Preoperatif değerlendirme konusunda birinci basamakta çalışan hekimlerin bilgi ve tutumlarının değerlendirilmesi

Demet Laflı Tunay

Preoperatif değerlendirme konusunda birinci basamakta çalışan hekimlerin bilgi ve tutumlarının değerlendirilmesi

Öz

Amaç: Preoperatif değerlendirme, hastayı bütünüyle iyileştirmekten ziyade hastaya ait riskleri, tıbbi koşulları ve tıbbi bakımı optimize etme planını ortaya koymaya yönelik, hastanın kapsamlı bir şekilde değerlendirmesini yapmaktır. Preoperatif değerlendirme multidisipliner bir olay olup dünyada geçerliliği olan birkaç modelden biri de birinci basamak hekim modelidir. Bu modelde cerrahi branşın konsültasyonu doğrultusunda preoperatif değerlendirme aile hekimi, dahiliye doktoru veya kardiyolog tarafından gerçekleştirilir. Bu çalışmada birinci basamak aile hekimlerinin preoperatif değerlendirme konusundaki bilgi düzeyleri anket çalışması ile ölçülmek istenmiştir.

Materyal ve Metot: Adana il merkezi görev yapan aile hekimliği uzmanlarına online anket formu üzerinden, sosyodemografik özellikleri ve Preoperatif değerlendirme konusunda bilgi, tutum ve uygulamalarını sorgulayan Avrupa Anesteziyoloji Derneği (ESA)'nin kardiyak olmayan cerrahi girişim geçiren yetişkinlerin preoperatif değerlendirilmesine ilişkin 2011 yılı kılavuzunda yer alan tavsiyelerin 2018 yılında yapılan güncellemesinden uyarlanmış standart anket uygulandı.

Bulgular: Katılımcıların %62,50’si aile hekimlerinin hastalarının preoperatif değerlendirilmesinden sorumlu olması gerektiğini düşündüklerini belirttiler. Aile hekimleri uygulanan ankette düşük bilgi düzeyi skoru olan kategorileri koagülasyon bozuklukları(%50,01), kardiyo vasküler hastalık(%61,87) ve renal hastalık(%67,19) iken yüksek skor alan kategoriler obezite(%87,51), anemi(%87,51) ve respiratuar hastalık(%75,01) olarak bulundu. Anket doğru yanıt ortalaması %71,40 olarak bulundu.

Sonuç: Bu çalışma birinci basamak hekimlerinin preoperatif hazırlık konusunda bilgili olmasına rağmen, birinci basamak hekim eğitim programlarında daha iyi tanımlanmış bir perioperatif tıp müfredatına ihtiyaç duyulduğunu ve birinci basamakta hizmet veren hekimlere bu konuda daha fazla eğitim verilmesinin gerekli olduğunu göstermiştir.

Anahtar kelimeler: Aile hekimliği, birinci basamak, Preoperatif değerlendirme

Anahtar Kelimeler

Birinci Basamak,Preoperatif değerlendirme

Kaynakça

1) http://ekutuphane.sagem.gov.tr/kitaplar/saglik_istatistikleri_yilligi_2014.pdf Erişim Tarihi 29.08.2019
2) Polanczyk, Carísi A., et al. "Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery." Annals of Internal Medicine 134.8 (2001): 637-643.
3) American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Practice advisory for preanesthesia evaluation. Anesthesiology 2012;116(3):1-17.
4) Jaffer, Amir K., and Bindu Sangani. "Related Products." https://www.reliasmedia.com/articles/5293-an-evidence-based-approach-to-the-preoperative-evaluation(An evidence-based approach to the preoperative evaluation.Amir K. Jaffer and Bindu Sangani. Primary Care Reports 10.10 (Oct 2004): p111(16). )
5) Dimick JB, Chen SL, Taheri PA, et al. Hospital costs associated with surgical complications: a report from the private-sector National Sur- gical Quality Improvement Program. J Am Coll Surg 2004;199:531-7.
6) (De Hert, S., Staender, S., Fritsch, G., Hinkelbein, J., Afshari, A., Bettelli, G., ... & Drinhaus, H. (2018). Preoperative evaluation of adults undergoing elective noncardiac surgery. European journal of anaesthesiology, 35(6), 407-465.).
7) Lurie JD, Miller DP, Lindenauer PK, Wachter RM, Sox HC. e po- tential size of the hospitalist workforce in the United States. Am J Med 1999;106(4):441–445. 17.
8) Hauer KE, Flanders SA, Wachter RM. Training future hospitalists. West J Med 1999;171(5–6):367–370.

9) American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Practice advisory for preanesthesia evaluation. Anesthesiology 2012;116(3):1-17. 
10) De Hert S, Moerman A, De Baerdemaeker L. Postoperative complications in cardiac patients undergoing noncardiac surgery. Curr Opin Crit Care 2016; 22:357 – 364.
11) Longrois D, Hoeft A, De Hert S. 2014 European Society of Cardiology/ European Society of Anaesthesiology guidelines on noncardiac surgery: cardiovascular assessment and management: A short explanatory statement from the European Society of Anaesthesiology members who participated in the European Task Force. Eur J Anaesthesiol 2014; 31:513 – 516.  
12) Kristensen S, Knuuti J, Saraste A. European Society of Anaesthesiology guidelines on noncardiac surgery: cardiovascular assessment and management. The Joint Task Force on noncardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol 2014; 31:517–573.
13) Devereaux P, Mrkobrada M, Sessler DI, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med 2014; 370:1494 – 1503.  
14) Devereaux P, Sessler DI, Leslie K, et al. Clonidine in patients undergoing  noncardiac surgery. N Engl J Med 2014; 370:1504 – 1513.  
15) Gupta HG, Gupta PK, Fang X, et al. Development and validation of a risk  calculator predicting postoperative respiratory failure. Chest 2011;  140:1207 – 1215.  
16) Imposti FC, Cizik A, Bransford R, et al. Risk factors for pulmonary  complications after spine surgery. Evid Based Spine Care J 2010; 1:  26–33.  
17) Canet J, Sabate S, Mazo V, et al. Development and validation of a score to  predict postoperative respiratory failure in a multicentre European cohort: a prospective, observational study. Eur J Anaesthesiol 2015; 32:458– 470.  
18) Fischer JPS, Shang EK, Butler CE, et al. Validated model for predicting postoperative respiratory failure: analysis of 1706 abdominal wall reconstructions. Plast Reconstr Surg 2013; 132:826e – 835e.  
19) Jeong BHS, Shin B, Eom JS, et al. Development of a prediction rule for estimating postoperative pulmonary complications. PLoS One [Electronic Resource] 2014; 9:e113656.  
20) Mazo V, Sabate S, Canet J, et al. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology 2014; 121:219 – 231.  
21) De Hert S, Imberger G, Carlisle J, et al. Preoperative evaluation of the adult patient undergoing noncardiac surgery: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2011; 28:684 – 722.
22) O’neill F, Carter E, Pink N, Smith I. Routine preoperative tests for elective surgery: summary of updated NICE guidance. BMJ 2016; 354:i3292.
23) Kaw RP, Pasupuleti V, Walker E, et al. Postoperative complications in patients with obstructive sleep apnea. Chest 2012; 141:436 – 441.
24) Abdelsattar ZMH, Hendren S, Wong SL, et al. The impact of untreated obstructive sleep apnea on cardiopulmonary complications in general and vascular surgery: a cohort study. Sleep 2015; 38:1205 – 1210.
25) Siyam MA, Benhamou D. Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg 2002; 95:1098 – 1102. 
26) Chung FL, Liao P, Elsaid H, et al. Factors associated with postoperative exacerbation of sleep-disordered breathing. Anesthesiology 2014; 120:299 – 311. 
27) Mutter TCC, Chateau D, Moffatt M, et al. A matched cohort study of postoperative outcomes in obstructive sleep apnea: could preoperative diagnosis and treatment prevent complications? Anesthesiology 2014; 121:707 – 718.
28) Chung F, Yegneswaran B, Liao P, et al. Stop questionnairea tool to screen patients for obstructive sleep apnea. Anesthesiology 2008; 108:812 – 821.
29) Khanna AKS, Sessler DI, Sun Z, et al. Using the STOP-BANG questionnaire to predict hypoxaemia in patients recovering from noncardiac surgery: a prospective cohort analysis. Br J Anaesth 2016; 116:632 – 640.
30) do Nascimento Junior P, Modolo NS, Andrade S, et al. Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev 2014;CD006058.  
31) Singh JA. Smoking and outcomes after knee and hip arthroplasty: a systematic review. J Rheumatol 2011; 38:1824 – 1834.  
32) Myers KH, Hajek P, Hinds C, McRobbie H. Stopping smoking shortly  before surgery and postoperative complications: a systematic review and  meta-analysis. Arch Intern Med 2011; 171:983 – 989.  
33) Mills EE, Eyawo O, Lockhart I, et al. Smoking cessation reduces  postoperative complications: a systematic review and meta-analysis. Am J Med 2011; 124:144 – 154; e8.
34) Wong JL, Lam DP, Abrishami A, et al. Short-term preoperative smoking  cessation and postoperative complications: a systematic review and  meta-analysis. Can J Anaesth 2012; 59:268 – 279.  
35) Kheterpal S, Tremper KK, Englesbe MJ, et al. Predictors of postoperative  acute renal failure after noncardiac surgery in patients with previously  normal renal function. Anesthesiology 2007; 107:892 – 902.  
36) van Kuijk J-P, Flu W-J, Chonchol M, et al. Temporary perioperative decline of renal function is an independent predictor for chronic kidney disease. Clin J Am Soc Nephrol 2010; 5:1198 – 1204.
37) Cywinski JB, Mascha EJ, Kurz A, Sessler DI. Estimated glomerular filtration rate better predicts 30-day mortality after noncardiac surgery than serum creatinine: a retrospective analysis of 92,888 patients. Can J Anesth 2015; 62:745 – 752.
38) AbuRahma AF, Srivastava M, Chong B, et al. Impact of chronic renal insufficiency using serum creatinine vs glomerular filtration rate on perioperative clinical outcomes of carotid endarterectomy. J Am Coll Surg 2013; 216:525 – 532.
39) AbuRahma AF, Alhalbouni S, Abu-Halimah S, et al. Impact of chronic renal insufficiency on the early and late clinical outcomes of carotid artery stenting using serum creatinine vs glomerular filtration rate. J Am Coll Surg 2014; 218:797 – 805 . 40) Argalious M, Dalton J, Cywinski J, et al. Association between preoperative statin therapy and postoperative change in glomerular filtration rate in endovascular aortic surgery. Br J Anaesth 2012; 109:161 – 167.
41) Krane LS, Sandberg JM, Rague JT, Hemal AK. Do statin medications impact renal functional or oncologic outcomes for robot-assisted partial nephrectomy? J Endourol 2014; 28:1308 – 1312.
42) Bock M, Fanolla A, Segur-Cabanac I, et al. A comparative effectiveness analysis of the implementation of surgical safety checklists in a tertiary care hospital. JAMA Surg 2016; 151:639 – 646.
43) Krolikowska M, Kataja M, Po€yhia ̈ R, et al. Mortality in diabetic patients undergoing noncardiac surgery: a 7-year follow-up study. Acta Anaesthesiol Scand 2009; 53:749 – 758.
44) Frisch A, Chandra P, Smiley D, et al. Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery. Diabetes Care 2010; 33:1783 – 1788.
45) Van den Boom W, Schroeder RA, Manning MW, et al. Effect of A1C and glucose on postoperative mortality in noncardiac and cardiac surgeries. Diabetes Care 2018; 41:782 – 788.  
46) O’neill F, Carter E, Pink N, Smith I. Routine preoperative tests for elective surgery: summary of updated NICE guidance. BMJ 2016; 354:i3292.
47) Rollins KE, Varadhan KK, Dhatariya K, Lobo DN. Systematic review of the impact of HbA1c on outcomes following surgery in patients with diabetes mellitus. Clin Nutr 2016; 35:308 – 316.  
48) Erden V, Basaranoglu G, Delatioglu H, Hamzaoglu N. Relationship of difficult laryngoscopy to long-term noninsulin-dependent diabetes and hand abnormality detected using the ‘prayer sign’. Br J Anaesth 2003; 91:159 – 160.
49) Catheline J-M, Bihan H, Le Quang T, et al. Preoperative cardiac and pulmonary assessment in bariatric surgery. Obes Surg 2008; 18:271– 277.
50) Lopez PP, Stefan B, Schulman CI, Byers PM. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg 2008; 74:834 – 838.
51) Teno rio LHS, Santos AC, Caˆmara Neto JB, et al. The influence of inspiratory muscle training on diaphragmatic mobility, pulmonary function and maximum respiratory pressures in morbidly obese individuals: a pilot study. Disabil Rehabil 2013; 35:1915 – 1920.
52) Nagappa M, Mokhlesi B, Wong J, et al. The effects of continuous positive airway pressure on postoperative outcomes in obstructive sleep apnea patients undergoing surgery: a systematic review and meta-analysis. Anesth Analg 2015; 120:1013 – 1023.  
53) Lee YH, Johan A, Wong KKH, et al. Prevalence and risk factors for obstructive sleep apnea in a multiethnic population of patients presenting for bariatric surgery in Singapore. Sleep Med 2009; 10:226 – 232.
54) Yamamoto K, Wada H, Sakakura K, et al. Cardiovascular and bleeding risk of noncardiac surgery in patients on antiplatelet therapy. J Cardiol 2014; 64:334 – 338.  
55) Venkat R, Hannallah JR, Krouse RS, Maegawa FB. Preoperative thrombocytopenia and outcomes of hepatectomy for hepatocellular carcinoma. J Surg Res 2016; 201:498 – 505.  
56) Dentali F, Marchesi C, Pierfranceschi MG, et al. Safety of prothrombin complex concentrates for rapid anticoagulation reversal of vitamin K antagonists. Thromb Haemost 2011; 106:429 – 438.  
57) Collyer T, Reynolds H, Truyens E, et al. Perioperative management of clopidogrel therapy: the effects on in-hospital cardiac morbidity in older patients with hip fractures. Br J Anaesth 2011; 107:911 – 915.  
58) Chu EW, Chernoguz A, Divino CM. The evaluation of clopidogrel use in perioperative general surgery patients: a prospective randomized controlled trial. Am J Surg 2016; 211:1019 – 1025.  
59) Patel MS, Carson JL. Anemia in the preoperative patient. Med Clin N Am 2009; 93:1095 – 1104.
60) Gombotz H. Patient blood management is key before elective surgery. Lancet 2011; 378:1362 – 1363.
61) Keeler B, Simpson J, Ng S, et al. The feasibility and clinical efficacy of intravenous iron administration for preoperative anaemia in patients with colorectal cancer. Colorectal Dis 2014; 16:794 – 800.
62) Calleja JL, Delgado S, Del Val A, et al. Ferric carboxymaltose reduces transfusions and hospital stay in patients with colon cancer and anemia. Int J Colorectal Dis 2016; 31:543 – 551.
63) Froessler B, Palm P, Weber I, et al. The important role for intravenous iron in perioperative patient blood management in major abdominal surgery: a randomized controlled trial. Ann Surg 2016; 264:41 – 46.
64) Serrano-Trenas JA, Ugalde PF, Cabello LM, et al. Role of perioperative intravenous iron therapy in elderly hip fracture patients: a single-center randomized controlled trial. Transfusion 2011; 51:97 – 104.
65) Keeler BD, Simpson JA, Ng S, et al. The feasibility and clinical efficacy of intravenous iron administration for preoperative anaemia in patients with colorectal cancer. Colorectal Dis 2014; 16:794 – 800.
66) Monsef JB, Buckup J, Mayman D, et al. Targeted preoperative autologous blood donation in total knee arthroplasty reduces the need for postoperative transfusion. HSS J 2013; 9:214 – 217.
67) Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 2005; 53:424 – 429.  
68) Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 2017; 34:192 – 214.  
69) Griffiths R, Beech F, Brown A, et al. Peri-operative care of the elderly 2014: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 2014; 69:81 – 98.  
70) Mohanty S, Rosenthal RA, Russell MM, et al. Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg 2016; 222:930 – 947.  
71) McEwen BJ. The influence of herbal medicine on platelet function and coagulation: a narrative review. Semin Thromb Hemost 2015; 41:300– 314
72) Cordier WS, Steenkamp V. Herbal remedies affecting coagulation: a review. Pharm Biol 2012; 50:443 – 452.
73) Kudoh A, Katagai H, Takase H, Takazawa T. Effect of preoperative discontinuation of antipsychotics in schizophrenic patients on outcome during and after anaesthesia. Eur J Anaesthesiol 2004; 21:414 – 416.  
74) Kudoh A, Katagai H, Takazawa T. Antidepressant treatment for chronic depressed patients should not be discontinued prior to anesthesia. Can J Anesth 2002; 49:132 – 136.  
75) Castanheira LF, Fresco P, MacEdo AF. Guidelines for the management of chronic medication in the perioperative period: systematic review and formal consensus. J Clin Pharm Ther 2011; 36:446 – 467.
76) Strauss J. Psychotropic medication use in older adults. Int Anesthesiol Clin 2014; 52:77 – 94.
77) Rasool FG, Ghafoor R, Lambert D. Antidepressants and antipsychotics: anaesthetic implications. Anaesth Intensive Care Med 2011; 12:166– 169.  
78) Doodeman HJ, Kalkman CJ, Egberts T. Antidepressive treatment with monoamine oxidase inhibitors and the occurrence of intraoperative hemodynamic events: a retrospective observational cohort study. J Clin Psychiatry 2012; 73:1103 – 1109.  
79) Huyse FJ, Touw DJ, Van Schijndel RS, et al. Psychotropic drugs and the perioperative period: a proposal for a guideline in elective surgery. Psychosomatics 2006; 47:8 – 22.
80) Kozek-Langenecker SA, Ahmed AB, Afshari A, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: first update 2016. Eur J Anaesthesiol 2017; 34: 332 – 395.

Ayrıntılar

Birincil Dil

Türkçe

Konular

Anesteziyoloji

Bölüm

Araştırma Makalesi

Yazarlar

Demet Laflı Tunay
0000-0002-7984-1800
Türkiye

Yayımlanma Tarihi

31 Ağustos 2019

Gönderilme Tarihi

30 Ağustos 2019

Kabul Tarihi

31 Ağustos 2019

Yayımlandığı Sayı

Yıl 2019 Cilt: 2 Sayı: 2

IZ

https://izlik.org/JA64NG92HG

Kaynak Göster

RIS / Bibtex

APA

Laflı Tunay, D. (2019). Preoperatif değerlendirme konusunda birinci basamakta çalışan hekimlerin bilgi ve tutumlarının değerlendirilmesi. Journal of Cukurova Anesthesia and Surgical Sciences, 2(2), 150-168. https://izlik.org/JA64NG92HG

AMA

1.Laflı Tunay D. Preoperatif değerlendirme konusunda birinci basamakta çalışan hekimlerin bilgi ve tutumlarının değerlendirilmesi. J Cukurova Anesth Surg. 2019;2(2):150-168. https://izlik.org/JA64NG92HG

Chicago

Laflı Tunay, Demet. 2019. “Preoperatif değerlendirme konusunda birinci basamakta çalışan hekimlerin bilgi ve tutumlarının değerlendirilmesi”. Journal of Cukurova Anesthesia and Surgical Sciences 2 (2): 150-68. https://izlik.org/JA64NG92HG.

EndNote

Laflı Tunay D (01 Ağustos 2019) Preoperatif değerlendirme konusunda birinci basamakta çalışan hekimlerin bilgi ve tutumlarının değerlendirilmesi. Journal of Cukurova Anesthesia and Surgical Sciences 2 2 150–168.

IEEE

[1]D. Laflı Tunay, “Preoperatif değerlendirme konusunda birinci basamakta çalışan hekimlerin bilgi ve tutumlarının değerlendirilmesi”, J Cukurova Anesth Surg, c. 2, sy 2, ss. 150–168, Ağu. 2019, [çevrimiçi]. Erişim adresi: https://izlik.org/JA64NG92HG

ISNAD

Laflı Tunay, Demet. “Preoperatif değerlendirme konusunda birinci basamakta çalışan hekimlerin bilgi ve tutumlarının değerlendirilmesi”. Journal of Cukurova Anesthesia and Surgical Sciences 2/2 (01 Ağustos 2019): 150-168. https://izlik.org/JA64NG92HG.

JAMA

1.Laflı Tunay D. Preoperatif değerlendirme konusunda birinci basamakta çalışan hekimlerin bilgi ve tutumlarının değerlendirilmesi. J Cukurova Anesth Surg. 2019;2:150–168.

MLA

Laflı Tunay, Demet. “Preoperatif değerlendirme konusunda birinci basamakta çalışan hekimlerin bilgi ve tutumlarının değerlendirilmesi”. Journal of Cukurova Anesthesia and Surgical Sciences, c. 2, sy 2, Ağustos 2019, ss. 150-68, https://izlik.org/JA64NG92HG.

Vancouver

1.Demet Laflı Tunay. Preoperatif değerlendirme konusunda birinci basamakta çalışan hekimlerin bilgi ve tutumlarının değerlendirilmesi. J Cukurova Anesth Surg [Internet]. 01 Ağustos 2019;2(2):150-68. Erişim adresi: https://izlik.org/JA64NG92HG