Ayşenur SÜMER COŞKUN, Şenay ÖZTÜRK DURMAZ

Covıd-19 Enfekte Hastalarda Cerrahi Operasyonlar, Prognoz-Mortalite Değerlendirmesi

Amaç: Pandeminin başlangıcından bu yana çeşitli makalelerde SARS-CoV-2 ile enfekte hastaların cerrahisinde olumsuz sonuçlar bildirilmiştir. Ancak sayıların yetersizliği ve vaka çeşitliliği açısından yeni verilere ihtiyaç duyulmaktadır. Bu çalışmanın amacı, perioperatif dönemde SARSCoV-2 ile enfekte hastaların, ameliyat sonrası prognozlarını bildirmektir. Yöntemler: Ameliyat geçirmiş bireylerde, ameliyattan 14 gün öncesine veya ameliyattan 14 gün sonrasına kadar nazofarengeal sürüntülerinde Polimeraz Zincir Reaksiyonu (PCR) ile COVID-19 (+) oldukları tespit edilen veya temas öyküsü bulunup semptomları olan ya da çekilen toraks tomografilerinde COVID-19 bulgusu saptanan hastalar çalışmaya dahil edildi. Hastaların demografik verileri, PCR test sonuçları, toraks tomografi bulguları, ASA skorları, ek hastalıkları, cerrahi tipi, operasyon süreleri, anestezi türü, hastaların taburculuk günü ve yoğun ba-kım/servis yatış günleri hasta dosyaları ve elektronik kayıtlardan elde edildi.Bulgular: Hastanemizde toplam 3093 hasta opere edilmiştir. Bu hasta-lardan 40’ı kesin veya olası COVID-19 olarak çalışmaya dahil edildi. Opere edilen 40 hastadan 5’i (%12,5) operasyon sonrası dönemde eksitus olmuştur. Eksitus olan hastaların yaş ortalaması 69,6 idi. Ölen hastalarda 4’ü (%80) erkek, 1’i (%20) kadın cinsiyetinde idi. Ölen hastaların 4’ünde eşlik eden hastalıklar mevcuttu. Hiçbir ameliyathane çalışanı cerrahi geçiren bu hastalarla ilişkili COVID-19 enfeksiyonu geçirmemiştir.Sonuç: Hastanemizde SARSCoV-2 ile enfekte hastaların cerrahi sonrası ölüm oranlarının literatürden biraz daha düşük olduğunu saptadık. Çalışmamızdan elde edilen veriler ışığında, acil cerrahi vakalar dışında elektif vakalar ertelenmelidir. Erkek cinsiyet, ileri yaş, 2 veya daha fazla eşlik eden hastalığın varlığı, COVID-19 (+) hastalarda ameliyat sonrası olumsuz sonuçlar için risk faktörleridir.

Anahtar Kelimeler:

COVID-19, SARS-CoV-2, pandemi, cerrahi, elektif

Percutaneous Endoscopic Gastrostomy Experience of a Tertiary Health Center

Introduction and Aim: Percutaneous endoscopic gastrostomy (PEG) is a low-risk, inexpensive, accessible and technically easier enteral procedure that can be performed in endoscopy units or at the bedside, in which intravenous or local agents can be used for sedation. In our study, we aimed to evaluate the indications, complications and outcomes of the patients who underwent PEG in our clinic. Materials and Methods: Patients who underwent percutaneous endoscopic gastrostomy (PEG) procedure between January 2015 and March 2021 in the general surgery endoscopy unit of a tertiary healthcare centre were included in the study. The clinical data of the cases, complications due to PEG, and mortality were investigated. Results: Of 260 patients with PEG, 158 (60.7%) were male and 102 (39.3%) were female. The mean age of the patients was 65.23 years (range 18-92 years). The clinic that requested PEG most frequently was the anesthesia and reanimation intensive care clinic (n=146; 56.1%). The most common indication for PEG was oral intake disorder due to cerebrovascular disease (n=194, 74.6%). Complications (6 early and 10 late) developed in 16 (6.1%) patients after PEG application. The most common early complication was peristomal infection (n=4, 1.5%). The most common late complication (n=7; 2.7%) was PEG catheter occlusion. While no mortality was observed in any patient due to PEG application, mortality secondary to primary disease was observed in 62 (23.8%) patients in the first 30 days. Discussion and Conclusion: Percutaneous endoscopic gastrostomy is a fast, safe and cost-effective method that does not require general anesthesia and can be performed by an experienced team in patients who require enteral nutrition.

Keywords:

Percutaneous endoscopic gastrostomy, complication, mortality.,

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Referans1. Yu P, Zhu J, Zhang Z, et al. A familial cluster of infection associated with the 2019 novel coronavirus indicating possible person-to-person transmission during the incubation period. J Infect Dis. 2020; 221(11): 1757-61.
Referans2. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü [Internet]. Covid-19 (SARS-CoV-2 İnfeksiyonu) Rehberi. Bilim Kurulu Çalışması. 12 Nisan 2020. [erişim 12 Nisan 2020]. https://ohsad.org/wp-content/uploads/2020/04/COVID-19_Rehberi-1.pdf.
Referans3. Patel NG, Reissis D, Mair M, et al. Safety of major reconstructive surgery during the peak of the COVID-19 pandemic in the United Kingdom and Ireland – multicentre national cohort study. J Plast Reconstr Aesthet Surg. 2021; 74(6): 1161-72.
Referans4. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans: Elective surgery during the SARS-CoV-2 pandemic. Br J Surg. 2020; 107(11): 1440-49.
Referans5. T.C. Sağlık Bakanlığı COVID-19 Rehberleri [İnternet]. Ankara: T.C. Sağlık Bakanlığı [erişim 13 Ekim 2020]. https://covid19bilgi. saglik.gov.tr/tr/
Referans6. American Society of Anesthesiologists Clinical Information [Internet]. Schaumburg, IL: American Society of Anesthesiologists; 2020. ASA Physical Status Classification System [Erişim:10 Eylül 2021]. https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system
Referans7. American Society of Anesthesiologist, Anesthesia Patient Safety Foundation [Internet]. The ASA and APSF joint statement on perioperative testing for the COVID-19 virus. [erişim 13 Ekim 2020] https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/asa-and-apsf-joint-statement-on-perioperative-testing-for-the-covid-19-virus.
Referans8. Glasbey JC, Nepogodiev D, Simoes JFF, et al. Elective cancer surgery in COVID‐19‐free surgical pathways during the SARS‐CoV‐2 pandemic: an international, multicenter, comparative cohort study. J Clin Oncol. 2021; 39(1): 66-78.
Referans9. Jonker PKC, van der Plas WY, Steinkamp PJ, et al. Perioperative SARS‐CoV‐2 infections increase mortality, pulmonary complications, and thromboembolic events: a Dutch, multicenter, matched‐cohort clinical study. Surgery. 2021; 169(2): 264-74.
Referans10. Coşkun AS. Postoperatif Yoğun Bakıma Kabul Edilen Hastaların 1 Yıllık İncelenmesi. Acta Med Nicomedia. 2020; 3(3): 105-8.
Referans11. Lei S, Jiang F, Su W, et.al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020; 21: 100331.
Referans12. COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. COVIDSurg Collaborative. Lancet. 2020; 396(10243): 27-38.
Referans13. Li SG, Sun TS, Liu Zet al. Factors influencing postoperative mortality one year after surgery for hip fracture in Chinese elderly population. Chin Med J (Engl). 2013; 126(14): 2715-9.
Referans14. Liu JL, Wang XL, Gong MW, et al. Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients. Patient Prefer Adherence. 2014; 8: 651-9.
Referans15. Qiu C, Chan PH, Zohman GL, et al. Impact of Anesthesia on Hospital Mortality and Morbidities in Geriatric Patients Following Emergency Hip Fracture Surgery. J Orthop Trauma. 2018; 32(3): 116-23.
Referans16. COVIDSurg Collaborative. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia. 2021; 76(6): 748-58.
Referans17. Chong SMY, Hung RKY , Gwozdz A, et al. 30-Day postoperative COVID-19 outcomes in 398 patients from regional hospitals utilising a designated COVID-19 minimal surgical site pathway. Annals 2021; 103(6): 395-403