Altm�� be� ya� �st� hastalarda, preoperatif d�nemde yo�un bak�m �nitesi ihtiyac�n� �ng�rmede k�lavuza ihtiya� var m�? ASA, LUSS, CACI, SORT indekslerinin kar��la�t�r�lmas�

Vahapo�lu, Ay�e; �avu�, Zuhal; Korkan, Fatma; �zakin, O�uz; T�rkmen, �lk� Aygen

Cilt : 29 Say� : 9 Y�l : 2024

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Altm�� be� ya� �st� hastalarda, preoperatif d�nemde yo�un bak�m �nitesi ihtiyac�n� �ng�rmede k�lavuza ihtiya� var m�? ASA, LUSS, CACI, SORT indekslerinin kar��la�t�r�lmas� [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2023; 29(9): 1004-1012 | DOI: 10.14744/tjtes.2023.43082

Altm�� be� ya� �st� hastalarda, preoperatif d�nemde yo�un bak�m �nitesi ihtiyac�n� �ng�rmede k�lavuza ihtiya� var m�? ASA, LUSS, CACI, SORT indekslerinin kar��la�t�r�lmas�

Ay�e Vahapo�lu, Zuhal �avu�, Fatma Korkan, O�uz �zakin, �lk� Aygen T�rkmen
Sa�l�k Bilimleri �niversitesi Gaziosmanpa�a E�itim ve Ara�t�rma Hastanesi, Anesteziyoloji ve Reanimasyon Klini�i, �stanbul, T�rkiye

AMA�: Altm�� be� ya� �st� cerrahi uygulanan hastalar�n, pre-intra ve postoperatif de�i�kenlerinin t�m� postoperatif yo�un bak�m �nitesi (YB�) takip gereklili�ini belirler. Ameliyat �ncesi hem cerrahi hem anesteziyi ilgilendiren, kolay ve h�zl� �ekilde ger�ekle�tirilecek ideal skorlama sistemleri ile postoperatif YB� endikasyonu belirlenerek y�ksek riskli hastalarda morbidite ve mortalite geli�imi engellenebilir. �al��mam�zda, YB� endikas-yonunu belirlemede Amerikan Anesteziyolojistler Derne�i (ASA) skoru, Akci�er Ultrason skoru (LUSS), Charlson Ya� Ekli Komorbidite �ndeksi (CACI), Cerrahi Sonu� Risk Arac� (SORT) skorunun etkinliklerini kar��la�t�rd�k. �al��mam�z�n hipotezi, real g�rsel olan LUSS�un, YB� endikasyonu belirlemede tarama testi olan SORT, CACI ve di�er skor olan ASA�ya g�re �st�n oldu�unu g�stermektir.
GERE� VE Y�NTEM: �al��maya, 65 ya� �st�, elektif �artlarda cerrahi uygulanacak, 101 hasta al�nd�. Hastalar�n demografik �zellikleri, klinik paramet-releri, YB� endikasyonlar�, ASA, LUSS, CACI ve SORT�lar� prospektif olarak hesaplan�p kaydedildi. Hastalar�n ASA, LUSS, CACI ve SORT�lar�n�n, postoperatif YBܒne yat�� ihtiyac�n�n belirlenmesine etkisi incelendi.
BULGULAR: Ameliyat sonras� YB�'ne yat�r�lmas� gereken hastalar�n ya��, ameliyat sonras� YB�'ne yat�r�lmas� gerekmeyenlere g�re anlaml� derecede y�ksekti (p<0.001). Gruplar cinsiyet, v�cut kitle indeksi (VK�), sigara kullan�m� ve anestezi tipi a��s�ndan farkl�l�k g�stermedi (p>0.05). ASA, LUSS, CACI, SORT postop YB�'ne yat�r�lmas� gereken hastalarda anlaml� olarak daha y�ksekti (p<0.001). Ameliyat sonras� YB� endikasyonu olan hasta-lardan, ameliyat sonras� YBܒne ihtiyac� olan hastalar�n oran� daha y�ksekti (p<0.001). Kons�ltasyon say�s�, ameliyat sonras� YBܒne yat�� gerektiren hastalarda anlaml� olarak daha y�ksekti (p<0.001). SORT�un, ameliyat sonras� YB�'ne yat�� ihtiyac�n� tahmin etmede en y�ksek do�ruluk oldu�u bulundu.
SONU�: Alt�m�� be� ya� �st� elektif cerrahi uygulanan hastalar�n preoperatif de�erlendirme s�recinde YB� endikasyonunu belirlemede ASA, LUSS, CACI, SORT�un etkili oldu�u tespit edilmi�tir. Buna kar��n SORT�un etkinli�i di�erlerinden �st�n bulunmu�tur.

Anahtar Kelimeler: Akci�er ultrason skoru, Amerikan anesteziyolojistler derne�i skoru; cerrahi sonu� risk arac� skoru; Charlson ya� ekli komorbidite indek-si; yo�un bak�m �nitesi endikasyonu.

Is a guideline required to predict the ICU need of patients over 65 years of age during the pre- operative period? A comparison of the ASA, lung ultrasound score, Charlson age-added comorbidity index, surgical outcome risk tool indexes

Ay�e Vahapo�lu, Zuhal �avu�, Fatma Korkan, O�uz �zakin, �lk� Aygen T�rkmen
Department of Anesthesiology and Reanimation Clinic, Health Sciences University Gaziosmanpa�a Training and Research Hospital, �stanbul-T�rkiye

BACKGROUND: All pre-operative, intra-operative, and post-operative variables of the patients at 65 years of age who had a surgi-cal procedure determine the necessity of post-operative intensive care unit (ICU) monitoring. The indication for post-operative ICU is detected through ideal scoring systems related to the surgery and anesthesia that will be performed easily and fast would prevent the development of morbidity and mortality in high-risk patients. In the present study, we compared the efficacy of the American Society of Anesthesiologists (ASA) score, lung ultrasound score (LUSS), Charlson age-added comorbidity index (CACI), and surgical outcome risk tool (SORT) score of the indication for ICU. The hypothesis of our study is to show that real visual LUSS is superior to the screening test SORT, CACI, and the other score, ASA, for ICU indication determination.
METHODS: The study enrolled 101 patients over 65 years of age who will have surgical procedures under elective conditions. De-mographic features, clinical parameters, ICU indications, ASA, LUSS, CACI, and SORTs of the patients were calculated prospectively and recorded. The effects of patients' ASA, LUSS, CACI, and SORT on determining the need for postoperative ICU admission were examined.
RESULTS: The age of patients who needed post-operative ICU admission was significantly higher than those who did not need post-operative ICU admission (P<0.001). The groups did not show differences in terms of gender, body mass index, smoking, and type of anesthesia (P>0.05). ASA, LUSS, CACI, and SORT were significantly higher for patients who needed post-operative ICU admission (P<0.001). The proportion of patients who needed post-operative ICU admission was higher for patients with post-operative ICU indication (P<0.001). The number of consultations was significantly higher for patients who needed post-operative ICU admission (P<0.001). SORT was found to be the highest accuracy for predicting the need for post-operative ICU admission.
CONCLUSION: It was detected that ASA, LUSS, CACI, and SORT are effective for the determination of the ICU indication in the pre-operative evaluation process of patients over the age of 65 who had elective surgery. However, the efficiency of SORT was found to be superior to the others.

Keywords: American Society of Anesthesiologists Score, Charlson age-added comorbidity index; intensive care unit indication; lung ultrasound score; surgical outcome risk tool score.

Sorumlu Yazar: Ay�e Vahapo�lu, T�rkiye
Makale Dili: �ngilizce

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