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Predictors of mortality and complications in patients treated in intensive care following non-cardiac emergency surgery

Yıl 2022, Cilt: 1 Sayı: 3, 105 - 112, 23.12.2022

Öz

Background: Due to the increasing population and life expectancy, the number of patients undergoing emergency surgery is expected to increase. However, different surgical diagnoses that require emergency surgery cause various complications and morbidity. This study examines outcomes in patients undergoing emergency surgery, including in-hospital mortality and morbidity predictors.
Materials and Methods: A retrospective study was conducted of patients who underwent emergency surgery in a tertiary healthcare institution between 2014 and 2019 and were indicated for post-surgical intensive care unit (ICU). Demographic data, comorbidities, surgical indications and perioperative risk assessment data of the patients were collected. Outcomes included length of stay in ICU, need for inotrope agents, discharge status, and in-hospital mortality and morbidity. Multivariate logistic regression was used to identify predictors of in-hospital mortality.
Results: The mean age of 886 patient admissions was 52.3 years. The mortality rate (38.1%) of patients aged 65 and over who underwent emergency surgery was statistically significantly higher than other patients (p < 0.001). The American Society of Anesthesiologists (ASA) physical condition classification mean was 3E. The mortality rate was found to be higher in patients with high ASA, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) III scores and preoperative leukocyte and neutrophil values (p <0.001).
Conclusions: Apart from APACHE II and SAPS III classifications and preoperative laboratory parameters such as leukocytes and lymphocytes, the ASA score can also predict mortality in the critically ill population requiring emergency surgery, and can be used to guide patient and family counseling.

Kaynakça

  • Akinbami, F., Askari, R., Steinberg, J., Panizales, M. & Rogers, S. O., Jr (2011). Factors affecting morbidity in emergency general surgery. American Journal of Surgery, 201(4),456–462.
  • Alcock, M. & Chilvers, C.R. (2012). Emergency surgery in the elderly: a retrospective observational study. Anaesthesia and Intensive Care, 40(1), 90–94.
  • Bettelli G. (2011). Preoperative evaluation in geriatric surgery: comorbidity, functional status and pharmacological history. Minerva Anestesiologica, 77(6), 637–646.
  • BouAkl, I., Bou-Khalil, P., Kanazi, G., Ayoub, C. & El-Khatib, M. (2012). Weaning from mechanical ventilation. Current Opinion in Anaesthesiology, 25(1), 42–47.
  • Campion, M. & Scully, G. (2018). Antibiotic use in the intensive care unit: optimization and de-escalation. Journal of intensive care medicine, 33(12), 647–655.
  • Christensen, K., Doblhammer, G., Rau, R. & Vaupel, J.W. (2009). Ageing populations: the challenges ahead. Lancet (London, England), 374(9696), 1196–1208.
  • Dasgupta, M., Rolfson, D. B., Stolee, P., Borrie, M.J. & Speechley, M. (2009). Frailty is associated with postoperative complications in older adults with medical problems. Archives of Gerontology and Geriatrics, 48(1), 78–83.
  • Fariña-Castro, R., Roque-Castellano, C., Artiles-Armas, M. & Marchena-Gómez, J. (2019). Emergency surgery and American Society of Anesthesiologists physical status score are the most influential risk factors of death in nonagenarian surgical patients. Geriatrics & Gerontology International, 19(4), 293–298.
  • Gabriel, R.A., A'Court, A.M., Schmidt, U.H., Dutton, R.P. & Urman, R.D. (2018). Time of day is not associated with increased rates of mortality in emergency surgery: An analysis of 49,196 surgical procedures. Journal of Clinical Anesthesia, 46, 85–90.
  • Gazala, S., Tul, Y., Wagg, A., Widder, S.L., Khadaroo, R.G. & Acute Care and Emergency Surgery (ACES) Group (2013). Quality of life and long-term outcomes of octo- and nonagenarians following acute care surgery: a cross sectional study. World Journal of Emergency Surgery: WJES, 8(1), 23.
  • Godinjak, A., Iglica, A., Rama, A., Tančica, I., Jusufović, S., Ajanović, A. & Kukuljac, A. (2016). Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit. Acta Medica Academica, 45(2), 97–103.
  • Huda, A.U., Yasir, M., Sheikh, N. & Khan, A.Z. (2022). Can ACS-NSQIP score be used to predict postoperative mortality in Saudi population? Saudi Journal of Anaesthesia, 16(2), 172–175.
  • Inouye S.K. (2000). Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies. Annals of Medicine, 32(4), 257–263.
  • Jayanama, K., Theou, O., Blodgett, J.M., Cahill, L. & Rockwood, K. (2018). Frailty, nutrition-related parameters, and mortality across the adult age spectrum. BMC Medicine, 16(1), 188.
  • Kojima, G., Iliffe, S. & Walters, K. (2018). Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age and Ageing, 47(2), 193–200.
  • Lin, H.S., Watts, J.N., Peel, N.M. & Hubbard, R.E. (2016). Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatrics, 16(1), 157.
  • McIsaac, D.I., Moloo, H., Bryson, G.L. & van Walraven, C. (2017). The association of frailty with outcomes and resource use after emergency General surgery: a population-based cohort study.Anesthesia and Analgesia, 124(5), 1653–1661.
  • Merani, S., Payne, J., Padwal, R.S., Hudson, D., Widder, S.L. & Khadaroo, R.G. (2014). Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery. World Journal of Emergency Surgery: WJES,9, 43.
  • Minne, L., Ludikhuize, J., de Jonge, E., de Rooij, S. & Abu-Hanna, A. (2011). Prognostic models for predicting mortality in elderly ICU patients: a systematic review. Intensive Care Medicine, 37(8), 1258–1268.
  • Nithiuthai, J., Siriussawakul, A., Junkai, R., Horugsa, N., Jarungjitaree, S. & Triyasunant, N. (2021). Do ARISCAT scores help to predict the incidence of postoperative pulmonary complications in elderly patients after upper abdominal surgery? An observational study at a single university hospital. Perioperative Medicine (London, England), 10(1), 43.
  • Paul, E., Bailey, M. & Pilcher, D. (2013). Risk prediction of hospital mortality for adult patients admitted to Australian and New Zealand intensive care units: development and validation of the Australian and New Zealand Risk of Death model. Journal of Critical Care, 28(6), 935–941.
  • Population Division US Census Bureau. Projections of the Population by Age and Sex for the United States: 2010 to 2050 (NP2008-T12) 2008. Available at:https://www.census.gov/data/tables/2008/demo/popproj/2008-summary-tables.html. Access Date: 19.06.2022.
  • Portuondo, J.I., Shah, S.R., Singh, H. & Massarweh, N.N. (2019). Failure to rescue as a surgical quality indicator: current concepts and future directions for improving surgical outcomes. Anesthesiology, 131(2), 426–437.
  • Rosenberg, M. W. & Moore, E.G. (1997). The health of Canada's elderly population: current status and future implications. CMAJ: Canadian Medical Association Journal = Journal de L'Association Medicale Canadienne, 157(8), 1025–1032.
  • Rosero, E.B., Romito, B.T. & Joshi, G.P. (2021). Failure to rescue: A quality indicator for postoperative care. Best Practice & Research. Clinical Anaesthesiology, 35(4), 575–589.
  • Turrentine, F.E., Wang, H., Simpson, V.B. & Jones, R. S. (2006). Surgical risk factors, morbidity, and mortality in elderly patients. Journal of the American College of Surgeons, 203(6), 865–877.
  • United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019: Highlights. ST/ESA/SER.A/423. Available at: https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf. Access Date: 19.06.2022.

Predictors of mortality and complications in patients treated in intensive care following non-cardiac emergency surgery

Yıl 2022, Cilt: 1 Sayı: 3, 105 - 112, 23.12.2022

Öz

Amaç: Artan nüfus ve yaşam süresi nedeniyle acil cerrahi geçiren hastaların sayısının artması beklenmektedir. Bununla birlikte acil cerrahi gerektiren farklı cerrahi tanılar farklı komplikasyonlara ve morbiditeye neden olmaktadır. Bu araştırma, hastane içi mortalite ve morbidite öngörücüleri de dahil olmak üzere, acil cerrahi uygulanan hastalardaki sonuçları incelemektedir.
Materyal ve Metot: 2014 ve 2019 yılları arasında üçüncü basamak bir sağlık kuruluşunda acil cerrahi geçiren ve cerrahi sonrası yoğun bakım endikasyonu konulan hastaların retrospektif bir çalışması yapıldı. Hastaların demografik verileri, komorbiditeleri, cerrahi endikasyonları ve perioperatif risk değerlendirme verileri toplandı. Sonuçlar, yoğun bakımda kalış süresi, inotrop ihtiyacı, taburculuk durumu ve hastane içi mortalite ve morbiditeyi içeriyordu. Hastane içi mortalite belirleyicilerini belirlemek için çok değişkenli lojistik regresyon kullanıldı.
Bulgular: 886 hasta başvurusunun ortalama yaşı 52.3 idi. Acil cerrahi uygulanan 65 yaş ve üstü hastaların mortalite oranı (%38.1) diğer hastalara göre istatistiksel açıdan anlamlı olarak yüksekti (p < 0.001). Amerikan Anesteziyologlar Derneği (ASA) fiziksel durum sınıflandırması ortalaması 3E idi. ASA, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE II), Basitleştirilmiş Akut Fizyoloji Skoru (SAPS) puanlamaları ve preoperatif lökosit, ve nötrofil değerleri yüksek olan hastalarda mortalite oranı daha yüksek saptandı (p <0.001).
Sonuç: APACHE II ve SAPS III sınıflamaları ve lökosit, lenfosit gibi preoperatif bakılan laboratuar parametreleri dışında ASA skoru da acil cerrahi gerektiren kritik hasta popülasyonunda mortaliteyi öngörebilir, ayrıca hasta ve aile danışmanlığına rehberlik etmek için kullanılabilir.

Kaynakça

  • Akinbami, F., Askari, R., Steinberg, J., Panizales, M. & Rogers, S. O., Jr (2011). Factors affecting morbidity in emergency general surgery. American Journal of Surgery, 201(4),456–462.
  • Alcock, M. & Chilvers, C.R. (2012). Emergency surgery in the elderly: a retrospective observational study. Anaesthesia and Intensive Care, 40(1), 90–94.
  • Bettelli G. (2011). Preoperative evaluation in geriatric surgery: comorbidity, functional status and pharmacological history. Minerva Anestesiologica, 77(6), 637–646.
  • BouAkl, I., Bou-Khalil, P., Kanazi, G., Ayoub, C. & El-Khatib, M. (2012). Weaning from mechanical ventilation. Current Opinion in Anaesthesiology, 25(1), 42–47.
  • Campion, M. & Scully, G. (2018). Antibiotic use in the intensive care unit: optimization and de-escalation. Journal of intensive care medicine, 33(12), 647–655.
  • Christensen, K., Doblhammer, G., Rau, R. & Vaupel, J.W. (2009). Ageing populations: the challenges ahead. Lancet (London, England), 374(9696), 1196–1208.
  • Dasgupta, M., Rolfson, D. B., Stolee, P., Borrie, M.J. & Speechley, M. (2009). Frailty is associated with postoperative complications in older adults with medical problems. Archives of Gerontology and Geriatrics, 48(1), 78–83.
  • Fariña-Castro, R., Roque-Castellano, C., Artiles-Armas, M. & Marchena-Gómez, J. (2019). Emergency surgery and American Society of Anesthesiologists physical status score are the most influential risk factors of death in nonagenarian surgical patients. Geriatrics & Gerontology International, 19(4), 293–298.
  • Gabriel, R.A., A'Court, A.M., Schmidt, U.H., Dutton, R.P. & Urman, R.D. (2018). Time of day is not associated with increased rates of mortality in emergency surgery: An analysis of 49,196 surgical procedures. Journal of Clinical Anesthesia, 46, 85–90.
  • Gazala, S., Tul, Y., Wagg, A., Widder, S.L., Khadaroo, R.G. & Acute Care and Emergency Surgery (ACES) Group (2013). Quality of life and long-term outcomes of octo- and nonagenarians following acute care surgery: a cross sectional study. World Journal of Emergency Surgery: WJES, 8(1), 23.
  • Godinjak, A., Iglica, A., Rama, A., Tančica, I., Jusufović, S., Ajanović, A. & Kukuljac, A. (2016). Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit. Acta Medica Academica, 45(2), 97–103.
  • Huda, A.U., Yasir, M., Sheikh, N. & Khan, A.Z. (2022). Can ACS-NSQIP score be used to predict postoperative mortality in Saudi population? Saudi Journal of Anaesthesia, 16(2), 172–175.
  • Inouye S.K. (2000). Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies. Annals of Medicine, 32(4), 257–263.
  • Jayanama, K., Theou, O., Blodgett, J.M., Cahill, L. & Rockwood, K. (2018). Frailty, nutrition-related parameters, and mortality across the adult age spectrum. BMC Medicine, 16(1), 188.
  • Kojima, G., Iliffe, S. & Walters, K. (2018). Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age and Ageing, 47(2), 193–200.
  • Lin, H.S., Watts, J.N., Peel, N.M. & Hubbard, R.E. (2016). Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatrics, 16(1), 157.
  • McIsaac, D.I., Moloo, H., Bryson, G.L. & van Walraven, C. (2017). The association of frailty with outcomes and resource use after emergency General surgery: a population-based cohort study.Anesthesia and Analgesia, 124(5), 1653–1661.
  • Merani, S., Payne, J., Padwal, R.S., Hudson, D., Widder, S.L. & Khadaroo, R.G. (2014). Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery. World Journal of Emergency Surgery: WJES,9, 43.
  • Minne, L., Ludikhuize, J., de Jonge, E., de Rooij, S. & Abu-Hanna, A. (2011). Prognostic models for predicting mortality in elderly ICU patients: a systematic review. Intensive Care Medicine, 37(8), 1258–1268.
  • Nithiuthai, J., Siriussawakul, A., Junkai, R., Horugsa, N., Jarungjitaree, S. & Triyasunant, N. (2021). Do ARISCAT scores help to predict the incidence of postoperative pulmonary complications in elderly patients after upper abdominal surgery? An observational study at a single university hospital. Perioperative Medicine (London, England), 10(1), 43.
  • Paul, E., Bailey, M. & Pilcher, D. (2013). Risk prediction of hospital mortality for adult patients admitted to Australian and New Zealand intensive care units: development and validation of the Australian and New Zealand Risk of Death model. Journal of Critical Care, 28(6), 935–941.
  • Population Division US Census Bureau. Projections of the Population by Age and Sex for the United States: 2010 to 2050 (NP2008-T12) 2008. Available at:https://www.census.gov/data/tables/2008/demo/popproj/2008-summary-tables.html. Access Date: 19.06.2022.
  • Portuondo, J.I., Shah, S.R., Singh, H. & Massarweh, N.N. (2019). Failure to rescue as a surgical quality indicator: current concepts and future directions for improving surgical outcomes. Anesthesiology, 131(2), 426–437.
  • Rosenberg, M. W. & Moore, E.G. (1997). The health of Canada's elderly population: current status and future implications. CMAJ: Canadian Medical Association Journal = Journal de L'Association Medicale Canadienne, 157(8), 1025–1032.
  • Rosero, E.B., Romito, B.T. & Joshi, G.P. (2021). Failure to rescue: A quality indicator for postoperative care. Best Practice & Research. Clinical Anaesthesiology, 35(4), 575–589.
  • Turrentine, F.E., Wang, H., Simpson, V.B. & Jones, R. S. (2006). Surgical risk factors, morbidity, and mortality in elderly patients. Journal of the American College of Surgeons, 203(6), 865–877.
  • United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019: Highlights. ST/ESA/SER.A/423. Available at: https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf. Access Date: 19.06.2022.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Birinci Basamak Sağlık Hizmetleri
Bölüm Araştırma Makaleleri
Yazarlar

Gökhan Sertçakacılar 0000-0002-4574-0147

Güneş Özlem Yıldız 0000-0002-4557-9517

İpek Bostancı 0000-0001-9766-453X

Zafer Cukurova 0000-0002-8893-3977

Yayımlanma Tarihi 23 Aralık 2022
Gönderilme Tarihi 21 Haziran 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 1 Sayı: 3

Kaynak Göster

APA Sertçakacılar, G., Yıldız, G. Ö., Bostancı, İ., Cukurova, Z. (2022). Predictors of mortality and complications in patients treated in intensive care following non-cardiac emergency surgery. Journal of Medical Topics and Updates, 1(3), 105-112.