Aysun YILMAZLAR, Ayça Sultan KOCABAŞ, Ulaş ÖZCAN, Ali AYDINLAR, Gayyur KURAP

Ortopedik cerrahide anestezi türü ve kardiyak risk faktörlerinin erken morbidite-mortalite ile ilişkisinin retrospektif olarak incelenmesi

Amaç: Kardiyak soruna sahip hastalarda anestezi türü seçimi morbidite ve mortalite açısından önemlidir. Çalışmamızda Revize Goldman Kardiyak Risk İndeksi' ni (RGKRÎ) kullanarak elektiftüm ortopedi ameliyatlarında kardiyak risk faktörü ile erken morbidite ve mortalitenin değerlendirilmesi ve anestezi türü ile ilişkisinin gösterilmesi amaçlanmıştır. Gereç ve Yöntem: 31 Aralık 2006 -1 Ocak 2008 tarihleri arasında Ortopedi ve Travmatoloji Anabilim Dalı tarafından ameliyat edilmiş tüm olguların (n-1095) cinsiyet, yaş, ASA, RGKRI, anestezi türü, cerrahi tipi, erken postoperatif morbidite ve mortalite kayıtları retrospektif olarak Anesteziyoloji ve Reanimasyon Anabilim Dalı arşivinden kaydedildi. Bulgular: Değerlendirmeye alınan 1095 hastanın 263'ünde kardiyak risk saptanmadı, geri kalan hastalar (%76) kardiyak riske sahipti ve bunların 64'ü (%5.8) yüksek kardiyak riskli hastalardı. Yüksek riskli olanlardan artroplasti ve ortopedik tümör cerrahi geçiren 2 hastada mortaliteye (%0.18) rastlandı. Bunlardan biri genel anestezi, diğeri spinal-epidural anestezi uygulanan hastalardı. Yaş ve ASA arttıkça RGKRI' nin arttığı gözlendi. RGKRI'nin en yüksek olduğu hasta grubunun travma cerrahisi (%32.8) ve diz ve kalça artroplasti geçiren (%20.3) hastalar olduğu gösterildi. Postoperatif kritik olaylara bakıldığında en fazla ağrı (%4) ve bulantı-kusma (%1.6) ile karşılaşıldı, bunlar genel anestezi uygulanan hastalardı. Çalışmada elde edilen verilerin istatistiksel analizi için "SPSS (Statistic Package for Social Sciences) 14.0" programı, Ki-kare testi, Kruskall Wallis testi ile Mann-Whitney-U testi kullanıldı. p< 0.05 değeri istatistiksel olarak anlamlı kabul edildi. Sonuç: Sonuç olarak; ortopedik cerrahide, artroplasti ve travma cerrahisinin RGKRI açısından yüksek olasılıkla risk altında olduğu; ancak anestezi türü ile mortalitenin risk açısından ilişkili olmadığı, ağrı ile bulantı-kusmanın genel anestezi alan hastalarda daha çok geliştiği bulunmuştur.

A retrospective analysis of the relationship between early morbidity - mortality and the type of anaesthesia and cardiac risk factors

Objective: The choice of anaesthesia type for patients with cardiac problems is of importance from the aspect of morbidity and mortality. Using the Revised Goldman Cardiac Risk Index (RGCRI), we aimed to evaluate the relationship between cardiac risk factors and early morbidity and mortality and the type of anaesthesia in all elective orthopaedic surgery. Method: Retrospective data consisting of gender, age, ASA, RGCRI, type of anaesthesia and surgery, early postoperative morbidity and mortality from the archives of the Department of Anaesthesia and Reanimation of all 1095 cases operated by the Department of Orthopaedics and Traumatology between December 31, 2006 and January 1, 2008 were recorded. Results: Of the 1095 cases evaluated 263 (24%) had no cardiac risk and of the remaining 76% at risk, 64 (5.8%) had high cardiac risk. Mortality was seen in 2 patients (0.18%) of high risk who had undergone arthroplasty and orthopaedic tumour surgery. One of these had had general anaesthesia and the other had had spinal-epidural anaesthesia. An increase in RGCRI was observed when age and ASA increased. RGCRI was seen to be highest in trauma surgery (32.8%) and arthroplasty surgery (20.3%). The most frequently occurring postoperative critical events were pain (4%) and nausea-vomiting (1.6%), and these were mostly patients to whom general anesthesia had been administered. Conclusion: According to the RGCRI there is a high probability of cardiac risk in knee and hip arthroplasty and trauma surgery whereas there was no relationship between anaesthesia type and mortality. Pain and nausea-vomiting was more frequent in patients who had undergone general anaesthesia.

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