Cerrahi hastalarda preoperatif pulmonary riskin değerlendirilmesi

Abstract

Giriş ve Amaç: Ameliyat sonrası gelişebilecek postoperatif pulmoner komplikasyonlar (PPK) önemli morbidite ve mortalite nedenleridir. PPC'ler hastanede kalış süresinin uzamasına ve hastanede yatış maliyetlerinin artmasına neden olur. Çalışmanın amacı, preoperatif değerlendirme için konsülte edilen hastalarda postoperatif pulmoner komplikasyonları öngörmede bir skorlama sistemi geliştirmektir. Gereç ve Yöntem: Bu araştırma kapsamında anestezi, cerrahi poliklinikleri ve diğer cerrahi kliniklerden preoperatif akciğer değerlendirmesi amacıyla konsültasyon için başvuran 200 hastanın verileri retrospektif olarak analiz edildi. Sigara içme durumu, fizik muayene bulguları, akciğer grafisi ve toraks BT bulguları, laboratuvar parametreleri, Solunum fonksiyon testi bulguları, tanı ve önerilen tedavi yaklaşımı bilgileri ile pulmoner risk skorları, postoperatif akciğer komplikasyonları, entübasyon ve yoğun bakıma yatışları değerlendirildi. Bulgular: Cinsiyete (erkeklerde daha fazla, p=0,001) ve sigara kullanımına (p=0,0001) göre hastalar arasında ameliyat sonrası akciğer komplikasyonlarının gelişimi açısından istatistiksel olarak anlamlı fark vardı. Ameliyat öncesi oksijen satürasyonu sPO2 ve FEV1/FVC oranı da PPC gelişiminin temel belirleyicileriydi ve düşük saturasyonlu kişilerde komplikasyonlar daha yüksekti (sırasıyla p=0,0001, p=0,013). sPO2 ve PPC arasındaki ilişki lojistik regresyon analizi (p=0,0001) ile doğrulandı ve PPC oluşumunun %13,6 olduğunu gösterdi. Satürasyondaki bir birimlik artış postoperatif solunum komplikasyonlarının oluşumunu 0,645 kat azalttı. Satürasyon değerinin kesme değeri %97,5, duyarlılığı %46,8 ve özgüllüğü 71,1 idi (p=0,0001). Sonuç: Bu çalışmada postoperatif pulmoner komplikasyonları öngörmek amacıyla Canet risk skorlama yöntemi kullanıldı. Bu skorlama sistemi Türkiye'de validasyonu yapılmış olup göğüs hastalıkları polikliniğine başvuran hastalarda preoperatif riskleri öngörebilecek tam kapsamlı bir skorlama sistemi mevcut değildir. Canet skorlamasının değerli bir preoperatif değerlendirme ve risk tahmini olduğu ve postoperatif pulmoner komplikasyonları ve mortaliteyi öngörmede faydalı olabileceği sonucuna varıldı.

Keywords

• preoperatif pulmoner değerlendirme,
• postoperatif pulmoner komplikasyonlar,
• cerrahi hastalar,
• pulmoner risk

Pre-operative pulmonary risk assessment in surgery patients

Abstract

Aims: Postoperative pulmonary complications (PPC) that may develop after surgery are important causes of morbidity and mortality. PPCs cause a prolongation of hospital stays and an increase in hospitalization costs. The study aims to determine factors associated with PPCs to predict PPCs in surgical patients undergoing preoperative evaluation. Methods: A retrospective cohort study was conducted at Şişli Hamidiye Etfal Training and Research Hospital using data from 200 patients referred for preoperative pulmonary evaluation from anesthesia and surgery clinics. This study analyzed the characteristics and outcomes of patients with PPC and those without PPC. The Canet pulmonary risk scores are used for PPC in all preoperative surgery patients. The study’s primary endpoints are to determine the development of respiratory failure, bronchospasm/asthma, COPD exacerbation, atelectasis, pleural effusion, or pneumonia. The study also analyzed the effective respiratory function parameters for PPC development using a logistic regression model. Results: The total study population included 200 patients with a median age of 53.5 years (aged between 19-88), 103 (51.5%) of whom were female. PPCs were observed in 38% (n=76) of the study group. There was a statistically significant difference between the patients in terms of the development of postoperative pulmonary complications according to gender (higher in males, p=0.001) and smoking (p=0.0001). Preoperative oxygen saturation (SpO2) and FEV1/FVC ratio were significant predictors of PPC development, and complications were more frequent in low-saturated patients (p=0.0001, p=0.013 respectively). The relationship between SpO2 and PPC was confirmed via logistic regression analysis. A one-unit increase in saturation reduced the occurrence of postoperative respiratory complications by 0.645-fold. The cut-off value for the saturation value was 97.5%, with a sensitivity of 46.8% and a specificity of 71.1% [p=0.0001, 95% CI, (0.521-0.798)]. Conclusion: In this study, the Canet (ARISCAT) score, a preoperative evaluation scale validated in Turkey that predicts postoperative pulmonary complications and mortality, was used. The Canet risk score is a simple risk score with moderate discriminatory performance for predicting PPCs. It may be useful in identifying individual patients at high risk of PPC and in the design of future studies to evaluate interventions to prevent these complications. However, a customized preoperative risk assessment system is needed for each patient.

Keywords

• Preoperative pulmonary evaluation
• postoperative pulmonary complication
• surgical patients
• pulmonary risk
• Canet (ARISCAT) scoring

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