Önemli komorbid durumları olan yaşlı hastalarda epidural anestezi altında kolesistektomi

Year 2022, Volume: 47 Issue: 2, 548 - 554, 30.06.2022

Mehmet Arif Usta , Serkan Tayar , Murat Emre Reis , Mehmet Uluşahin , Etem Alhan

https://doi.org/10.17826/cumj.1000941

Abstract

Amaç: Bu çalışmanın amacı, önemli komorbid durumları olan yaşlı hastalarda epidural anestezi altında açık kolesistektomi ile safra taşı hastalığının cerrahi tedavisini değerlendirmektir.
Gereç ve Yöntem: 1 Ocak 2009 ile 31 Aralık 2019 tarihleri arasında safra kesesi taşı cerrahi tedavisi için epidural anestezi altında açık kolesitektomi uygulanan, önemli komorbid durumları olan 65 yaş üstü 80 ardışık yaşlı hastayı geriye dönük olarak inceledik. Hastalar tek bir cerrah tarafından ameliyat edildi.
Bulgular: Ortalama yaş 77 ± 16 yıl olarak bulundu. Hastaların 50'si (% 62.5) kadındı. Kırk yedi hastanın (% 58.75) Amerikan Anestezi Uzmanları Derneği Fiziksel Skoru >3 idi. Eşlik eden en sık komorbiditeler kardiyovasküler sistemle ilgili idi (46 hasta, % 57.5). Cerrahi endikasyonlar 37 hastada (% 46.25) akut kolesistit (AK), 32 hastada (% 40) kronik kolesistit idi. Ortalama operasyon süresi 55 ± 22 dakika idi. Ortalama hastanede kalış süresi 12 ± 5 gündü. Toplam komplikasyon oranı % 38.75 olup, en sık pulmoner komplikasyonlar (% 13.75) ile karşılaşıldı. 30 günlük mortalite 5 hastada (% 6.25) görüldü.
Sonuç: İleri yaşlı, yüksek riskli safra taşı hastalarında epidural anestezi ile açık kolesistektomi önerilebilir. Bu hasta popülasyonu için mortalite ve morbidite oranları kabul edilebilir düzeydedir.

Keywords

Safra taşı hastalığı, yüksek riskli hastalar, komorbid durumlar, epidural anestezi, açık kolesistektomi

Supporting Institution

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Project Number

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Thanks

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Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions

Abstract

Purpose: The aim of this study was to evaluate the surgical treatment of gallstone disease with open cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions.
Materials and Methods: We retrospectively analyzed 80 consecutive elderly patients over 65 years of age with significant comorbid conditions who underwent open cholecytectomy under epidural anesthesia for the surgical treatment of gallstone disease between January 1, 2009 and December 31, 2019, all performed by one surgeon.
Results: Mean age was found 77 ± 16 years. Fifty of the patients (62.5%) were females. Forty-seven patients (58.75%) showed an American Society of Anesthesiologist Physical Status (ASA, PS) of 3. The most frequently associated comorbidity involved the cardiovascular system (46 patients, 57.5%). Surgical indications were acute cholecystitis (AC) in 37 patients (46.25%) and chronic cholecystitis in 32 patients (40%). Mean operation time was 55 ± 22 minutes. Hospital stay was mean 12 ± 5 days. Total complication rate was 38.75%, and pulmonary complication was the most frequently encountered (13.75%). 30-day mortality was seen in 5 patients (6.25%).
Conclusion: In older, high-risk gallstone patients, an open cholecystectomy with epidural anesthesia may be recommended. For this patient population, the mortality and morbidity rates are acceptable.

Keywords

Gallstone disease, high risk patients, comorbid conditions, epidural anesthesia, open cholecystectomy

Project Number

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