Acil kolorektal cerrahi yapılan hastalarda mortaliteyi öngörmede Amerikan Anesteziyoloji Derneği Sınıflaması ve Charlson Komorbidite İndeksi’nin karşılaştırılması

Amaç: Acil kolorektal cerrahi yapılan hastalarda kolay uygulanabilir ve pratik olan ASA (Amerikan Anesteziyoloji Derneği Sınıflaması) ve CCI (Charlson Komorbidite İndeksi) gibi skorlama sistemlerini kullanarak preoperatif değerlendirme ile mortaliteyi öngörebilmeyi amaçladık.Gereç ve Yöntemler: Ocak 2014-Aralık 2017 tarihleri arasında Sağlık Bilimleri Üniversitesi Ankara Numune Eğitim ve Araştırma Hastanesi Genel Cerrahi/Acil Cerrahi Kliniğine başvuran Acil Kolorektal Cerrahi (AKC) yapılan 198 hastanın verileri retrospektif olarak incelendi. Hastaların demografik özellikleri, klinik tanıları, uygulanan cerrahi tipi, postoperatif komplikasyonlar, komorbiditeler, ASA ve CCI skorları elektronik veri tabanından elde edildi.Bulgular: 198 hastanın 95’i (%47,9) kadın ve 103’ü (%52,1) erkek idi. Ortanca yaş 62 (23 -93) olarak bulundu. 49(% 24) hastada mortalite gelişti. Mortalite gelişen hastaların ortanca ASA skoru: 4, CCI: 5 ve mortalite gelişmeyen hastaların ortanca ASA skoru: 3, CCI: 5 idi. Mortalite için ASA skoru istatistiksel olarak anlamlı bulundu (ASA için p=0,001 ve CCI için p=0,611).Sonuç: Bu çalışmanın, yüksek riskli hastaların yönetiminde pratik olarak kullanılabilecek basit ve yararlı veri sağladığına inanmaktayız. Acil kolorektal cerrahide, mortaliteyi öngörmede ASA skoru hızlı uygulanabilir ve yeterli bir skorlamadır.

Comparison of American Society of Anesthesiology Classification and Charlson's Comorbidity Index for predicting mortality in emergency colorectal surgery

Aim: We aimed to predict mortality by using preoperative evaluation scoring systems such as ASA (American Society of Anesthesiologists Classification) and CCI (Charlson Comorbidity Index), which are easily practicable in emergency colorectal surgery patients. Material and Methods: The data of 198 patients with Emergency Colorectal Surgery (ECS) who applied to Ankara Numune Training and Research Hospital General Surgery / Emergency Surgery Clinic of Health Sciences University between January 2014 and December 2017 were retrospectively analyzed. Demographic characteristics, clinical diagnoses, type of surgery, postoperative complications, comorbidities, ASA and CCI scores were obtained from electronic databases. Results: Of the 198 patients, 95 (47.9%) were female and 103 (52.1%) were male. The median age was 62 (23 -93). 49 (%24) mortality was seen in patients. The median ASA score was 4, the CCI was 5 in patients with mortality; and the median ASA score was 3, CCI was 5 in patients with no mortality. The ASA score for predicting mortality was found statistically significant (respectively p value for ASA and CCI; 0.001 and 0.611). Conclusion: We believe this study provides simple and useful data that can be used practically in the management of highrisk patients. In emergency colorectal surgery, ASA score is quickly applicable and adequate score for predicting mortality.

PDF

___

Jiang J, Lan Y, Lin T, Chen W et al. Primary vs. delayed resection for obstructive left-sided colorectal cancer: impact of surgery on patient outcome. Diseases of the Colon & Rectum 2008; 51: 306-11.
Fazio VW, Tekkis PP, Remzi F, Lavery IC. Assessment of operative risk in colorectal cancer surgery: the Cleveland Clinic Foundation colorectal cancer model. Diseases of the Colon & Rectum 2004; 47: 2015-24.
Jrvinen O, Laurikka J, Salenius J, Tarkka M, editors. Acute intestinal ischaemia. A review of 214 cases. Annales chirurgiae et gynaecologiae; 1994.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases 1987; 40: 373-83.
Roffman CE, Buchanan J, Allison GT. Predictors of non-use of prostheses by people with lower limb amputation after discharge from rehabilitation: development and validation of clinical prediction rules. Journal of physiotherapy 2014; 60: 224-31.
Molto A, Dougados M. Comorbidity indices. Clin Exp Rheumatol 2014; 32: 131-34. 7. 8. 9.
Hall WH, Ramachandran R, Narayan S, Jani AB, Vijayakumar S. An electronic application for rapidly calculating Charlson comorbidity score. BMC cancer 2004; 4: 94.
Erden A, Uzun Ş, Turgut H, Aypar Ü. Yaşlı hastalarda anestezi. Akademik Geriatri Dergisi 2009; 1: 162-66.
Kettunen J, Paajanen H, Kostiainen S. Emergency abdominal surgery in the elderly. Hepato-gastroenterology. 1995; 42: 106-8.
10. Duraes LC, Stocchi L, Dietz D et al. The disproportionate effect of perioperative complications on mortality within 1 year after colorectal cancer resection in octogenarians. Annals of surgical oncology 2016; 23: 4293-301.
11. Chang C-M, Yin W-Y, Wei C-K et al. Adjusted age-adjusted Charlson Comorbidity Index score as a risk measure of perioperative mortality before cancer surgery. PLoS One 2016; 11: 0148076.
12. Mayr R, May M, Martini T et al. Comorbidity and performance indices as predictors of cancer-independent mortality but not of cancer-specific mortality after radical cystectomy for urothelial carcinoma of the bladder. European urology 2012; 62: 662-70.
13. Ng ACC, Chow V, Yong ASC, Chung T, Kritharides L. Prognostic impact of the Charlson comorbidity index on mortality following acute pulmonary embolism. Respiration 2013; 85: 408-16.
14. Schneider EB, Hyder O, Brooke BS et al. Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors. Journal of the American College of Surgeons. 2012; 214: 390-98.
15. Smith J, Tilney H, Heriot A et al. Social deprivation and outcomes in colorectal cancer. British Journal of Surgery: Incorporating European Journal of Surgery and Swiss Surgery. 2006; 93: 1123-31.
16. Iversen LH. Aspects of survival from colorectal cancer in Denmark. Danish medical journal. 2012; 59: 4428