Zehra TUTAL BAYKAL, ÇİĞDEM YILDIRIM GÜÇLÜ, Çiğdem Evren DENKER

Koroner arter bypass greft cerrahisi uygulanan hastalarda euroscore ve care risk değerlendirme modellerinin retrospektif olarak karşılaştırılması

Amaç: KABG cerrahisinden sonra komplikasyonların gelişme ihtimalini cerrahi öncesi değerlendirme sırasında öngörebilmek için bazı risk belirleme yöntemleri kullanılmaktadır. Bu çalışmada; KABG operasyonu geçiren hastalarda EuroSCORE ile CARE risk modellerinin cerrahi sonrası mortalite ve morbiditeleri öngörme kapasitelerinin karşılaştırılması amaçlanmıştır. Yöntem: Çalışmaya 200 hasta alınmıştır. Yoğun bakımda ve hastanede kalış süreleri, mortalite, uzamış hastane ve yoğun bakım ihtiyacı, inme/serebrovasküler olay, miyokard enfarktüsü, cerrahi yara enfeksiyonu, reoperasyon, sepsis ve/veya endokardit, akut böbrek yetmezliği, solunum yetmezliğine ilişkin veriler geriye dönük olarak toplanmıştır. Risk değerlendirmesi için daha önce literatürde önerilen yöntemler kullanılmıştır. Bulgular: Çalışmaya alınan hastaların ortanca EuroSCORE değeri 2 (0-11) saptanırken 109 hastanın düşük risk, 60 hastanın orta risk, 31 hastanın ise yüksek risk grubunda olduğu görülmüştür. CARE risk gruplarının dağılımında ise 104 hasta 1. grupta, 65 hasta 2. grupta, 24 hasta 3. grupta, 5 hasta 4. grupta, 2 hasta ise 5. grupta saptanmıştır. Hastaların EuroSCORE ve CARE risk gruplarındaki dağılımları birbiriyle uyumlu ve koreledir (p: 0.0001). CARE skorlama modelinde risk arttıkça cerrahi sonrası stroke/serebrovasküler olay, transmural miyokard enfarktüsü, yara yeri enfeksiyonu, sepsis/endokardit, akut böbrek yetmezliği, solunum yetmezliği, uzamış hastane ve yoğun bakım yatışı ve uzamış entübasyon süresi sıklığı belirgin şekilde artmaktadır (p: 0.001 0.0001). EuroSCORE modelinde risk arttıkça cerrahi sonrası yara yeri enfeksiyonu, akut böbrek yetmezliği, solunum yetmezliği, uzamış hastane ve yoğun bakım yatışı ve uzamış entübasyon süresi sıklığı belirgin şekilde artmaktadır (p: 0.024 0.0001). Sonuç: Çalışmamızda EuroSCORE ve CARE risk modellerinin KABG cerrahisi geçiren Türk hasta popülasyonunda, cerrahi sonrası mortalite, uzamış yoğun bakım ve/veya hastane yatış sürelerini öngörmede benzer etkinlikle kullanılabilecekleri sonucuna varılmıştır.

Retrospective comparison of euroscore and care risk evaluation models in a group of coronary artery bypass graft patients

Objective: Risk models that predict postoperative mortality and morbidities in CABG patients gain more importance in clinical practice. In this study we aimed to compare the efficacy and predictive powers of EuroSCORE and CARE models in a group of patients who have undergone CABG. Method: 200 patients were included in the study. Data regarding length of intensive care and hospital stay, hospital mortality, stroke, transmural myocardial infarction, surgical site infection, reoperation, sepsis/endocarditis, acute renal failure, respiratory failure was collected retrospectively. Risk stratifications were performed according to routine EuroSCORE and CARE questionnaire forms. Results: Median EuroSCORE value was 2 (0-11) while 109 patients were in low risk, 60 patients were in medium risk and 31 patients were in high risk groups. CARE risk group distribution was as follows; 104 patients in group 1, 65 patients in group 2, 24 patients in group 3, 5 patients in group 4, 2 patients in group 5. Distribution of patients in EuroSCORE and CARE risk groups were correlated with each other (p: 0.0001). Increased CARE risk was associated with increased stroke, transmural myocardial infarction, surgical site infection, sepsis, acute renal failure, respiratory failure, increased intensive care and hospital stay rates (p: 0.001 - 0.0001). Increased EuroSCORE risk was associated with increased surgical site infection, acute renal failure, respiratory failure, increased intensive care and hospital stay rates (p: 0.024 - 0.0001). Conclusion: According to our study both EuroSCORE and CARE risk models were both effective predictors for mortality, increased hospital and intensive care stay and occurence of any defined morbidity in Turkish population.

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