Açık kalp cerrahisi geçiren 80 yaş üstü hastalarda Geriatrik Nutrisyonel Risk İndeksinin mortalite oranını tahmin edebilme gücü

Year 2023, Volume: 48 Issue: 4, 1374 - 1379, 29.12.2023

Özgür Çoban , Hacı Ali Uçak

https://doi.org/10.17826/cumj.1354167

Abstract

Amaç: Bu retrospektif çalışmada açık kalp cerrahisi geçiren 80 yaş üstü hastaların operasyon öncesi albümin değeri kullanılarak hesaplanan geriatrik nutrisyonel risk indeksinin, ameliyat sonrası mortalite oranını tahmin edebilme gücü ortaya konulmaya çalışıldı.
Gereç ve Yöntem: Temmuz 2019 – Eylül 2022 tarihleri arasında koroner bypass ve kalp kapağı değişimi nedeniyle açık elektif kalp cerrahisi uygulanan toplam 22 hasta (13 erkek, 9 kadın; ortalama yaş: 82,1±2,4 yıl; dağılım, 80-88 yıl) geriatrik nutrisyonel risk indeksi ile retrospektif olarak incelendi. Bu indekse göre iki grup oluşturuldu. 98 ve altındaki değerler riskli, 99 ve üstündeki değerler risksiz grup olarak belirlendi. Riskli grupta 6 hasta vardı. Diğer 16 hasta risksiz grupta bulunuyordu. Tüm hasta grubu cerrahi işlemler, cinsiyet, yaş, vücut kütle indeksi (kg/m2), atrial fibrilasyon, diyabet, hipertansiyon, sigara içiciliği ve operatif özellikler yönüyle karşılaştırıldı.
Bulgular: Çalışmada geriatrik nutrisyonel risk indeksine göre 6 riskli (%27,3) ve 16 risksiz (%72,7) hasta incelendi ve risk varlığı tespit edilen hastalarda mortalite oranı yüksek (%66,7) bulundu. Risk grubundaki hastalar, risk grubu olmayanlara kıyasla daha düşük vücut kitle indeksi ve albümin değerlerine sahipti (sırasıyla 25,0±1,8 ve 30,1±2,4; 28,1±2,4 ve 36,7±3,1). Ayrıca, ortalama entübasyon değerlerinin yüksek bulunduğu belirlendi (11,2±4,2). Diğer parametreler ile risk varlığı arasında anlamlı bir farklılığa rastlanılmadı.
Sonuç: Açık kalp cerrahisi öncesi değerlendirilen geriatrik nutrisyonel risk indeksi, operasyon sonrası mortalite oranını öngörmede güçlü bir belirleyici olarak kullanılabilir.

Keywords

geriatrik nutrisyonel risk indeksi, oktogenarian, albümin, malnütrisyon

Supporting Institution

Adana Şehir Eğitim ve Araştırma Hastanesi

Predictive power of the Geriatric Nutritional Risk Index for mortality in patients over 80 years of age undergoing open heart surgery

Abstract

Purpose: This retrospective study aimed to determine the predictive power of the geriatric nutritional risk index, calculated using the preoperative albumin value of patients over 80 years old who underwent open-heart surgery, in relation to the postoperative mortality rate.
Materials and Methods: A total of 22 patients (13 males, 9 females; mean age: 82.1±2.4 years; range, 80-88 years) who underwent open elective heart surgery for coronary bypass and heart valve replacement between July 2019 and September 2022 were retrospectively analyzed using the geriatric nutritional risk index. Based on this index, two distinct groups were formed. Values 98 and below were considered risky, and values 99 and above were considered risk-free. There were 6 patients in the risk group. The other 16 patients were in the risk-free group. All patient groups were compared on the basis of surgical procedures, age, gender, body mass index (kg/m2), diabetes, hypertension, atrial fibrillation, smoking, and operative characteristics.
Results: In the study, 6 risky (27.3%) and 16 risk-free (%72.7) patients were examined according to the geriatric nutritional risk index and the mortality rate was found to be high (%66.7) in the risky group. The patients in the risk group had lower body mass index and albumin values (25.0±1.8 and 30.1±2.4) compared with the risk-free group (28.1±2.4 and 36.7±3.1). In addition, the mean extubation values were high (11.2±4.2). No significant difference was found between the other parameters and the presence of risk.
Conclusion: Before undergoing open heart surgery, the Geriatric Nutritional Risk Index can strongly predict postoperative mortality rates.

Keywords

geriatric nutritional risk index, octogenarian, albumin, malnutrition

Ethical Statement

Declaration of conflicting interests The authors declared no conflicts of interest with respect to the authorship and/or publication of this article. Funding The authors received no financial support for the research and/or authorship of this article.

Supporting Institution

Adana City Training and Research Hospital

References

• Volk L, Chao J, Dombrovskiy V, Ikegami H, Russo MJ, Lemaire A et al. Impact of risk factors on in-hospital mortality for octogenarians undergoing cardiac surgery. J Card Surg. 2021;36:2400-6.
• Barili F, Pacini D, Capo A, Rasovic O, Grossi C, Alamanni F et al. Does EuroSCORE II perform better than its original versions? A multicentre validation study. Eur Heart J. 2013;34:22-9.
• Vetta F, Locorotondo G, Vetta G, Mignano M, Bracchitta S. Prognostic impact of frailty in elderly cardiac surgery patients. Monaldi Arch Chest Dis. 2017;87:855.
• Gill TM, Gahbauer EA, Allore HG, Han L. Transitions between frailty states among community-living older persons. Arch Intern Med. 2006;166:418-23.
• Chen Y, Yang X, Zhu Y, Zhang X, Ni J, Li Y. Malnutrition defined by geriatric nutritional risk index predicts outcomes in severe stroke patients: a propensity score-matched analysis. Nutrients. 2022;14:4786.
• Norman K, Haß U, Pirlich M. Malnutrition in older adults-recent advances and remaining challenges. Nutrients. 2021;13:2764.
• Ogawa M, Izawa KP, Satomi-Kobayashi S, Kitamura A, Tsuboi Y, Komaki K et al. Preoperative exercise capacity is associated with the prevalence of postoperative delirium in elective cardiac surgery. Aging Clin Exp Res. 2018;30:27-34.
• Unosawa S, Taoka M, Osaka S, Yuji D, Kitazumi Y, Suzuki K et al. Is malnutrition associated with postoperative complications after cardiac surgery? J Card Surg. 2019;34:908-12.
• Shoji F, Miura N, Matsubara T, Akamine T, Kozuma Y, Haratake N et al. Prognostic significance of immune-nutritional parameters for surgically resected elderly lung cancer patients: a multicenter retrospective study. Interact Cardiovasc Thorac Surg. 2018;26:389-94.
• Shibata K, Yamamoto M, Kano S, Koyama Y, Shimura T, Kagase A et al. Importance of geriatric nutritional risk index assessment in patients undergoing transcatheter aortic valve replacement. Am Heart J. 2018;202:68‐75.
• Marinangeli CPF, Curran J, Barr SI, Slavin J, Puri S, Swaminathan S et al. Enhancing nutrition with pulses: defining a recommended serving size for adults. Nutr Rev. 2017;75:990-1006.
• Arthur SS, Nyide B, Soura AB, Kahn K, Weston M, Sankoh O. Tackling malnutrition: a systematic review of 15-year research evidence from indepth health and demographic surveillance systems. Glob Health Action. 2015;8:282-98.
• Heilmann C, Stahl R, Schneider C, Sukhodolya T, Siepe M, Olschewski M et al. Wound complications after median sternotomy: a single-center study. Interact Cardiovasc Thorac Surg. 2013;16:643-8.