TUFAN EGELİ, Serhan DERİCİ, Cihan AĞALAR, Süleyman Özkan AKSOY, Tayfun BİŞGİN, Ali CEVLİK, Mücahit ÖZBİLGİN, Başak BAYRAM, Aras Emre CANDA

GERİATRİK HASTALARDA AKUT KARIN NEDENLERİ, ACİL CERRAHİ GİRİŞİM ENDİKASYONLARI VE POSTOPERATİF KOMPLİKASYONLARLA CHARLSON KOMORBİDİTE İNDEKSİ İLİŞKİSİNİN DEĞERLENDİRİLMESİ

Giriş: Bu çalışmada geriatrik hasta grubunda akut karına yol açan nedenlerin, acil cerrahi girişim endikasyonlarının belirlenmesi ve Charlson Komorbidite indeksi skoru ile postoperatif komplikasyon gelişimi arasındaki ilişkinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya Ocak 2016-Aralık 2016 tarihleri arasında, Dokuz Eylül Üniversitesi Hastanesi Acil Servisi’ne, travmatik olmayan akut karın ağrısı şikayeti ile başvuran ve genel cerrahi servisine yatışı yapılan 65 yaş ve üzeri hastalar alındı. Hastalar cinsiyet, yaş, karın ağrısı etiyolojisi, eşlik eden hastalıklar, radyolojik tanı yöntemi, CKİ skoru, uygulanan tedavi yöntemleri (medikal/cerrahi), uygulanan cerrahi girişim tipi bakımından değerlendirmeye alındı. Cerrahi tedavi uygulanan hastalarda CKİ skorunun prognozla ilişkisi araştırıldı. Bulgular: Çalışmaya 128(%53.1)’i erkek, 113(%46.9) kadın olmak üzere 241 hasta alındı. Hastaların ortanca yaşı 74(65-92)’tü. Akut karına yol açan en sık patolojiler sırasıyla; 106(%43.9)ileus, 53(%21.9)akut kolesistit ve 35(%14.5) akut apandisitti. Doksan bir (%37.8) hastaya cerrahi müdahale yapıldı. Toplamda 9(%3.7) hastada mortalite gelişti. Cerrahi tedavi uygulanan hastaların 13(%14.3)’ünde morbidite, 4(%4.4)’ünde mortalite gelişti. Bu hastalar CKİ skoruna göre değerlendirildiğinde CKİ≥5 olan 37 hastanın 9(%24.3)’unda komplikasyon geliştiği saptandı (p=0.023) ve istatistiksel olarak anlamlıydı. Sonuç: Geriatrik hastalarda akut karın nedenleri genç hastalara kıyasla farklılıklar göstermektedir. Bu olgularda tanı konulması da nispeten daha zordur. Geriatrik hastalarda acil cerrahi girişim gerektiren patolojiler benzerdir ve postoperatif prognozu belirlemede CKİ skoru faydalı bir araç olarak kullanılabilir.

CAUSES OF ACUTE ABDOMINAL PAIN, INDICATIONS OF URGENT SURGERY IN GERIATRIC PATIENTS AND ANALYSIS OF RELATIONSHIP BETWEEN POSTOPERATIVE COMPLICATIONS AND CHARLSON COMORBIDITY INDEX

Introduction: In this study, we aim to demonstrate the indications of emergency surgery for diseases causing acute abdomen in geriatric population and examine the relationship between Charlson Comorbidity Index (CCI) score and occurence of post operative complications. Materials and Method: We included patients aged 65 or older who applied to Dokuz Eylul University Hospital Emergency Department with non-traumatic acute abdomen signs and transferred to general surgery department in-patient unit. Patients are grouped regarding age, gender, etiology of abdominal pain, concommitant disease, diagnostic radiologic method, CCI score, method of treatment (surgical/medical), type of surgical intervention. We examined the relationship between CCI score and prognosis in surgically treated patients. Results: We included total of 241 patients, 128 males (%53.1) and 113 females (46.9%). Median age of the patients are calculated as 74 (65-92). The most common diseases causing acute abdominal pain are ileus (106, 43.9%) acute cholecystitis (53, 21.9%) and acute appendicitis (35, 14%) respectively. Ninetyone (37.8%) patients are treated with surgical interventions. In total 9(3.7%) patients were deceased. In patients treated surgically, 13 (14.3%) morbidity and 4 (4.4%) mortality occured. When compared in terms of CCI score, 9(24.3%) of 37 patients whose CCI≥5 were developed postoperative complications (p=0.023) and it was statistically significant. Conclusion: The etiology of acute abdominal pain differs in geriatric patients when compared to general population. In these patients, diagnosis is relatively difficult. In geriatric patients, diseases that require surgical intervention are grossly similar and CCI score can be used to predict the prognosis in these kind of patients.

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