Ulus Travma Acil Cerrahi Derg. 2010; 16(5): 439-444

Geriatrik akut cerrahi karýnda mortalite ve morbiditeyi etkileyen faktörler

Erkan Özkan, Mehmet Mahir Fersahoðlu, Ender Dulundu, Yahya Özel, Mehmet Kamil Yýldýz, Ümit Topaloðlu
Haydarpaþa Numune Eðitim Ve Araþtýrma Hastanesi, 5.genel Cerrahi Kliniði, Ýstanbul

AMAÇ
Çalýþmamýzýn amacý, abdominal cerrahi giriþim uygulanan yaþlý hastalarda morbidite ve mortaliteyi etkileyen nedenleri incelemektir.
GEREÇ VE YÖNTEM
Akut karýn nedeniyle ameliyat edilen 65 yaþ ve üzerindeki 92 hastada cerrahi endikasyonlar, morbidite ve mortalite oranlarý ve bunlar üzerine etkili olan faktörler yönünden incelendi. Hastalarýn 48’i (%52,2) erkek, 44’ü (%47,8) kadýndý. Ortalama yaþ 73,32±6,37 (65-92) idi.
BULGULAR
En sýk cerrahi endikasyon akut kolesistitdi (%26,09). Morbidite sayýsý 21 (%22,82) oldu. Mortalite sayýsý 14 (%15,21) olup en sýk neden mezenterik vasküler oklüzyondu. Yoðun bakýma giden hastalarýn %90,05’i, ölümle sonuçlanan vakalarýn %92,85’i Amerikan Anesteziyoloji Derneði skoru (ASA) IV idi. Ortalama hastanede kalýþ süresi 7,94±7,13 (medyan deðeri 7) gün bulundu. Ýleri yaþ, yüksek ASA skorunun morbidite, mortalite, hastanede kalýþ süresi üzerinde anlamlý etkisi görülürken, cinsiyetin anlamlý bir fark oluþturmadýðý görüldü (p>0,05).
SONUÇ
Geriyatrik hastalarda ameliyat sonrasý mortalite hýzýný azaltabilmek için ameliyat komplikasyonlarýnýn ortaya çýkmadan önce önlenmesi gerekir. Akut kolesistit, boðulmuþ fýtýk gibi yaþlýlarda sýk görülen akut karýn nedenleri elektif þartlarda opere edilerek bu acil durumlarýn ortaya çýkma ihtimalini azaltabiliriz.

Anahtar Kelimeler: Akut karýn, geriyatrik hasta; mortalite; morbidite.

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Factors affecting mortality and morbidity in emergency abdominal surgery in geriatric patients

Erkan Özkan, Mehmet Mahir Fersahoðlu, Ender Dulundu, Yahya Özel, Mehmet Kamil Yýldýz, Ümit Topaloðlu
Haydarpasa Numune Training And Research Hospital, 5 Th General Surgery Clinic, Istanbul, Turkey

BACKGROUND
The purpose of the present study was to determine the factors affecting morbidity and mortality in geriatric patients undergoing abdominal surgery.
METHODS
Ninety-two patients who had undergone acute abdominal surgery at >65 years of age were evaluated in terms of surgical indications, morbidity and mortality rates and the factors affecting morbidity and mortality. Forty-eight patients (52.2%) were males and 44 (47.8%) were females. The mean age was 73.32±6.37 (65-92) years.
RESULTS
The most common surgical indication was acute cholecystitis (26.09%). Morbidity was established as 21 (22.82%) and mortality as 14 (15.21%), and the most common cause of mortality was mesenteric vascular occlusion. American Society of Anesthesiology (ASA) IV was noted in 90.05% of the patients admitted to intensive care, and 92.85% of the patients had mortal progression. The mean hospitalization duration was 7.94±7.13 days (median, 7 days). While older age and high ASA scores were significantly correlated with morbidity, mortality and duration of hospitalization, gender was not (p>0.05).
CONCLUSION
In order to decrease the postoperative mortality rate in geriatric patients, precaution should be taken beforehand to avoid surgical complications. By carrying out elective surgery in geriatric patients, the likelihood of common causes of acute abdomen, such as acute cholecystitis and incarcerated hernia, can be reduced.

Keywords: Acute abdomen, geriatric patient; mortality; morbidity.

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ATIF KOPYALA