Is there a predictive value of the preoperative neutrophil-lymphocyte ratio in terms of intensive care need in geriatric patients who underwent pertrochanteric fracture surgery?

BACKGROUND: Pertrochanteric fractures are serious health problem with an ever-increasing prevalence in elderly population. Potential post-operative intensive care need leads to delays in the timing of surgery due to the referral of patients to better equipped hospitals as well as the inability to arrange a reserved intensive care bed. The purpose of this study is to investigate whether pre-op-erative neutrophillymphocyte ratio (NLR) has predictive value in terms of post-operative intensive care need in geriatric patients who underwent surgery following pertrochanteric fractures.
METHODS: A total of 535 patients aged 65 years and above with hip fractures who presented to the emergency service between 2017 and 2020 were retrospectively screened. Out of 535 patients, 317 patients who met the inclusion and exclusion criteria were included in the study. The screened patient population was divided into two groups as those followed in the post-operative intensive care unit (ICU) and those followed in the orthopedic ward.
RESULTS: There were 190 patients (59.9%) who were followed in the orthopedic ward postoperatively and 127 (40.1%) patients followed in the ICU postoperatively. While the mean pre-operative NLR value of all patients was 6.57, the mean pre-operative NLR of the patients who were followed up postoperatively in the orthopedic ward was 5.85, and the mean NLR of those who were followed up in the ICU was 7.65. It was found that the admission NLR values of the ICU group patients were significantly higher compared to those of the orthopedic ward group (p<0.001) and also the cutoff value of NLR was calculated as 6.14.
CONCLUSION: We believe that this objective, simple, cost-effective, and rapid marker can be used in combination with other parameters to predict ICU need to prevent surgical delays due to the lack of a reserved intensive care bed in the ASA 3 geriatric patient group with pertrochanteric fractures, whose intensive care need cannot be clarified, thereby reducing mortality and morbidity.

Pertrokanterik femur kýrýðý geçiren geriatrik hastalarda preoperatif nötrofil-lenfosit oranýnýn yoðun bakým ihtiyacý açýsýndan prediktif deðeri var mý?

AMAÇ: Pertrokanterik femur kýrýklarý, yaþlý popülasyonda giderek artan prevalansý ile ciddi bir saðlýk sorunudur. Muhtemel ameliyat sonrasý yoðun bakým ihtiyacý, hastalarýn daha donanýmlý hastanelere sevk edilmek zorunda kalmasýnýn yaný sýra, rezerve bir yoðun bakým yataðý ayarlanamamasý nedeniyle ameliyat zamanlamasýnda gecikmelere yol açmaktadýr. Bu çalýþmanýn amacý, pertrokanterik femur kýrýðý sonrasý cerrahi uygulanan geriatrik hastalarda ameliyat öncesi nötrofil-lenfosit oranýnýn (NLO) ameliyat sonrasý yoðun bakým ihtiyacý açýsýndan prediktif deðeri olup olmadýðýný araþtýrmaktýr. GEREÇ VE YÖNTEM: 2017–2020 yýllarý arasýnda acil servise baþvuran 65 yaþ ve üzeri 535 kalça kýrýðý tanýlý hasta retrospektif olarak tarandý. Beþ yüz otuz beþ hastadan dahil etme ve dýþlama kriterlerini karþýlayan ASA 3 skorlu 317 hasta çalýþmaya alýndý. Taranan hasta popülasyonu ameliyat sonrasý yoðun bakým ünitesinde (YBÜ) ve ortopedi ve travmatoloji servisinde takip edilenler olarak iki gruba ayrýldý.
BULGULAR: Ameliyat sonrasý ortopedi ve travmatoloji servisinde takip edilen 190 hasta (%59.9) ve ameliyat sonrasý yoðun bakýmda takip edilen 127 hasta (%40.1) mevcuttu. Tüm hastalarda ortalama ameliyat öncesi NLO 6.57 iken, ameliyat sonrasý ortopedi ve travmatoloji servisinde takip edilen has-talarýn ortalama ameliyat öncesi NLO deðeri 5.85, YBÜ’de izlenenlerin ortalama NLO deðeri 7.65 olarak bulundu. YBÜ grubu hastalarýnýn baþvuru NLO deðerlerinin ortopedi servisi grubuna göre anlamlý derecede yüksek olduðu saptandý (p<0.001). Ayrýca NLO için kestirim deðeri 6.14 olarak hesaplandý. TARTIÞMA: Yoðun bakým ihtiyacý tam olarak belirsiz olan pertrokanterik kýrýklý ortogeriatrik ASA 3 hastalar için bulduðumuz bu objektif, basit, uygun maliyetli ve hýzlý belirtecin baþka belirteçlerle kombine edilmesinin yoðun bakým ihtiyacýný öngörmede yardýmcý olabileceðine ve böylece rezerve YBÜ yataðýnýn bulunmamasý nedeniyle oluþan cerrahi gecikmelerin önlenebileceðine, dolayýsýyla bu gecikmelerden kaynaklanan mortalite ve morbiditenin azaltýlabileceðine inanýyoruz.