Acil Servise Başvuran Hastalarda Post Operatif Komplikasyonların Epidemiyolojik İncelenmesi

Öz

Amaç: Bu çalışmanın amacı postoperatif komplikasyonlara bağlı olarak planlanmamış acil servis ziyaretlerinin değerlendirilmesidir. Bu çalışmada  postoperatif komplikasyonlara bağlı klinik ve laboratuvar nedenler ve görülme oranlarını belirlendi.

Gereç ve Yöntem: Bu prospektif çalışmaya, Mayıs 2014 ve Nisan 2015 döneminde, postoperatif komplikasyonlar nedeniyle Gaziosmanpaşa Üniversitesi Tıp Fakültesi Hastanesi Acil Servisine başvuran 640 hastanın 300'ü dahil edildi. Veriler SPSS ortamında kaydedildi. Niteliksel veriler Ki-kare testleri kullanılarak analiz edildi. Nicel veriler, tek yönlü varyans analizi kullanılarak analiz edildi. Çoklu karşılaştırma için Tukey testi kullanıldı.

Sonuçlar: Planlanmamış yeniden kabul oranı, ülke çapında hastane bakım sonuçları ölçütüdür. Acil servisimize başvuran toplam 11755 hastadan 640'ı postoperatif komplikasyonlar için başvurdu. Tekrar operasyona alınma;  ileri yaş, yüksek ortalama arter basıncı ve tekrarlayan acil geri kabul ile ilişkilidir. Ameliyat sonrası komplikasyonlar nedeniyle acil servise birden çok başvuran bu grupta, ortalama CRP değeri anlamlı olarak yüksek bulundu. Bu hastalarda yara yeri enfeksiyonları (% 20.3), hemoraji-hematom (% 10) ve pulmoner emboli (% 2,33) vardı. Bu durumlar için insidans oranları literatürde bildirilen oranlardan daha yüksekti.

Sonuçlar: İlşeri yaş, komplikasyonlu hastalıklar, artmış CRP ve uzun yatışları olan hastalar, gelişebilecek komplikasyonlar hakkında bilgilendirildikten sonra hastaneden taburcu edilmeli. Yüksek morbidite ve mortalite oranlarından dolayı tekrarlayan başvuruları olan hastalara acil bakım dikkatle verilmelidir. Gerekli önlemlerin alınması hem maliyet hem de acil servis ziyaretlerinin sayısını önemli ölçüde azaltacaktır.

Anahtar Kelimeler

• acil servis,postoperatif komplikasyon,tekrar başvuru

Epidemiology of post-operative complications in patients admitted to emergency service

Öz

Aim: The aim of this study was to evaluate unplanned emergency room visits due to postoperative complications.The present study was to determine incidence rates of and clinic and laboratory causes of readmissions due to postoperative complications.

Materials and Methods: This prospective study included 300 of 640 patients who presented to Emergency Service of Gaziosmanpaşa University, Faculty of Medicine Hospital due to postoperative complications in May 2014 and April 2015 period. The data were recorded in the SPSS environment. Qualitative data were analyzed using Chi-square tests. Quantitative data were analyzed using one-way analysis of variance. Tukey test was used for multiple comparisons.

Results: The unplanned readmission rate is a nation-wide measure of hospital care outcomes. Of all 11,755 patients presenting to our emergency department, 640 applied for postoperative complications. Re-operation is associated with older age, high mean arterial pressure and recurrent emergency readmission. Average CRP was significantly higher in this group of patients admitted to the emergency service with postoperative complications for reoperation. These patients had wound infections (20.3%), hemorrhage-hematoma (10%) and pulmonary embolism (2.33%). The incidence rates for these conditions were higher than the rates reported in literature.

Conclusions: Patients with old age, comorbid diseases, elevated CRP and long hospitalizations should be discharged from hospital after they have been informed about the complications that may develop. Emergency care should be given more carefully to patients with recurrent readmissions because of their high morbidity and mortality rates. Taking necessary precautions will significantly reduce both cost and number of emergency service visits.

Anahtar Kelimeler

• postoperative complication,emergency service,readmission

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