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Ortopedik cerrahi sonrası erken dönem hastane mortalitesi ve etki eden faktörler

Year 2019, Volume: 44 Issue: 3, 977 - 983, 30.09.2019
https://doi.org/10.17826/cumj.471849

Abstract

Amaç: Çalışmamızın amacı erken dönem en yüksek hastane mortalitesine sahip ortopedik cerrahi prosedürü ve mortalite üzerine etki eden faktörleri saptamaktır.

Gereç ve Yöntem: 1998-2016 yılları arasında ortopedik cerrahi geçirmiş 19.727 hasta çalışmaya dahil edildi. Bu hastalardan ameliyat sonrası dönemde ilk 30 gün içinde hastanede ölen 370 hastanın dosyası tarandı. Genel mortalite ortalamasının üzerinde olan hastalara uygulanan cerrahiler, yaş, cinsiyet, malignite varlığı, koroner arter hastalığı öyküsü, diyabet, hemodiyaliz, geçirilmiş serebrovasküler olay öyküsü, hipertansiyon varlığı ASA değerlendirme skoru ve anestezi şekilleri kaydedildi.

Bulgular: Ortopedik cerrahi geçiren 19.727 hastadan 237 (%1.23) hastanın cerrahi sonrası erken dönem hastanede öldüğü saptadık. Mortalitesi en yüksek 4 cerrahi prosedür; ampütasyon cerrahisinde % 6.35, femur boyun kırığında %5.2, intertrokanterik kalça kırığında %4.2, vertebra cerrahisinde %2.6 olarak bulundu. Mortalite üzerine etki eden faktörler  ampütasyon cerrahisi yapılan hastalarda yaş, erkek cinsiyet, hipertansiyon, ameliyatın genel anestezi altında yapılması, ve hastanın hemodiyalize giriyor olması, Yüksek ASA skorunun tüm cerrahi türlerinde istatistiksel olarak anlamlı bulundu.

Sonuç: İleri yaş ve buna bağlı ek kronik hastalıklar, ortopedik cerrahi gerektiren hastaların mortalitesini etkilemektedir. Ampütasyon cerrahisi, ve bu cerrahiye sebep olan nedenlerden dolayı, mortalitesi en yüksek ortopedik cerrahidir. 


References

  • 1. Kadono Y, Yasunaga H, Horiguchi H, et al. Statistics for orthopedic surgery 2006-2007: data from the Japanese Diagnosis Procedure Combination database. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2010;15(2):162-70 doi: 10.1007/s00776-009-1448-2
  • 2. Menendez ME, Neuhaus V, Ring D. Inpatient mortality after orthopaedic surgery. Int Orthop 2015;39(7):1307-14 doi: 10.1007/s00264-015-2702-1
  • 3. Bhattacharyya T, Iorio R, Healy WL. Rate of and risk factors for acute inpatient mortality after orthopaedic surgery. The Journal of bone and joint surgery. American volume 2002;84-A(4):562-72
  • 4. Sheehan KJ, Sobolev B, Guy P, et al. In-hospital mortality after hip fracture by treatment setting. CMAJ 2016;188(17-18):1219-25 doi: 10.1503/cmaj.160522
  • 5. Shohat N, Foltz C, Restrepo C, Goswami K, Tan T, Parvizi J. Increased postoperative glucose variability is associated with adverse outcomes following orthopaedic surgery. The bone & joint journal 2018;100-B(8):1125-32 doi: 10.1302/0301-620X.100B8.BJJ-2017-1283.R1
  • 6. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet 2013;382(9889):339-52 doi: 10.1016/S0140-6736(13)60595-4
  • 7. Alavi A, Sibbald RG, Mayer D, et al. Diabetic foot ulcers: Part I. Pathophysiology and prevention. J Am Acad Dermatol 2014;70(1):1 e1-18; quiz 19-20 doi: 10.1016/j.jaad.2013.06.055
  • 8. Nasri H, Rafieian-Kopaei M. Diabetes mellitus and renal failure: Prevention and management. J Res Med Sci 2015;20(11):1112-20 doi: 10.4103/1735-1995.172845
  • 9. Moulik PK, Mtonga R, Gill GV. Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes care 2003;26(2):491-4
  • 10. Chow SK, Qin JH, Wong RM, et al. One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry. Journal of orthopaedic surgery and research 2018;13(1):235 doi: 10.1186/s13018-018-0936-5
  • 11. Sennerby U, Melhus H, Gedeborg R, et al. Cardiovascular diseases and risk of hip fracture. JAMA 2009;302(15):1666-73 doi: 10.1001/jama.2009.1463
  • 12. von Friesendorff M, McGuigan FE, Wizert A, et al. Hip fracture, mortality risk, and cause of death over two decades. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2016;27(10):2945-53 doi: 10.1007/s00198-016-3616-5
  • 13. Mundell BF, Luetmer MT, Kremers HM, Visscher S, Hoppe KM, Kaufman KR. The risk of major cardiovascular events for adults with transfemoral amputation. J Neuroeng Rehabil 2018;15(Suppl 1):58 doi: 10.1186/s12984-018-0400-0
  • 14. Zuo D, Jin C, Shan M, Zhou L, Li Y. A comparison of general versus regional anesthesia for hip fracture surgery: a meta-analysis. Int J Clin Exp Med 2015;8(11):20295-301
  • 15. Rashid RH, Shah AA, Shakoor A, Noordin S. Hip fracture surgery: does type of anesthesia matter? BioMed research international 2013;2013:252356 doi: 10.1155/2013/252356
  • 16. Rycroft CE, Heyes A, Lanza L, Becker K. Epidemiology of chronic obstructive pulmonary disease: a literature review. Int J Chron Obstruct Pulmon Dis 2012;7:457-94 doi: 10.2147/COPD.S32330
  • 17. Gu A, Wei C, Maybee CM, Sobrio SA, Abdel MP, Sculco PK. The Impact of Chronic Obstructive Pulmonary Disease on Postoperative Outcomes in Patients Undergoing Revision Total Knee Arthroplasty. The Journal of arthroplasty 2018;33(9):2956-60 doi: 10.1016/j.arth.2018.05.009
  • 18. Christie J, Burnett R, Potts HR, Pell AC. Echocardiography of transatrial embolism during cemented and uncemented hemiarthroplasty of the hip. The Journal of bone and joint surgery. British volume 1994;76(3):409-12
  • 19. Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth 2009;102(1):12-22 doi: 10.1093/bja/aen328
  • 20. Keats AS. The Estimate of Anesthetic Risk in Medical Evaluations. Am J Cardiol 1963;12:330-3
  • 21. Parenti N, Reggiani ML, Percudani D, Melotti RM. Reliability of American Society of Anesthesiologists physical status classification. Indian J Anaesth 2016;60(3):208-14 doi: 10.4103/0019-5049.177875

Early period hospital mortality after orthopedic surgery and affecting factors

Year 2019, Volume: 44 Issue: 3, 977 - 983, 30.09.2019
https://doi.org/10.17826/cumj.471849

Abstract

Purpose: The aim of this study was to determine the factors affecting the mortality and the orthopedic surgical procedure with the highest hospital mortality.

Materials and Methods: 19,727 patients who had undergone orthopedic surgery between 1998-2016 were included in the study. Of these patients, 370 patients who died in the hospital within the first 30 days were screened. Surgical procedures for patients with a higher than average mortality, age, gender, presence of malignancy, history of coronary artery disease, diabetes, hemodialysis, cerebrovascular event history, presence of hypertension, The American Society of Anesthesiologists (ASA) assessment score and anesthesia patterns were recorded.

Results: Of 19,727 patients undergoing orthopedic surgery, 237 (1.23%) patients died early in the hospital after surgery. 4 surgical procedures with the highest mortality rate; It was found 6.35% in amputation surgery, 5.2% in femoral neck fracture, 4.2% in intertrochanteric hip fracture and 2.6% in vertabra surgery. Factors affecting the mortality were age, male gender, hypertension, having general anesthesia, having amputation surgery and having  hemodialysis. ASA score was statistically significant in mortality all surgical types.

Conclusion: Amputation is the most deadly orthopedic surgery in the early period. comorbid chronic diseases are the most important factors affecting mortality in orthopedic surgery.


References

  • 1. Kadono Y, Yasunaga H, Horiguchi H, et al. Statistics for orthopedic surgery 2006-2007: data from the Japanese Diagnosis Procedure Combination database. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2010;15(2):162-70 doi: 10.1007/s00776-009-1448-2
  • 2. Menendez ME, Neuhaus V, Ring D. Inpatient mortality after orthopaedic surgery. Int Orthop 2015;39(7):1307-14 doi: 10.1007/s00264-015-2702-1
  • 3. Bhattacharyya T, Iorio R, Healy WL. Rate of and risk factors for acute inpatient mortality after orthopaedic surgery. The Journal of bone and joint surgery. American volume 2002;84-A(4):562-72
  • 4. Sheehan KJ, Sobolev B, Guy P, et al. In-hospital mortality after hip fracture by treatment setting. CMAJ 2016;188(17-18):1219-25 doi: 10.1503/cmaj.160522
  • 5. Shohat N, Foltz C, Restrepo C, Goswami K, Tan T, Parvizi J. Increased postoperative glucose variability is associated with adverse outcomes following orthopaedic surgery. The bone & joint journal 2018;100-B(8):1125-32 doi: 10.1302/0301-620X.100B8.BJJ-2017-1283.R1
  • 6. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet 2013;382(9889):339-52 doi: 10.1016/S0140-6736(13)60595-4
  • 7. Alavi A, Sibbald RG, Mayer D, et al. Diabetic foot ulcers: Part I. Pathophysiology and prevention. J Am Acad Dermatol 2014;70(1):1 e1-18; quiz 19-20 doi: 10.1016/j.jaad.2013.06.055
  • 8. Nasri H, Rafieian-Kopaei M. Diabetes mellitus and renal failure: Prevention and management. J Res Med Sci 2015;20(11):1112-20 doi: 10.4103/1735-1995.172845
  • 9. Moulik PK, Mtonga R, Gill GV. Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes care 2003;26(2):491-4
  • 10. Chow SK, Qin JH, Wong RM, et al. One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry. Journal of orthopaedic surgery and research 2018;13(1):235 doi: 10.1186/s13018-018-0936-5
  • 11. Sennerby U, Melhus H, Gedeborg R, et al. Cardiovascular diseases and risk of hip fracture. JAMA 2009;302(15):1666-73 doi: 10.1001/jama.2009.1463
  • 12. von Friesendorff M, McGuigan FE, Wizert A, et al. Hip fracture, mortality risk, and cause of death over two decades. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2016;27(10):2945-53 doi: 10.1007/s00198-016-3616-5
  • 13. Mundell BF, Luetmer MT, Kremers HM, Visscher S, Hoppe KM, Kaufman KR. The risk of major cardiovascular events for adults with transfemoral amputation. J Neuroeng Rehabil 2018;15(Suppl 1):58 doi: 10.1186/s12984-018-0400-0
  • 14. Zuo D, Jin C, Shan M, Zhou L, Li Y. A comparison of general versus regional anesthesia for hip fracture surgery: a meta-analysis. Int J Clin Exp Med 2015;8(11):20295-301
  • 15. Rashid RH, Shah AA, Shakoor A, Noordin S. Hip fracture surgery: does type of anesthesia matter? BioMed research international 2013;2013:252356 doi: 10.1155/2013/252356
  • 16. Rycroft CE, Heyes A, Lanza L, Becker K. Epidemiology of chronic obstructive pulmonary disease: a literature review. Int J Chron Obstruct Pulmon Dis 2012;7:457-94 doi: 10.2147/COPD.S32330
  • 17. Gu A, Wei C, Maybee CM, Sobrio SA, Abdel MP, Sculco PK. The Impact of Chronic Obstructive Pulmonary Disease on Postoperative Outcomes in Patients Undergoing Revision Total Knee Arthroplasty. The Journal of arthroplasty 2018;33(9):2956-60 doi: 10.1016/j.arth.2018.05.009
  • 18. Christie J, Burnett R, Potts HR, Pell AC. Echocardiography of transatrial embolism during cemented and uncemented hemiarthroplasty of the hip. The Journal of bone and joint surgery. British volume 1994;76(3):409-12
  • 19. Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth 2009;102(1):12-22 doi: 10.1093/bja/aen328
  • 20. Keats AS. The Estimate of Anesthetic Risk in Medical Evaluations. Am J Cardiol 1963;12:330-3
  • 21. Parenti N, Reggiani ML, Percudani D, Melotti RM. Reliability of American Society of Anesthesiologists physical status classification. Indian J Anaesth 2016;60(3):208-14 doi: 10.4103/0019-5049.177875
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research
Authors

Salih Beyaz 0000-0002-5788-5116

Publication Date September 30, 2019
Acceptance Date February 15, 2019
Published in Issue Year 2019 Volume: 44 Issue: 3

Cite

MLA Beyaz, Salih. “Ortopedik Cerrahi Sonrası Erken dönem Hastane Mortalitesi Ve Etki Eden faktörler”. Cukurova Medical Journal, vol. 44, no. 3, 2019, pp. 977-83, doi:10.17826/cumj.471849.