etkinliklerini karþýlaþtýrdýk. Çalýþmamýzýn hipotezi, real görsel olan LUSS’un, YBÜ endikasyonu belirlemede tarama testi olan SORT, CACI ve diðer skor olan ASA’ya göre üstün olduðunu göstermektir.
GEREÇ VE YÖNTEM: Çalýþmaya, 65 yaþ üstü, elektif þartlarda cerrahi uygulanacak, 101 hasta alýndý. Hastalarýn demografik özellikleri, klinik paramet-releri, YBÜ endikasyonlarý, ASA, LUSS, CACI ve SORT’larý prospektif olarak hesaplanýp kaydedildi. Hastalarýn ASA, LUSS, CACI ve SORT’larýnýn, postoperatif YBÜ’ne yatýþ ihtiyacýnýn belirlenmesine etkisi incelendi.
BULGULAR: Ameliyat sonrasý YBÜ'ne yatýrýlmasý gereken hastalarýn yaþý, ameliyat sonrasý YBÜ'ne yatýrýlmasý gerekmeyenlere göre anlamlý derecede yüksekti (p<0.001). Gruplar cinsiyet, vücut kitle indeksi (VKÝ), sigara kullanýmý ve anestezi tipi açýsýndan farklýlýk göstermedi (p>0.05). ASA, LUSS, CACI, SORT postop YBÜ'ne yatýrýlmasý gereken hastalarda anlamlý olarak daha yüksekti (p<0.001). Ameliyat sonrasý YBÜ endikasyonu olan hasta-lardan, ameliyat sonrasý YBÜ’ne ihtiyacý olan hastalarýn oraný daha yüksekti (p<0.001). Konsültasyon sayýsý, ameliyat sonrasý YBÜ’ne yatýþ gerektiren hastalarda anlamlý olarak daha yüksekti (p<0.001). SORT’un, ameliyat sonrasý YBÜ'ne yatýþ ihtiyacýný tahmin etmede en yüksek doðruluk olduðu bulundu.
SONUÇ: Altýmýþ beþ yaþ üstü elektif cerrahi uygulanan hastalarýn preoperatif deðerlendirme sürecinde YBÜ endikasyonunu belirlemede ASA, LUSS, CACI, SORT’un etkili olduðu tespit edilmiþtir. Buna karþýn SORT’un etkinliði diðerlerinden üstün bulunmuþtur.

Is a guideline required to predict the ICU need of patients over 65 years of age during the pre- operative period? A comparison of the ASA, lung ultrasound score, Charlson age-added comorbidity index, surgical outcome risk tool indexes

BACKGROUND: All pre-operative, intra-operative, and post-operative variables of the patients at 65 years of age who had a surgi-cal procedure determine the necessity of post-operative intensive care unit (ICU) monitoring. The indication for post-operative ICU is detected through ideal scoring systems related to the surgery and anesthesia that will be performed easily and fast would prevent the development of morbidity and mortality in high-risk patients. In the present study, we compared the efficacy of the American Society of Anesthesiologists (ASA) score, lung ultrasound score (LUSS), Charlson age-added comorbidity index (CACI), and surgical outcome risk tool (SORT) score of the indication for ICU. The hypothesis of our study is to show that real visual LUSS is superior to the screening test SORT, CACI, and the other score, ASA, for ICU indication determination.
METHODS: The study enrolled 101 patients over 65 years of age who will have surgical procedures under elective conditions. De-mographic features, clinical parameters, ICU indications, ASA, LUSS, CACI, and SORTs of the patients were calculated prospectively and recorded. The effects of patients' ASA, LUSS, CACI, and SORT on determining the need for postoperative ICU admission were examined.
RESULTS: The age of patients who needed post-operative ICU admission was significantly higher than those who did not need post-operative ICU admission (P<0.001). The groups did not show differences in terms of gender, body mass index, smoking, and type of anesthesia (P>0.05). ASA, LUSS, CACI, and SORT were significantly higher for patients who needed post-operative ICU admission (P<0.001). The proportion of patients who needed post-operative ICU admission was higher for patients with post-operative ICU indication (P<0.001). The number of consultations was significantly higher for patients who needed post-operative ICU admission (P<0.001). SORT was found to be the highest accuracy for predicting the need for post-operative ICU admission.
CONCLUSION: It was detected that ASA, LUSS, CACI, and SORT are effective for the determination of the ICU indication in the pre-operative evaluation process of patients over the age of 65 who had elective surgery. However, the efficiency of SORT was found to be superior to the others.