Decision-making for Postoperative Care in Geriatric Patients Undergoing Minor Surgeries using Mini Mental State Examination, Barthel Index of Activities of Daily Living and CSHA-Clinical Frailty Scale

Abstract

Purpose: Prediction of postoperative outcome following major surgery in elderly patients requires a decision-making process based on data on cognitive function, functional status and frailty. In this study, we aimed to evaluate the predictive value of these parameters for minor surgeries. Materials and Methods: Patients aged ≥65 years with American society of Anesthesiologists (ASA) score 1-3 scheduled for elective minor surgery were included in the study. Mini Mental Test (MMSE), Barthel Index (BI) and Clinical Frailty Scale (CSHA-CFS) were used to assess cognitive function, functional status and frailty at hospitalization. The associations of these parameters with postoperative hospitalization status were evaluated. Results: Ninety-nine patients were included in the study. MMSE scores, Barthel Indices and CSHA-CFS scores were similar in all groups. The number of inpatients was higher in patients with MMSE<24 alone (n=49 (66.2%)) or MMSE<24 and ASA>2 (n=19 (82.6%)). The number of inpatients was higher in patients with a frailty score of CSHA-CFS≥4 (n=33 (75%)) (p=0.025) or ASA >2 (n=20 (83.3%)) (p=0.023). Patients with ASA>2 were more likely to have >1 day length of stay (LOS) (p=0.036) and intensive care unit (PACU) stay (p=0.042), independent of the frailty score. Readmission within 30 days was not correlated with the parameters. Conclusion: ASA>2 and MMSE<24 correlate with inpatient status and are independent predictive factors for length of stay of more than one day in the elderly after minor surgery. CSHA-CFS ≥4 was also independently associated with hospitalization.

Keywords

• barthel index
• frailty
• length of stay
• minor surgical procedures
• MMSE

Minör Cerrahi Geçiren Geriatrik Hastalarda Mini Mental Durum Muayenesi, Barthel Günlük Yaşam Aktiviteleri İndeksi ve CSHA-Klinik Kırılganlık Ölçeği ile Postoperatif Bakım Kararı Verme

Abstract

Amaç: Yaşlı hastalardaki majör cerrahileri takiben postoperatif sonucun tahmini, bilişsel işlev, işlevsel durum ve kırılganlıkla ilgili verilere dayanan bir karar verme süreci gerektirir. Bu çalışmada söz konusu parametrelerin minör cerrahiler için prediktif değerlerini değerlendirmeyi amaçladık. Araçlar ve Yöntem: Elektif minör cerrahi planlanan American society of Anesthesiologists (ASA) skoru 1-3'e sahip ≥65 yaş hastalar çalışmaya alındı. Hastaneye yatıştaki kognitif fonksiyonu, fonksiyonel durumu ve kırılganlığı değerlendirmek için Mini Mental Test (MMSE), Barthel İndeksi (BI) ve Clinical Frailty Scale (CSHA-CFS) kullanıldı. Bu parametrelerin ameliyat sonrası yatış durumu ile ilişkileri değerlendirildi. Bulgular: Doksan dokuz hasta çalışmaya dahil edildi. MMSE puanları, Barthel Indeksleri ve CSHA-CFS puanları tüm gruplarda benzerdi. Yatan hasta sayısı tek başına MMSE <24 (n=49 (%66.2)) veya MMSE<24 ve ASA>2 (n=19 (%82.6)) olan hastalarda daha fazlaydı. Kırılganlık skoru CSHA-CFS≥4 (n=33 (%75)) (p=0.025) veya ASA >2 (n=20 (%83.3)) (p=0.023) olan hastalarda yatan hasta sayısı daha yüksekti. ASA>2 olan hastalarda kırılganlık skorundan bağımsız olarak >1 gün yatış süresi (LOS) (p=0,036) ve yoğun bakım (PACU) kalış olasılığı (p=0.042) daha yüksekti. 30 gün içinde yeniden kabul ile parametreler arasında korelasyon yoktu. Sonuç: ASA>2 ve MMSE<24 yatarak tedavi durumu ile korelasyon göstermektedir ve minör cerrahilerden sonra yaşlılarda kalış süresinin bir günden fazla olması için bağımsız bir prediktif faktördür. CSHA-CFS ≥4 olması ayrıca bağımsız olarak yatış verilmesi ile ilişkili bulunmuştur.

Keywords

• barthel indeksi
• kırılganlık
• minor cerrahi girişimler
• MMSE
• yatış süresi

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