COVID-19 Pandemi Döneminde Kalça Kırığı Ameliyatı Sonrasında Yoğun Bakıma Alınan Geriatrik Hastaların Risk Faktörleri

Amaç: Yoğun bakım ünitesi (YBÜ)’nde yatak tahsisi, sınırlı kaynaklar nedeniyle pahalı ve zor bir iştir. Koronavirüs hastalığı 2019 (COVID-19) pandemisinde, kalça cerrahisi geçiren geriatrik hastaların YBÜ’ye gereksinimi ile ilişkili preoperatif risk faktörlerini belirlemeyi amaçladık.Araçlar ve Yöntem: Bu retrospektif kohort çalışmada elektif kalça cerrahisi geçiren 65 yaş üzeri geriatrik hastalar değerlendirildi. Hastaların demografik özellikleri, Amerikan Anestezistler Derneği fiziksel durum (ASA) sınıfı, eşlik eden hastalıkları, preoperatif özellikleri (ameliyatı bekleme süresi, 3 ay içinde COVID-19 hastalık geçirme öyküsü, laboratuvar bulguları) ve postoperatif YBÜ’ye girip girmedikleri incelendi.Bulgular: Çalışmaya 120 hasta dahil edildi. YBÜ’ye ihtiyacı olan 39 (%32.5) hasta vardı. Tek değişkenli lojistik regresyon anali-zinde; ileri yaş, ASA sınıfının artması, preoperatif ameliyat bekleme süresi, hipertansiyon, koroner arter hastalığı (KAH)/kalp yet-mezliği (KY), respiratuar hastalık, tiroid hastalığı, serebrovasküler hastalık, düşük hemoglobin ve hematokrit değerlerinin önemli risk faktörleri olduğu tespit edilmiştir[(OR:1.05;p=0.022),(OR:9.10;p=0.000), (OR:1.23;p=0.024), (OR:3.78;p=0.003), (OR:17.95;p=0.000), (OR:6.86;p=0.000), (OR:7.80;p=0.003), (OR:6.04;p=0.000), (OR:0.63;p=0.004), (OR:0.89;p=0.040), sırasıyla ]. Çok değişkenli lojistik regresyon analizinde; ASA sınıfının artması, hipertansiyon, KAH/KY, respiratuar hastalık ve hipoalbüminemi değişkenleri YBÜ’ye hasta kabülünde etkili bağımsız risk faktörleri olarak saptanmıştır [(OR:8.96;p=0.006), (OR:11.65;p=0.003), (OR:32.40;p=0.000), (OR:21.85;p=0.000), (OR:50.16;p=0.009), sırasıyla ]. COVID-19 geçiren hastaların sadece preoperatif ameliyat bekleme süresi uzamıştır (p=0.009).Sonuç: Kalça cerrahisi geçiren geriatrik hastalarda ASA sınıfının artması, hipertansiyon, KAH/KY hastalıkları, respiratuar hastalık ve hipoalbüminemi postoperatif YBÜ’ye kabul edilmesi ile ilişkili risk faktörleri olarak belirlenmiştir.

Anahtar Kelimeler:

geriatri, kalça kırıkları, risk faktörleri, yaşlı, yoğun bakım ünitesi

Risk Factors of Geriatric Patients Admitted to Intensive Care After Hip Fracture Surgery in the COVID-19 Pandemic Period

Objective: Bed allocation in the intensive care unit (ICU) is an expensive and difficult task due to limited resources. In the Coronavirus disease 2019 (COVID-19) pandemic, we aimed to determine the preoperative risk factors associated with the ICU need of geriatric patients who underwent hip surgery.Materials and Methods: Geriatric patients over 65 years of age who underwent elective hip surgery were evaluated in this retrospective cohort study. The demographic characteristics of the patients, American Society of Anesthesiologists physical condition (ASA) class, co-existing diseases, preoperative characteristics (waiting time for surgery, history of having COVID-19 disease in 3 months, laboratory findings), and whether they entered the postoperative ICU were examined.Results: One hundred-twenty patients were included in the study. There were 39 (32.5%) patients who needed ICU. In univariate logistic regression analysis; advanced age, increased ASA class, preoperative waiting time for surgery, hypertension, coronary artery disease (CAD)/heart failure (HF), respiratory disease, thyroid disease, cerebrovascular disease, low hemoglobin, and hematocrit values were found to be important risk factors [(OR:1.05;p=0.022), (OR:9.10;p=0.000), (OR:1.23;p=0.024), (OR:3.78;p=0.003), (OR:17.95;p=0.000), (OR:6.86;p=0.000), (OR:7.80;p=0.003), (OR:6.04;p=0.000), (OR:0.63;p=0.004), (OR:0.89;p=0.040), respectively]. In multivariate logistic regression analysis; increased ASA class, hypertension, CAD/HF, respiratory disease, and hypoalbuminemia variables were found to be independent risk factors for patient admission to ICU [(OR:8.96;p=0.006), (OR:11.65;p=0.003), (OR:32.40;p=0.000), (OR:21.85;p=0.000), (OR:50.16;p=0.009), respectively]. Only the preoperative waiting time of the patients who had COVID-19 was prolonged (p=0.009).Conclusion: In geriatric patients undergoing hip surgery, increased ASA class, hypertension, CAD/HF diseases, respiratory disease, and hypoalbuminemia have been determined as risk factors associated with postoperative admission to the ICU.

Keywords:

elderly, geriatrics, hip fractures, intensive care unit, risk factors,

PDF

___

1. Marshall JC, Bosco L, Adhikari NK, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit. Care. 2017;37:270-276.
2. Talmor D, Shapiro N, Greenberg D, Stone PW, Neumann PJ. When is critical care medicine cost-effective? A systematic review of the cost-effectiveness literature. Crit Care Med. 2006;34(11):2738-2747.
3. Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA. 2020;323(16):1545-1546.
4. Arabi YM, Azoulay E, Al-Dorzi HM, et al. How the COVID-19 pandemic will change the future of critical care. Intensive Care Med. 2021;47(3):282-291.
5. Kim BH, Lee S, Yoo B, et al. Risk factors associated with outcomes of hip fracture surgery in elderly patients. Korean J Anesthesiol. 2015;68(6):561-567.
6. Egol KA, Konda SR, Bird ML, et al. Increased Mortality and Major Complications in Hip Fracture Care During the COVID-19 Pandemic: A New York City Perspective. J Orthop Trauma. 2020;34(8):395-402.
7. Tripathy SK, Varghese P, Panigrahi S, et al. Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: A systematic review and meta-analysis. World J Orthop. 2021;12(1):35-50.
8. Macey ARM, Butler J, Martin SC, Tan TY, Leach WJ, Jamal B. 30-day outcomes in hip fracture patients during the COVID-19 pandemic compared to the preceding year. Bone Jt Open. 2020;1(7):415-419.
9. Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2(3):281-284.
10. Dripps RD. New classification of physical status. Anesthesiologist 1963;24:111.
11. Zeyneloğlu P, Pirat A, Candan S, ve ark. Kalça protezi cerrahisi yapılan geriatrik hastaların yoğun bakım ünitesine kabul önbelirleyicileri. Yoğun Bakım Dergisi 2006;6(2):108-111.
12. Miniksar OH, Kacmaz O, Yuksek A, Aydin A, Oz H. Intensive Care Unit Admission Predictors of Geriatric Patients who Underwent Hemiarthroplasty due to Hip Fracture. J Crit Intensive Care. 2021;12(1):1-20.
13. Kamath AF, McAuliffe CL, Baldwin KD, Lucas JB, Kosseim LM, Israelite CL. Unplanned admission to the intensive care unit after total hip arthroplasty. J Arthroplasty. 2012;27(6):1027-1032.
14. Quinn TD, Gabriel RA, Dutton RP, Urman RD. Analysis of Unplanned Postoperative Admissions to the Intensive Care Unit. J Intensive Care Med. 2017;32(7):436-443.
15. Bennett A, Li H, Patel A, et al. Retrospective Analysis of Geriatric Patients Undergoing Hip Fracture Surgery: Delaying Surgery Is Associated With Increased Morbidity, Mortality, and Length of Stay. Geriatr Orthop Surg Rehabil. 2018;9:1-7.
16. Coburn M, Röhl AB, Knobe M, Stevanovic A, Stoppe C, Rossaint R. Anästhesiologisches Management in der Alterstraumatologie [Anesthesiological management of elderly trauma patients]. Der Anaesthesist. 2016;65(2):98-106.
17. Courtney PM, Whitaker CM, Gutsche JT, Hume EL, Lee GC. Predictors of the need for critical care after total joint arthroplasty: an update of our institutional risk stratification model. J Arthroplasty. 2014;29(7):1350-1354.
18. Patel SK, Kacheriwala SM, Duttaroy DD. Audit of Postoperative Surgical Intensive Care Unit Admissions. Indian J Crit Care Med. 2018;22(1):10-15.
19. AbdelSalam H, Restrepo C, Tarity TD, Sangster W, Parvizi J. Predictors of Intensive Care Unit Admission After Total Joint Arthroplasty. J Arthroplasty. 2012;27(5):720-725.
20. Sukhonthamarn K, Grosso MJ, Sherman MB, Restrepo C, Parvizi J. Risk Factors for Unplanned Admission to the Intensive Care Unit After Elective Total Joint Arthroplasty. J Arthroplasty. 2020;35(7):1937-1940.