Minör Cerrahi Geçiren Geriatrik Hastalarda Mini Mental Durum Muayenesi, Barthel Günlük Yaşam Aktiviteleri İndeksi ve CSHA-Klinik Kırılganlık Ölçeği ile Postoperatif Bakım Kararı Verme
Öz
Amaç: Yaşlı hastalardaki majör cerrahileri takiben postoperatif sonucun tahmini, bilişsel işlev, işlevsel durum ve kırılganlıkla ilgili verilere dayanan bir karar verme süreci gerektirir. Bu çalışmada söz konusu parametrelerin minör cerrahiler için prediktif değerlerini değerlendirmeyi amaçladık.
Araçlar ve Yöntem: Elektif minör cerrahi planlanan American society of Anesthesiologists (ASA) skoru 1-3'e sahip ≥65 yaş hastalar çalışmaya alındı. Hastaneye yatıştaki kognitif fonksiyonu, fonksiyonel durumu ve kırılganlığı değerlendirmek için Mini Mental Test (MMSE), Barthel İndeksi (BI) ve Clinical Frailty Scale (CSHA-CFS) kullanıldı. Bu parametrelerin ameliyat sonrası yatış durumu ile ilişkileri değerlendirildi.
Bulgular: Doksan dokuz hasta çalışmaya dahil edildi. MMSE puanları, Barthel Indeksleri ve CSHA-CFS puanları tüm gruplarda benzerdi. Yatan hasta sayısı tek başına MMSE <24 (n=49 (%66.2)) veya MMSE<24 ve ASA>2 (n=19 (%82.6)) olan hastalarda daha fazlaydı. Kırılganlık skoru CSHA-CFS≥4 (n=33 (%75)) (p=0.025) veya ASA >2 (n=20 (%83.3)) (p=0.023) olan hastalarda yatan hasta sayısı daha yüksekti. ASA>2 olan hastalarda kırılganlık skorundan bağımsız olarak >1 gün yatış süresi (LOS) (p=0,036) ve yoğun bakım (PACU) kalış olasılığı (p=0.042) daha yüksekti. 30 gün içinde yeniden kabul ile parametreler arasında korelasyon yoktu.
Sonuç: ASA>2 ve MMSE<24 yatarak tedavi durumu ile korelasyon göstermektedir ve minör cerrahilerden sonra yaşlılarda kalış süresinin bir günden fazla olması için bağımsız bir prediktif faktördür. CSHA-CFS ≥4 olması ayrıca bağımsız olarak yatış verilmesi ile ilişkili bulunmuştur.
Anahtar Kelimeler
barthel indeksi kırılganlık minor cerrahi girişimler MMSE yatış süresi
Kaynakça
- 1. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489-495.
- 2. Artiles-Armas M, Roque-Castellano C, Conde-Martel A, et al. The comprehensive complication index is related to frailty in elderly surgical patients. J. Surg. Res. 2019;244:218-224.
- 3. Chao YT, Kuo FH, Lee YS, et al. Characteristics and Outcome Determinants of Hospitalized Older Patients with Cognitive Dysfunction. Int J Environ Res Public Health. 2022;19(1):584.
- 4. Kang Y, Zhang G-C, Zhu J-Q, et al. Activities of daily living associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery: An observational cohort study. Medicine. 2021;100(22):e26056.
- 5. Church S, Rogers E, Rockwood K, et al. Scoping review of the Clinical Frailty Scale. BMC geriatrics. 2020;20(1):1-18.
- 6. Mukadam N, Sampson EL. A systematic review of the prevalence, associations and outcomes of dementia in older general hospital inpatients. Int. Psychogeriatr. 2011;23(3):344-355.
- 7. Zekry D, Herrmann FR, Grandjean R, et al. Demented versus non-demented very old inpatients: the same comorbidities but poorer functional and nutritional status. Age Ageing. 2008;37(1):83-89.
- 8. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-M156.
- 9. Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J. Gerontol. A Biol. Sci. Med. Sci. 2004;59(3):M255-M263.
- 10. Shah R, Borrebach JD, Hodges JC, et al. Validation of the Risk Analysis Index for evaluating frailty in ambulatory patients. J Am Geriatr Soc. 2020;68(8):1818-1824.
- 11. Varley PR, Borrebach JD, Arya S, et al. Clinical utility of the risk analysis index as a prospective frailty screening tool within a multi-practice, multi-hospital integrated healthcare system. Ann. Surg. 2021;274(6): e1230-e1237.
- 12. Shinall MC, Arya S, Youk A, et al. Association of preoperative patient frailty and operative stress with postoperative mortality. JAMA surgery. 2020;155(1): e194620-e194620.
- 13. Andreou A, Lasithiotakis K, Venianaki M, et al. A comparison of two preoperative frailty models in predicting postoperative outcomes in geriatric general surgical patients. World J. Surg. 2018;42:3897-3902.
- 14. Lee SY, Lee S-H, Tan JH, et al. Factors associated with prolonged length of stay for elective hepatobiliary and neurosurgery patients: a retrospective medical record review. BMC Health Serv. Res. 2018;18(1):1-9.
- 15. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198.
- 16. Güngen C, Ertan T, Eker E, et al. [Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population]. Turk Psikiyatri Derg. 2002;13(4):273-281.
- 17. Collin C, Wade D, Davies S, et al. The Barthel ADL Index: a reliability study. Int. Disabil. Stud. 1988;10 (2):61-63.
- 18. Formiga F, Fort I, Robles MJ, et al. Comorbidity and clinical features in elderly patients with dementia: differences according to dementia severity. J Nutr Health Aging. 2009;13(5):423-427.
- 19. Duthie A, Chew D, Soiza R. Non-psychiatric comorbidity associated with Alzheimer’s disease. QJM. 2011;104(11):913-920.
- 20. Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J. Am. Coll. Surg. 2010;210(6):901-908.
- 21. Okabe H, Ohsaki T, Ogawa K, et al. Frailty predicts severe postoperative complications after elective colorectal surgery. Am J Surg. 2019;217(4):677-681.
- 22. Cheung A, Haas B, Ringer TJ, et al. Canadian study of health and aging clinical frailty scale: does it predict adverse outcomes among geriatric trauma patients? J. Am. Coll. Surg. 2017;225(5):658-665.
- 23. Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54(6):991-1001.
- 24. Birkelbach O, Mörgeli R, Spies C, et al. Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines–a retrospective observational study. BMC Anesthesiol. 2019;19(1):1-10.
- 25. Robinson TN, Wu DS, Pointer L, et al. Simple frailty score predicts postoperative complications across surgical specialties. Am. J. Surg. 2013;206(4):544-550.
- 26. Merkow RP, Ju MH, Chung JW, et al. Underlying reasons associated with hospital readmission following surgery in the United States. Jama. 2015;313(5):483-495.
- 27. Glance LG, Kellermann AL, Osler TM, et al. Hospital readmission after noncardiac surgery: the role of major complications. JAMA Surg. 2014;149(5):439-445.
- 28. Lin HS, Watts JN, Peel NM, et al. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157.
- 29. Shahrokni A, Tin A, Alexander K, et al. Development and evaluation of a new frailty index for older surgical patients with cancer. JAMA Network Open. 2019;2 (5):e193545-e193545.
Decision-making for Postoperative Care in Geriatric Patients Undergoing Minor Surgeries using Mini Mental State Examination, Barthel Index of Activities of Daily Living and CSHA-Clinical Frailty Scale
Öz
Purpose: Prediction of postoperative outcome following major surgery in elderly patients requires a decision-making process based on data on cognitive function, functional status and frailty. In this study, we aimed to evaluate the predictive value of these parameters for minor surgeries.
Materials and Methods: Patients aged ≥65 years with American society of Anesthesiologists (ASA) score 1-3 scheduled for elective minor surgery were included in the study. Mini Mental Test (MMSE), Barthel Index (BI) and Clinical Frailty Scale (CSHA-CFS) were used to assess cognitive function, functional status and frailty at hospitalization. The associations of these parameters with postoperative hospitalization status were evaluated.
Results: Ninety-nine patients were included in the study. MMSE scores, Barthel Indices and CSHA-CFS scores were similar in all groups. The number of inpatients was higher in patients with MMSE<24 alone (n=49 (66.2%)) or MMSE<24 and ASA>2 (n=19 (82.6%)). The number of inpatients was higher in patients with a frailty score of CSHA-CFS≥4 (n=33 (75%)) (p=0.025) or ASA >2 (n=20 (83.3%)) (p=0.023). Patients with ASA>2 were more likely to have >1 day length of stay (LOS) (p=0.036) and intensive care unit (PACU) stay (p=0.042), independent of the frailty score. Readmission within 30 days was not correlated with the parameters.
Conclusion: ASA>2 and MMSE<24 correlate with inpatient status and are independent predictive factors for length of stay of more than one day in the elderly after minor surgery. CSHA-CFS ≥4 was also independently associated with hospitalization.
Anahtar Kelimeler
barthel index frailty length of stay minor surgical procedures MMSE
Teşekkür
We would like to thank to our collegues and proffesors for their support and valued contributions.
Kaynakça
- 1. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489-495.
- 2. Artiles-Armas M, Roque-Castellano C, Conde-Martel A, et al. The comprehensive complication index is related to frailty in elderly surgical patients. J. Surg. Res. 2019;244:218-224.
- 3. Chao YT, Kuo FH, Lee YS, et al. Characteristics and Outcome Determinants of Hospitalized Older Patients with Cognitive Dysfunction. Int J Environ Res Public Health. 2022;19(1):584.
- 4. Kang Y, Zhang G-C, Zhu J-Q, et al. Activities of daily living associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery: An observational cohort study. Medicine. 2021;100(22):e26056.
- 5. Church S, Rogers E, Rockwood K, et al. Scoping review of the Clinical Frailty Scale. BMC geriatrics. 2020;20(1):1-18.
- 6. Mukadam N, Sampson EL. A systematic review of the prevalence, associations and outcomes of dementia in older general hospital inpatients. Int. Psychogeriatr. 2011;23(3):344-355.
- 7. Zekry D, Herrmann FR, Grandjean R, et al. Demented versus non-demented very old inpatients: the same comorbidities but poorer functional and nutritional status. Age Ageing. 2008;37(1):83-89.
- 8. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-M156.
- 9. Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J. Gerontol. A Biol. Sci. Med. Sci. 2004;59(3):M255-M263.
- 10. Shah R, Borrebach JD, Hodges JC, et al. Validation of the Risk Analysis Index for evaluating frailty in ambulatory patients. J Am Geriatr Soc. 2020;68(8):1818-1824.
- 11. Varley PR, Borrebach JD, Arya S, et al. Clinical utility of the risk analysis index as a prospective frailty screening tool within a multi-practice, multi-hospital integrated healthcare system. Ann. Surg. 2021;274(6): e1230-e1237.
- 12. Shinall MC, Arya S, Youk A, et al. Association of preoperative patient frailty and operative stress with postoperative mortality. JAMA surgery. 2020;155(1): e194620-e194620.
- 13. Andreou A, Lasithiotakis K, Venianaki M, et al. A comparison of two preoperative frailty models in predicting postoperative outcomes in geriatric general surgical patients. World J. Surg. 2018;42:3897-3902.
- 14. Lee SY, Lee S-H, Tan JH, et al. Factors associated with prolonged length of stay for elective hepatobiliary and neurosurgery patients: a retrospective medical record review. BMC Health Serv. Res. 2018;18(1):1-9.
- 15. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198.
- 16. Güngen C, Ertan T, Eker E, et al. [Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population]. Turk Psikiyatri Derg. 2002;13(4):273-281.
- 17. Collin C, Wade D, Davies S, et al. The Barthel ADL Index: a reliability study. Int. Disabil. Stud. 1988;10 (2):61-63.
- 18. Formiga F, Fort I, Robles MJ, et al. Comorbidity and clinical features in elderly patients with dementia: differences according to dementia severity. J Nutr Health Aging. 2009;13(5):423-427.
- 19. Duthie A, Chew D, Soiza R. Non-psychiatric comorbidity associated with Alzheimer’s disease. QJM. 2011;104(11):913-920.
- 20. Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J. Am. Coll. Surg. 2010;210(6):901-908.
- 21. Okabe H, Ohsaki T, Ogawa K, et al. Frailty predicts severe postoperative complications after elective colorectal surgery. Am J Surg. 2019;217(4):677-681.
- 22. Cheung A, Haas B, Ringer TJ, et al. Canadian study of health and aging clinical frailty scale: does it predict adverse outcomes among geriatric trauma patients? J. Am. Coll. Surg. 2017;225(5):658-665.
- 23. Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54(6):991-1001.
- 24. Birkelbach O, Mörgeli R, Spies C, et al. Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines–a retrospective observational study. BMC Anesthesiol. 2019;19(1):1-10.
- 25. Robinson TN, Wu DS, Pointer L, et al. Simple frailty score predicts postoperative complications across surgical specialties. Am. J. Surg. 2013;206(4):544-550.
- 26. Merkow RP, Ju MH, Chung JW, et al. Underlying reasons associated with hospital readmission following surgery in the United States. Jama. 2015;313(5):483-495.
- 27. Glance LG, Kellermann AL, Osler TM, et al. Hospital readmission after noncardiac surgery: the role of major complications. JAMA Surg. 2014;149(5):439-445.
- 28. Lin HS, Watts JN, Peel NM, et al. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157.
- 29. Shahrokni A, Tin A, Alexander K, et al. Development and evaluation of a new frailty index for older surgical patients with cancer. JAMA Network Open. 2019;2 (5):e193545-e193545.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Anesteziyoloji |
| Bölüm | Bilimsel Araştırma Makaleleri |
| Yazarlar | |
| Erken Görünüm Tarihi | 5 Nisan 2024 |
| Yayımlanma Tarihi | 29 Nisan 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 8 Sayı: 1 |
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