MAJOR ABDOMİNOPELVİK CERRAHİ SONRASI YOĞUN BAKIM ÜNİTESİNE KABUL EDİLEN HASTALARIN ASA SINIFLAMASI VE POSTOPERATİF KOMPLİKASYONLAR AÇISINDAN RETROSPEKTİF DEĞERLENDİRİLMESİ

Abstract

Amaç: Amerikan Anesteziyoloji Derneği Fiziksel Durum Skoru (ASA) postoperatif hastalarda yoğun bakım ünitesi (YBÜ) takibi endikasyonu koymada yararlı bir araçtır. Öte yandan hekimlerin yanlış skorlamaları yatakların gereksiz meşguliyetine ve artan hastane masraflarına yol açabilir. Bu çalışmada major abdominopelvik cerrahi sonrası komplikasyonların preoperatif ASA skorları ile ilişkisi incelendi. Gereç ve Yöntem: Kasım 2016 ve Şubat 2019 tarihleri arasında üçüncü düzey YBÜ’de postoperatif takibi gerçekleştirilen semi-acil ve acil major abdominopelvik cerrahi hastaları değerlendirildi. Morbidite ve mortalite ile ilişkili veriler; akut postoperatif komplikasyonlar (hipotansiyon, kanama, desaturasyon, uzamış entübasyon, başarısız “weaning”, akut böbrek hasarı, kardiyak arrest, eksitus), YBÜ takip süresi, tekrarlayan YBÜ yatışları, genel mortalite insidansı ve 30-gün mortalite insidansı şeklinde analiz edildi. Bulgular: 122 gastrointestinal, jinekolojik ve ürolojik cerrahi hastası retrospektif olarak analiz edildi. Hastalar; ASA II (n=59), ASA III (N=45) ve ASA IV (n=18) olarak gruplandırıldı. Genel komplikasyon oranlarında gruplar arasında anlamlı farklılık yoktu. Eksitus oranı ASA IV grubunda anlamlı yüksekti (p=0,022). Aynı şekilde YBÜ yatış süresi, YBÜ’ne tekrarlayan yatış ve 30-gün mortalite yine ASA IV grubunda anlamlı yüksekti (p<0,05). Hasta gruplandırması semi-acil (n=87) ve acil (n=35) olarak yapıldığında uzamış entübasyon, desaturasyon ve başarısız “weaning” gibi solunumsal komplikasyonlar, ayrıca YBÜ yatış süresi ve 30-gün mortalite oranı acil vakalarda daha fazlaydı (p<0,001). Yarı-acil onkolojik cerrahilerde YBÜ’de eksitus gözlenmedi. Sonuç: ASA IV major abdominopelvik cerrahi hastalarının postoperatif YBÜ takibinde solunumsal komplikasyonlar açısından diğer gruplar ile fark gözlenmedi. Buna karşın acil vakalarda hem solunumsal komplikasyon hem de mortalite oranları anlamlı yüksekti. Yarı-acil onkolojik cerrahilerde komplikasyonların az olması preoperatif optimum cerrahi hazırlık sağlanması ile açıklanabilir.

Keywords

• Yoğun bakım
• major abdominal cerrahi
• major pelvik cerrahi
• onkolojik cerrahi
• postoperatif komplikasyonlar
• mortalite

RETROSPECTIVE EVALUATION OF ASA CLASSIFICATION’S PREDICTIVE ABILITY OF POSTOPERATIVE COMPLICATIONS IN PATIENTS ADMITTED TO INTENSIVE CARE UNIT AFTER MAJOR ABDOMINOPELVIC SURGERY

Abstract

Objective: The American Society of Anaesthesiologists Physical Status Score (ASA) is a useful tool for indicating the need for intensive care unit (ICU) monitoring in postoperative patients. However, physician misclassification can lead to unnecessary bed occupancy and increased costs. This study examined the relationship between preoperative ASA scores and complications following major abdominopelvic surgery. Materials and Methods: Patients who underwent postoperative monitoring in a tertiary ICU between November 2016 and February 2019 for semi-urgent and urgent major abdominopelvic surgery were evaluated. Data related to morbidity and mortality were analysed, including acute postoperative complications (hypotension, bleeding, desaturation, prolonged intubation, failed weaning, acute kidney injury, cardiac arrest, exitus), length of ICU stay, recurrent ICU admissions, overall mortality incidence, and 30-day mortality incidence. Results: A total of 122 patients who underwent gastrointestinal, gynaecological, and urological surgeries were retrospectively analysed. Patients were grouped as ASA II (N=59), ASA III (N=45), and ASA IV (n=18). Overall complication rates among the groups did not differ. The exitus rate was significantly higher in ASA IV (p=0.022). Similarly, the duration of ICU stay, recurrent ICU admissions, and 30-day mortality were significantly higher in ASA IV (p<0.05). When patients were grouped as semi-urgent (n=87) and urgent (n=35), respiratory complications such as prolonged intubation, desaturation, and failed weaning, as well as ICU stay and 30-day mortality rates were higher in urgent cases (p<0.001). No exitus was observed in the semi-urgent oncological surgeries in the ICU. Conclusion: No difference in respiratory complications was observed in the postoperative ICU follow-up of ASA IV major abdominal surgery patients compared with other ASA groups. However, both respiratory complications and mortality rates were significantly higher in the urgent cases. The low rate of complications in semi-urgent oncological surgeries can be explained by the optimal preoperative surgical preparation.

Keywords

• Intensive care
• major abdominal surgery
• major pelvic surgery
• oncologic surgery
• postoperative complications
• mortality

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