The analysis of scoring systems predicting mortality in geriatric emergency abdominal surgery

BACKGROUND: Accurate measurement of surgical outcomes, proper evaluation of hospitals and surgeons regardless of case can be performed by mortality prediction models. The aim of this study was to analyze factors affecting mortality, present our clinical experience and patient profile and evaluate different scoring systems in use of these patients.
METHODS: A retrospective review of one hundred and twelve geriatric patients who underwent major abdominal emergency surgery between 2004 and 2008 was performed. APACHE II, ODIN, SAPS II expanded, P-POSSUM, Manheim peritonitis and Charlson comorbidity index, Goldman and ASA scores were calculated using patient data. Sensitivity, positive predictive value and Odd’s ratio were calculated to predict the mortality for these scoring systems.
RESULTS: The overall mortality rate for our patients was found 33.9%. The factors affecting mortality in this study were found to be the duration of initial complaint, requirement of intensive care unit, requirement of mechanical ventilation and its duration, the presence of coexisting disease and peritonitis.
CONCLUSION: According to our study, in this particular group of patients, APACHE II scoring system is more valid and accurate in estimating the mortality risk when compared to other scoring systems.

Geriatrik abdominal acil cerrahide mortaliteyi öngörmede skorlama sistemlerinin analizi

AMAÇ: Cerrahi sonuçlarýn doðru ölçümü, hastane ve cerrahýn doðru deðerlendirilmesi, olgudan baðýmsýz olarak mortalite tahmin yöntemleri tarafýndan yapýlýr. Bu çalýþmanýn amacý, mortaliteyi etkileyen faktörleri analiz etmek, klinik deneyimimizi ve hasta profilimizi sunmak ve bu hastalarda farklý skorlama sistemlerinin kullanýmýný araþtýrmaktýr.
GEREÇ VE YÖNTEM: 2004-2008 yýllarý arasýnda majör abdominal acil cerrahi geçirmiþ 112 yaþlý hastanýn dosyasý geriye dönük olarak incelendi. APACHE II, ODIN, SAPS II geniþletilmiþ, P-POSSUM, Manheim peritonit skoru, Charlson komorbidite indeksi, Goldman ve ASA skorlarý hesaplandý. Bu skorlama sistemlerinin mortaliteyi öngörme açýsýndan duyarlýlýk, pozitif prediktif deðer ve odds oranlarý hesaplandý.
BULGULAR: Hastalarýmýz için tüm mortalite oraný %33.9 oldu. Bu çalýþmada mortaliteyi etkileyen faktörler baþlangýç þikayeti, yoðun bakým ihtiyacý, mekanik ventilasyon ihtiyacý ve süresi, peritonit varlýðý ve eþlik eden hastalýk durumu olarak belirlendi.
TARTIÞMA: Buna göre, bizim çalýþmamýzda APACHE II skorlama sisteminin bu grup hastalarda mortalite riskini öngörmede daha gerçekçi sonuçlar verdiði saptanmýþtýr.