Risk Factors of Geriatric Patients Admitted to Intensive Care After Hip Fracture Surgery in the COVID-19 Pandemic Period

Abstract

Objective: Bed allocation in the intensive care unit (ICU) is an expensive and difficult task due to limited resources. In the Coronavirus disease 2019 (COVID-19) pandemic, we aimed to determine the preoperative risk factors associated with the ICU need of geriatric patients who underwent hip surgery.

Materials and Methods: Geriatric patients over 65 years of age who underwent elective hip surgery were evaluated in this retrospective cohort study. The demographic characteristics of the patients, American Society of Anesthesiologists physical condition (ASA) class, co-existing diseases, preoperative characteristics (waiting time for surgery, history of having COVID-19 disease in 3 months, laboratory findings), and whether they entered the postoperative ICU were examined.

Results: One hundred-twenty patients were included in the study. There were 39 (32.5%) patients who needed ICU. In univariate logistic regression analysis; advanced age, increased ASA class, preoperative waiting time for surgery, hypertension, coronary artery disease (CAD)/heart failure (HF), respiratory disease, thyroid disease, cerebrovascular disease, low hemoglobin, and hematocrit values were found to be important risk factors [(OR:1.05;p=0.022), (OR:9.10;p=0.000), (OR:1.23;p=0.024), (OR:3.78;p=0.003), (OR:17.95;p=0.000), (OR:6.86;p=0.000), (OR:7.80;p=0.003), (OR:6.04;p=0.000), (OR:0.63;p=0.004), (OR:0.89;p=0.040), respectively]. In multivariate logistic regression analysis; increased ASA class, hypertension, CAD/HF, respiratory disease, and hypoalbuminemia variables were found to be independent risk factors for patient admission to ICU [(OR:8.96;p=0.006), (OR:11.65;p=0.003), (OR:32.40;p=0.000), (OR:21.85;p=0.000), (OR:50.16;p=0.009), respectively]. Only the preoperative waiting time of the patients who had COVID-19 was prolonged (p=0.009).

Conclusion: In geriatric patients undergoing hip surgery, increased ASA class, hypertension, CAD/HF diseases, respiratory disease, and hypoalbuminemia have been determined as risk factors associated with postoperative admission to the ICU.

Keywords

• elderly
• geriatrics
• hip fractures
• intensive care unit
• risk factors

COVID-19 Pandemi Döneminde Kalça Kırığı Ameliyatı Sonrasında Yoğun Bakıma Alınan Geriatrik Hastaların Risk Faktörleri

Abstract

Amaç: Yoğun bakım ünitesi (YBÜ)’nde yatak tahsisi, sınırlı kaynaklar nedeniyle pahalı ve zor bir iştir. Koronavirüs hastalığı 2019 (COVID-19) pandemisinde, kalça cerrahisi geçiren geriatrik hastaların YBÜ’ye gereksinimi ile ilişkili preoperatif risk faktörlerini belirlemeyi amaçladık.

Araçlar ve Yöntem: Bu retrospektif kohort çalışmada elektif kalça cerrahisi geçiren 65 yaş üzeri geriatrik hastalar değerlendirildi. Hastaların demografik özellikleri, Amerikan Anestezistler Derneği fiziksel durum (ASA) sınıfı, eşlik eden hastalıkları, preoperatif özellikleri (ameliyatı bekleme süresi, 3 ay içinde COVID-19 hastalık geçirme öyküsü, laboratuvar bulguları) ve postoperatif YBÜ’ye girip girmedikleri incelendi.

Bulgular: Çalışmaya 120 hasta dahil edildi. YBÜ’ye ihtiyacı olan 39 (%32.5) hasta vardı. Tek değişkenli lojistik regresyon anali-zinde; ileri yaş, ASA sınıfının artması, preoperatif ameliyat bekleme süresi, hipertansiyon, koroner arter hastalığı (KAH)/kalp yet-mezliği (KY), respiratuar hastalık, tiroid hastalığı, serebrovasküler hastalık, düşük hemoglobin ve hematokrit değerlerinin önemli risk faktörleri olduğu tespit edilmiştir[(OR:1.05;p=0.022),(OR:9.10;p=0.000), (OR:1.23;p=0.024), (OR:3.78;p=0.003), (OR:17.95;p=0.000), (OR:6.86;p=0.000), (OR:7.80;p=0.003), (OR:6.04;p=0.000), (OR:0.63;p=0.004), (OR:0.89;p=0.040), sırasıyla ]. Çok değişkenli lojistik regresyon analizinde; ASA sınıfının artması, hipertansiyon, KAH/KY, respiratuar hastalık ve hipoalbüminemi değişkenleri YBÜ’ye hasta kabülünde etkili bağımsız risk faktörleri olarak saptanmıştır [(OR:8.96;p=0.006), (OR:11.65;p=0.003), (OR:32.40;p=0.000), (OR:21.85;p=0.000), (OR:50.16;p=0.009), sırasıyla ]. COVID-19 geçiren hastaların sadece preoperatif ameliyat bekleme süresi uzamıştır (p=0.009).

Sonuç: Kalça cerrahisi geçiren geriatrik hastalarda ASA sınıfının artması, hipertansiyon, KAH/KY hastalıkları, respiratuar hastalık ve hipoalbüminemi postoperatif YBÜ’ye kabul edilmesi ile ilişkili risk faktörleri olarak belirlenmiştir.

Keywords

• geriatri
• kalça kırıkları
• risk faktörleri
• yaşlı
• yoğun bakım ünitesi

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