Yaşlı Cerrahi Hastalarının Kırılganlık ve Malnütrisyon Durumlarının ve Risk Faktörlerinin Belirlenmesi

Abstract

Amaç: Cerrahi uygulanan yaşlı hastaların kırılganlık ve malnütrisyon durumlarının ve risk faktörlerinin belirlenmesidir. Yöntem: Araştırma, tanımlayıcı ve kesitsel niteliktedir. Veriler, Hasta Tanılama Formu, FRAİL Ölçeği, Mini Nütrisyonel Değerlendirme (MNA) testi ile toplandı. Veriler, SPSS 23.0 ile değerlendirilmiştir. Bulgular: Araştırmaya dahil edilen 140 hastanın yaş ortalaması 70.03±5.74 olup; %47.9’una ortopedik cerrahi uygulanmıştır. Hastaların %63.6’sı kırılgan ve %10.7’sinde ise malnütrisyon olduğu belirlenmiştir. Ameliyat sonrası yoğun bakımda kalan hastaların ameliyat öncesi beslenme durumları daha kötüydü. Ameliyat öncesi mobilizasyon düzeyi ve ASA skorunun kırılganlık durumu üzerinde; ASA skoru ve beden kitle indeksinin ise beslenme durumu üzerinde anlamlı bir etkiye sahip olduğu belirlenmiştir. Sonuç: Çalışmamızda, cerrahi uygulanan yaşlı yetişkinlerde kırılganlığın yaygın olduğu ve hastaların yarısından fazlasının malnütrisyon riski altında olduğu gösterilmiştir. Bu sonuçlar, ameliyat öncesi hastaların kırılganlık ve beslenme durumlarının değerlendirilmesinin önemli olduğunu vurgulamaktadır. Bu sonuçlar, ameliyat öncesi hastaların kırılganlık ve beslenme durumlarının değerlendirilmesinin önemli olduğunu vurgulamaktadır.

Keywords

• Kırılganlık
• Malnütrisyon
• Beslenme Risk Değerlendirmesi
• Cerrahi Hastalar
• Yaşlı Hastalar

Project Number

Tubitak 2209-A - Research Project Support Programme for Undergraduate Students.

Determination of Frailty and Malnutrition Status and Risk Factors in Elderly Surgical Patients

Abstract

Objective: To determine the frailty and malnutrition status and risk factors of elderly patients undergoing surgery. Material and Methods: The study is descriptive and cross-sectional. Data were collected using the Patient Identification Form, FRAIL Scale, and Mini Nutritional Assessment (MNA) test. Data evaluated by SPSS 23.0. Results: The mean age of the patients was 70.03±5.74; 47.9% underwent orthopedic surgery. 63.6% of the patients were frail and 10.7% were malnourished. It was determined that women, patients with chronic diseases, those using medication, and patients who were mobilized with assistive device or immobile before surgery were more fragile. Patients who stayed in intensive care following surgery had poorer nutritional status before the operation. It was determined that preoperative mobilization level and ASA score had a significant effect on frailty status, while ASA score and body mass index had a significant effect on nutritional status. Conclusion: Our study showed that frailty is common in older adults undergoing surgery and more than half of the patients were at risk of malnutrition. These results emphasize the importance of evaluating the frailty and nutritional status of patients before surgery. These results emphasize the importance of evaluating the frailty and nutritional status of patients before surgery.

Keywords

• Frailty
• Malnutrition
• Nutritional Risk Assessment
• Surgical Patients
• Elderly Patients

Supporting Institution

TUBİTAK

Project Number

Tubitak 2209-A - Research Project Support Programme for Undergraduate Students.

Ethical Statement

Institution: Balikesir University Health Sciences Non-Interventional Research Ethics Committee Date: 13.06.2023 Approval No: 2023/58

Thanks

The authors would like to extend their sincere thanks to anyone who contributed to this study.

References

1. Birkelbach, O., Mörgeli, R., Spies, C., Olbert, M., Weiss, B., Brauner, M., Neuner, B., Francis, R. C. E., Treskatsch, S., & Balzer, F. (2019). Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines - A retrospective observational study. BMC Anesthesiology, 19(1). https://doi.org/10.1186/s12871-019-0880-x
2. Cederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., Baptista, G., Barazzoni, R., Blaauw, R., Coats, A., Crivelli, A., Evans, D. C., Gramlich, L., Fuchs-Tarlovsky, V., Keller, H., Llido, L., Malone, A., Mogensen, K. M., Morley, J. E., … Fuchs, V. (2019). GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clinical Nutrition, 38(1). https://doi.org/10.1016/j.clnu.2018.08.002
3. Committe of Oversight. (2019). ASA Physical Status Classification System Committee. American Society of Anesthesiologist.
4. Cooper, Z., Rogers, S. O., Ngo, L., Guess, J., Schmitt, E., Jones, R. N., Ayres, D. K., Walston, J. D., Gill, T. M., Gleason, L. J., Inouye, S. K., & Marcantonio, E. R. (2016). Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery. Journal of the American Geriatrics Society, 64(12), 2464–2471. https://doi.org/10.1111/jgs.14387
5. Elsamadicy, A. A., Koo, A. B., Reeves, B. C., Craft, S., Sayeed, S., Sherman, J. J. Z., Sarkozy, M., Aurich, L., Fernandez, T., Lo, S. F. L., Shin, J. H., Sciubba, D. M., & Mendel, E. (2023). Prevalence and Influence of Frailty on Hospital Outcomes After Surgical Resection of Spinal Meningiomas. World Neurosurgery, 173. https://doi.org/10.1016/j.wneu.2023.02.019
6. Gastelurrutia, P., Lupón, J., Domingo, M., Ribas, N., Noguero, M., Martinez, C., Cortes, M., & Bayes-Genis, A. (2011). Usefulness of body mass index to characterize nutritional status in patients with heart failure. American Journal of Cardiology, 108(8). https://doi.org/10.1016/j.amjcard.2011.06.020
7. George, D., & Mallery, P. (2010). SPSS for Windows Step by Step: A Simple Guide and Reference Fourth Edition. In Boston: Pearson Education, Inc (10a ed.). Pearson.
8. Geurden, B., Franck, E., Weyler, J., & Ysebaert, D. (2015). The risk of malnutrition in community-living elderly on admission to hospital for major surgery. Acta Chirurgica Belgica, 115(5), 341–347. https://doi.org/10.1080/00015458.2015.11681126

9. Ghebreyesus, T. A. (2021). It takes knowledge to transform the world to be a better place to grow older. Nature Aging, 1(10), 865–865. https://doi.org/10.1038/s43587-021-00120-9
10. Gillis, C., & Wischmeyer, P. E. (2019). Pre-operative nutrition and the elective surgical patient: why, how and what? Anaesthesia, 74, 27–35. https://doi.org/10.1111/anae.14506
11. Gleason, L. J., Benton, E. A., Alvarez-Nebreda, M. L., Weaver, M. J., Harris, M. B., & Javedan, H. (2017). FRAIL Questionnaire Screening Tool and Short-Term Outcomes in Geriatric Fracture Patients. Journal of the American Medical Directors Association, 18(12), 1082–1086. https://doi.org/10.1016/j.jamda.2017.07.005
12. Gn, Y. M., Abdullah, H. R., Loke, W., & Sim, Y. E. (2021). Prevalence and risk factors of preoperative malnutrition risk in older patients and its impact on surgical outcomes: a retrospective observational study. Canadian Journal of Anesthesia, 68(5), 622–632. https://doi.org/10.1007/s12630-021-01933-3
13. Gordon, E. H., Peel, N. M., Samanta, M., Theou, O., Howlett, S. E., & Hubbard, R. E. (2017). Sex differences in frailty: A systematic review and meta-analysis. In Experimental Gerontology (Vol. 89). https://doi.org/10.1016/j.exger.2016.12.021
14. Greenstein, A. S., & Gorczyca, J. T. (2019). Orthopedic Surgery and the Geriatric Patient. Clinics in Geriatric Medicine, 35(1), 65–92. https://doi.org/10.1016/j.cger.2018.08.007
15. Guigoz, Y. (2006). The Mini Nutritional Assessment (MNA®) review of the literature - What does it tell us? In Journal of Nutrition, Health and Aging (Vol. 10, Issue 6).
16. He, B., Ma, Y., Wang, C., Jiang, M., Geng, C., Chang, X., Ma, B., & Han, L. (2019). Prevalence and Risk Factors for Frailty Among Community-Dwelling Older People in China: A Systematic Review and Meta-Analysis. In Journal of Nutrition, Health and Aging (Vol. 23, Issue 5). https://doi.org/10.1007/s12603-019-1179-9
17. Hirsch, K. R., Wolfe, R. R., & Ferrando, A. A. (2021). Pre-and post-surgical nutrition for preservation of muscle mass, strength, and functionality following orthopedic surgery. Nutrients, 13(5). https://doi.org/10.3390/nu13051675
18. Hogan, D. B. (2018). Models, definitions, and criteria for frailty. In Conn’s Handbook of Models for Human Aging. https://doi.org/10.1016/B978-0-12-811353-0.00003-8
19. Jiao, J., Wang, Y., Zhu, C., Li, F., Zhu, M., Wen, X., Jin, J., Wang, H., Lv, D., Zhao, S., Wu, X., & Xu, T. (2020). Prevalence and associated factors for frailty among elder patients in China: A multicentre cross-sectional study. BMC Geriatrics, 20(1). https://doi.org/10.1186/s12877-020-1496-1
20. Kamath, A. F., Nelson, C. L., Elkassabany, N., Guo, Z., & Liu, J. (2017). Low Albumin Is a Risk Factor for Complications after Revision Total Knee Arthroplasty. Journal of Knee Surgery, 30(3), 889–895. https://doi.org/10.1055/s-0036-1584575
21. Kishawi, D., Schwarzman, G., Mejia, A., Hussain, A. K., & Gonzalez, M. H. (2020). Low Preoperative Albumin Levels Predict Adverse Outcomes After Total Joint Arthroplasty. The Journal of Bone and Joint Surgery. American Volume, 102(10), 889–895. https://doi.org/10.2106/JBJS.19.00511
22. Li, G., Walco, J. P., Mueller, D. A., Wanderer, J. P., & Freundlich, R. E. (2021). Reliability of the ASA Physical Status Classification System in Predicting Surgical Morbidity: a Retrospective Analysis. Journal of Medical Systems, 45(9). https://doi.org/10.1007/s10916-021-01758-z
23. Lin, H. S., Watts, J. N., Peel, N. M., & Hubbard, R. E. (2016). Frailty and post-operative outcomes in older surgical patients: A systematic review. BMC Geriatrics, 16(157), 1–12. https://doi.org/10.1186/s12877-016-0329-8
24. Mahakalkar, C., Modi, S., Yeola, M., Kaple, M., Patwardhan, M., & Laddha, P. (2014a). Malnutrition in hospitalised patients; a real concern in surgical outcomes. International Journal of Research in Medical Sciences, 2(1), 250. https://doi.org/10.5455/2320-6012.ijrms20140248
25. Mahakalkar, C., Modi, S., Yeola, M., Kaple, M., Patwardhan, M., & Laddha, P. (2014b). Malnutrition in hospitalised patients; a real concern in surgical outcomes. International Journal of Research in Medical Sciences, 2(1), 250. https://doi.org/10.5455/2320-6012.ijrms20140248
26. Makary, M. A., Segev, D. L., Pronovost, P. J., Syin, D., Bandeen-Roche, K., Patel, P., Takenaga, R., Devgan, L., Holzmueller, C. G., Tian, J., & Fried, L. P. (2010). Frailty as a Predictor of Surgical Outcomes in Older Patients. Journal of the American College of Surgeons, 210(6), 901–908. https://doi.org/10.1016/j.jamcollsurg.2010.01.028
27. Marques-Santos, C., & de Oliveira, G. M. M. (2021). Are Women the Fragile Sex? Or are They the Singular Sex? In International Journal of Cardiovascular Sciences 34(4). https://doi.org/10.36660/ijcs.20210171
28. Morley, J. E., Malmstrom, T. K., & Miller, D. K. (2012). A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged african americans. Journal of Nutrition, Health and Aging, 16(7). https://doi.org/10.1007/s12603-012-0084-2
29. Muradi, H. (2017). Yaşlılarda kirilganliği ölçmeye yönelik FRAİL ölçeğinin Türkçe geçerlik ve güvenirlik çalişması. [Uzmanlık Tezi]. Hacettepe Üniversitesi.
30. Panayi, A. C., Orkaby, A. R., Sakthivel, D., Endo, Y., Varon, D., Roh, D., Orgill, D. P., Neppl, R. L., Javedan, H., Bhasin, S., & Sinha, I. (2019). Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis. American Journal of Surgery, 218(2). https://doi.org/10.1016/j.amjsurg.2018.11.020
31. Richards, S. J., Frizelle, F. A., Geddes, J. A., Eglinton, T. W., & Hampton, M. B. (2018). Frailty in surgical patients. International journal of colorectal disease, 33, 1657-1666.
32. Qin, Y., Hao, X., Lv, M., Zhao, X., Wu, S., & Li, K. (2023). A global perspective on risk factors for frailty in community-dwelling older adults: A systematic review and meta-analysis. In Archives of Gerontology and Geriatrics (Vol. 105). https://doi.org/10.1016/j.archger.2022.104844
33. Sarikaya, D., Halil, M., Kuyumcu, M. E., Kilic, M. K., Yesil, Y., Kara, O., Ozturk, S., Gungor, E., Karabulut, E., Balam Yavuz, B., Cankurtaran, M., & Ariogul, S. (2015). Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Archives of Gerontology and Geriatrics, 61(1). https://doi.org/10.1016/j.archger.2015.04.006
34. Setiati, S., Laksmi, P. W., Aryana, I. G. P. S., Sunarti, S., Widajanti, N., Dwipa, L., Seto, E., Istanti, R., Ardian, L. J., & Chotimah, S. C. (2019). Frailty state among Indonesian elderly: Prevalence, associated factors, and frailty state transition. BMC Geriatrics, 19(1). https://doi.org/10.1186/s12877-019-1198-8
35. Shander, A., Corwin, H. L., Meier, J., Auerbach, M., Bisbe, E., Blitz, J., Erhard, J., Faraoni, D., Farmer, S. L., Frank, S. M., Girelli, D., Hall, T., Hardy, J. F., Hofmann, A., Lee, C. K., Leung, T. W., Ozawa, S., Sathar, J., Spahn, D. R., … Muñoz, M. (2023). Recommendations From the International Consensus Conference on Anemia Management in Surgical Patients (ICCAMS). In Annals of Surgery 277(4). https://doi.org/10.1097/SLA.0000000000005721
36. Theriault, B. C., Pazniokas, J., Adkoli, A. S., Cho, E. K., Rao, N., Schmidt, M., Cole, C., Gandhi, C., Couldwell, W. T., Al-Mufti, F., & Bowers, C. A. (2020). Frailty predicts worse outcomes after intracranial meningioma surgery irrespective of existing prognostic factors. Neurosurgical Focus, 49(4). https://doi.org/10.3171/2020.7.focus20324
37. Thomas, M. N., Kufeldt, J., Kisser, U., Hornung, H. M., Hoffmann, J., Andraschko, M., Werner, J., & Rittler, P. (2016). Effects of malnutrition on complication rates, length of hospital stay, and revenue in elective surgical patients in the G-DRG-system. Nutrition, 32(2), 249–254. https://doi.org/10.1016/j.nut.2015.08.021
38. Turhan Damar, H., Savcı, A., Bilik, Ö., Demokrasi Üniversitesi, İ., Hizmetleri Meslek Yüksekokulu, S., Bakım Programı, Y., Sağlık Bilimleri Üniversitesi, K., Bilimleri Fakültesi, S., Bölümü, H., Eylül Üniversitesi, D., Fakültesi, H., & Hastalıkları Hemşireliği, C. (2021). Ortopedi Hastalarının Malnütrisyon Durumları ve Risk Faktörlerinin Belirlenmesi Determination of Malnutrition Status and Risk Factors in Orthopedic Patients. 8(3), 487–494. https://doi.org/10.34087/cbusbed
39. Vellas, B., Villars, H., Abellan, G., Soto, M. E., Rolland, Y., Guigoz, Y., Morley, J. E., Chumlea, W., Salva, A., Rubenstein, L. Z., & Garry, P. (2006). Overview of the MNA® - Its history and challenges. In Journal of Nutrition, Health and Aging (Vol. 10, Issue 6).
40. Venianaki, M., Andreou, A., Nikolouzakis, T. K., Chrysos, E., Chalkiadakis, G., & Lasithiotakis, K. (2021). Factors associated with malnutrition and its impact on postoperative outcomes in older patients. Journal of Clinical Medicine, 10(12). https://doi.org/10.3390/jcm10122550
41. Walters, S., Chan, S., Goh, L., Ong, T., & Sahota, O. (2016). The Prevalence of Frailty in Patients Admitted to Hospital with Vertebral Fragility Fractures. Current Rheumatology Reviews, 12(3). https://doi.org/10.2174/1573397112666160619190744
42. Watt, J., Tricco, A. C., Talbot-Hamon, C., Pham, B., Rios, P., Grudniewicz, A., Wong, C., Sinclair, D., & Straus, S. E. (2018). Identifying older adults at risk of harm following elective surgery: A systematic review and meta-analysis. BMC Medicine, 16(1), 1–14. https://doi.org/10.1186/s12916-017-0986-2 Williams, D. G. A., & Wischmeyer, P. E. (2020). Perioperative Nutrition Care of Orthopedic Surgery Patient. Tech Orthop., 35(1), 15–18. https://doi.org/10.1097/bto.0000000000000412. Yuwen, P., Chen, W., Lv, H., Feng, C., Li, Y., Zhang, T., Hu, P., Guo, J., Tian, Y., Liu, L., Sun, J., & Zhang, Y. (2017). Albumin and surgical site infection risk in orthopaedics: A meta-analysis. BMC Surgery, 17(1). https://doi.org/10.1186/s12893-016-0186-6 Zhang, X., Liu, Y., Van der Schans, C. P., Krijnen, W., & Hobbelen, J. S. M. (2020). Frailty among older people in a community setting in China. Geriatric Nursing, 41(3), 320–324. https://doi.org/10.1016/j.gerinurse.2019.11.013