HASAN BOMBACI, Özgür ERDOĞAN, Fatih ÇETİNKAYA, Mehmet KUYUMCU, Emre KAYA, Elif BOMBACI

Preoperative indicators affecting postoperative mortality in elderly patients with hip fractures

Amaç: Bu çalışmanın amacı kalça kırığı olan yaşlı hastalarda ameliyat sonrası mortaliteyi etkileyen faktörleri ve ASA (American Society of Anesthesiologists) sınıflamasının güvenilirliğini değerlendirmekti. Çalışma planı: Kalça kırığı nedeniyle ameliyat edilen 65 yaşında veya daha büyük 107 hasta (70 kadın, 37 erkek) çalışmaya dahil edildi. Hastaların ameliyat öncesi laboratuvar ve klinik verileri hasta dosyalarından derlenirken, takipleri telefon konuşması ile gerçekleştirildi. Ameliyat sonrası ilk 12 ay içinde ölen hasta sayısı Türkiye İstatistik Kurumu resmi ölüm oranları ile kıyaslandı. Sağ kalan ve ölen hastaların ameliyat öncesi klinik ve laboratuvar bulguları ile ASA skorları karşılaştırıldı. Bulgular: Yirmi sekiz hastanın ilk bir yıl içerisinde öldüğü saptandı. İlk yıl ölüm oranı normal nüfusa göre anlamlı derecede yüksekti (p

Kalça kırığı olan yaşlı hastalarda ameliyat sonrası mortaliteye etki eden ameliyat öncesi belirteçler

Objective: In this study, we aimed to evaluate the factors which affect postoperative mortality in elderly patients with hip fractures and the reliability of the American Society of Anesthesiologists (ASA) classification. Methods: The study included 107 patients (70 females, 37 males) of 65 years of age or older who were operated due to hip fracture. Preoperative laboratory and clinical data were collected from hospital files. Follow-up was conducted over the phone. The number of the patients who died in the first postoperative 12 months was compared with the official Turkish Statistical Institute mortality data. Preoperative clinical and laboratory findings and ASA scores were compared between surviving and deceased patients. Results: Twenty-eight patients died in the postoperative first year. The first year mortality rate was significantly higher than the normal population (p<0.05). Of these 28 patients, 16 died within the first 3 months; the majority due to respiratory insufficiency. The death ratio was significantly higher in patients with abnormal creatinine values (p=0.001) in the preoperative laboratory results and classified as ASA 4 (p<0.0001). Postoperative mobilization was slower and mortality was higher in patients with cognitive dysfunction, such as senile dementia. Conclusion: The mortality rate in patients operated for hip fractures is higher when compared to the mortality rate in patients of the same age group. Because most deaths caused by pulmonary insufficiency occurred in the first 3 months in which patients were not adequately mobilized, the main cause of death might be pulmonary embolism. Abnormal creatinine values might indicate insufficient kidney function as another reason of death. ASA classification is useful for determination of preoperative risk in the elderly patients with hip fractures.

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