Öz
Amaç: Abdominal
cerrahilerde postoperatif pulmoner komplikasyonlar (PPK), morbitide ve
mortalitenin önemli bir nedenidir. Ayrıca hastanede yatış süresini uzatan
önemli bir faktördür.
Preoperatif değerlendirme,
komplikasyonların tahmin edilmesinde ve önlem alınmasında önemli bir yer
oluşturmaktadır. Değerlendirme sıklıkla öykü, fizik muayene, akciğer grafisi,
solunum fonksiyon testleri, gerekli olgularda arteriyel kan gazı, ve egzersiz
testleri ile yapılmaktadır. Bu çalışmada, diğer değerlendirme parametrelerinden
farklı olarak PPK’ı öngörmede yaşam kalitesinin önemini araştırmayı amaçladık.
Yöntem:
Çalışmamıza
Genel Cerrahi AD’da elektif batın cerrahisi yapılacak olan 124 hasta
alınmıştır. Hastalar ameliyat öncesi 1 haftalık dönemde değerlendirilmiş ve
nottingham sağlık profili (NSP) skoru hesaplanmıştır. Postoperatif 48.saat
sonrasında semptomlar ve komplikasyonlar incelenerek, preoperatif NSP değerleri
ile karşılaştırılmıştır.
Bulgular PPK görülen
hastalarda NSP-total puanı ort. 125,71 ± 114,09 puan ve
görülmeyenlerde ort. 63,65 ± 72,75 puandı
(p=0.002). Fiziksel mobilite, ağrı, enerji düzeyi, duygusal reaksiyon, uyku
durumu, ve sosyal izolasyon düzeylerine göre yapılan değerlendirmede emosyonel
durum haricinde diğer tüm puanlar komplikasyon görülen hastalarda daha yüksek
saptandı. Mortalite görülen hastaların ort. 209,31 ± 130,74 puan olduğu görüldü. Hastalar NSP puanlarına göre grup-1 (0-49,9), grup-2
(50,0-99,9), grup-3 (100-149,9) ve grup-4 (>150 puan) olarak
sınıflandırıldı. Buna göre grup-4 olan hastalarda %72,7 pulmoner
komplikasyon görüldü (p<0.001). Yine 150 puan ve üzeri olan hastalarda
solunumsal komplikasyonlar 7,6 kat, solunum dışı komplikasyonlar ise 6,7 kat
artmış bulundu.
Sonuç: Çalışmamız,
hastaların NSP puanı 150 ve üzerinde olması durumunda komplikasyonların daha
fazla olduğunu göstermiştir. Ayrıca NSP sağ kalımı da iyi predikte etmiştir. Bu
sonuçlar ile NSP’nin preoperatif risk değerlendirmede yararlı olabileceği
düşünülmüştür.
Anahtar Kelimeler
Elektif batın cerrahisi nottingham sağlık profili postoperatif pulmoner komplikasyonlar yaşam kalitesi
Kaynakça
- Lawrence VA, Dhanda R, Hilsenbeck SG, et al. Risk of pulmonary complications after elective abdominal surgery. Chest 1996; 110 (3): 744-50.
- DeLisser HM, Grippi MA. Perioperative respiratory considerations in the surgical patients. In: Fishman AP (ed). Pulmonary Diseases and Disorders. 3rd ed: McGraw-Hill; 1998; 619-69.
- Wolters U, Wolf T, Stützer H, et al. ASA Classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996; 77 (2): 217-22.
- Hunt SM, McEwen J. The development of a subjective health indicator. Sociol Health Illn 1980; 2 (3): 231-46.
- Awdeh H, Kassak K, Sfeir P, et al. The SF-36 and 6-minute walk test are significant predictors of complications after major surgery. World J Surg 2015; 39 (6): 1406-12.
- Kiebzak GM, Pierson LM, Campbell M, et al. Use of the SF36 general health status survey to document health-related quality of life in patients with coronary artery disease: effect of disease and response to coronary artery bypass graft surgery. Heart Lung 2002; 31 (3): 207-13.
- Tabesh H, Tafti HA, Ameri S, et al. Evaluation of quality of life after cardiac surgery in high-risk patients. Heart Surg Forum 2014; 17 (6): 277-81.
- Prieto L, Alonso J, Ferrer M, et al. Are results of the SF-36 health survey and the Nottingham Health Profile similar? A comparison in COPD patients. Quality of Life in COPD Study Group. J Clin Epidemiol 1997; 50 (4): 463-73.
- Kücükdeveci AA, McKenna SP, Kutlay S, et al. The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehabil Res 2000; 23 (1): 31-8.
- Kurfirst V, Mokráček A, Krupauerová M, et al. Health-related quality of life after cardiac surgery--the effects of age, preoperative conditions and postoperative complications. J Cardiothorac Surg 2014; 9 (1): 46.
- Westerdahl E, Jonsson M, Emtner M. Pulmonary function and health-related quality of life 1-year follow up after cardiac surgery. J Cardiothorac Surg 2016; 11 (1): 99.
- Wong DH, Weber EC, Schell MJ, et al. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg 1995; 80 (2): 276-84.
- Djokovic JL, Hedley-Whyte J. Prediction of outcome of surgery and anesthesia in patients over 80. JAMA 1979; 242 (21): 2301-6.
- Thorsen H, McKenna S, Tennant A, et al. Nottingham health profile scores predict the outcome and support aggressive revascularisation for critical ischaemia. Eur J Vasc Endovasc Surg 2002; 23 (6): 495-9.
- Peric VM, Borzanovic MD, Stolic RV, et al. Severity of angina as a predictor of quality of life changes six months after coronary artery bypass surgery. Ann Thorac Surg 2006; 81 (6): 2115-20
- Steffens D, Beckenkamp PR, Hancock M,et al. Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer. Br J Sports Med 2018; 52 (5): 344.
- Hwang D, Shakir N, Limann B, et al. Association of sleep-disordered breathing with postoperative complications. Chest 2008; 133 (5): 1128–34.
- Kim ES, Kim YT, Kang CH, et al. Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD. Int J Chron Obstruct Pulmon Dis 2016; 11 (1): 1317-26.
- Chocron S, Etievent JP, Viel JF, et al. Preoperative quality of life as a predictive factor of 3-year survival after open heart operations. Ann Thorac Surg 2000; 69 (3): 722-7.
- Jokinen JJ, Hippeläinen MJ, Hänninen T, et al. Prospective assessment of quality of life of octogenarians after cardiac surgery: factors predicting long-term outcome. Interact Cardiovasc Thorac Surg. 2008; 7 (5): 813-8.
Öz
Aim: Postoperative pulmonary
complications (PPC) in abdominal surgeons is an important factor that prolongs
the hospitalization period as well as is an important cause of morbidity and
mortality. Preoperative evaluation is an important part of estimating
complications and taking precautions. However, pulmonary function tests,
arterial blood gases, and exercise tests are used in the evaluation. In this
study, we aimed to investigate the importance of quality of life in predicting
PPC different from other evaluation parameters.
Patients
and Methods: 124 patients who were assigned for various elective abdominal procedures
in department of surgery; were included in the study. Notthingham health
profile (NHP) scores 1 week prior to the surgery were calculated for each
patient and were compared to the pulmonary complications (PPC) that evolved in
the postoperative 48th hour.
Results:
In
patients with PPC mean NHP score was 125,71 + 114,09 and in patients
without PPC the score was found to be 63,5 + 72,75. The
difference among the groups was statistically significant. The patients were
distributed in to 4 groups according to their score and in group 4 (>150)
pulmonary complication rate was 72,7% (p<0.001). Patients were classified according to their NHP scores as group-1 (0-49,9),
group-2 (50,0-99,9), group-3 (100-149,9) and group-4 (150 points).Furthermore; in group-4;
pulmonary complication frequency was 7,6 times greater than the others.
Conclusion:
In the
present study it is found that patients with a NHP score greater than 150
encountered complications more frequently. Therefore; it can be assumed that
NHP scoring system can be used in preoperative evaluation and postoperative
risk prediction.
Anahtar Kelimeler
Elective abdominal surgery postoperative pulmonary complications nottingham health profile healt quality.
Kaynakça
- Lawrence VA, Dhanda R, Hilsenbeck SG, et al. Risk of pulmonary complications after elective abdominal surgery. Chest 1996; 110 (3): 744-50.
- DeLisser HM, Grippi MA. Perioperative respiratory considerations in the surgical patients. In: Fishman AP (ed). Pulmonary Diseases and Disorders. 3rd ed: McGraw-Hill; 1998; 619-69.
- Wolters U, Wolf T, Stützer H, et al. ASA Classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996; 77 (2): 217-22.
- Hunt SM, McEwen J. The development of a subjective health indicator. Sociol Health Illn 1980; 2 (3): 231-46.
- Awdeh H, Kassak K, Sfeir P, et al. The SF-36 and 6-minute walk test are significant predictors of complications after major surgery. World J Surg 2015; 39 (6): 1406-12.
- Kiebzak GM, Pierson LM, Campbell M, et al. Use of the SF36 general health status survey to document health-related quality of life in patients with coronary artery disease: effect of disease and response to coronary artery bypass graft surgery. Heart Lung 2002; 31 (3): 207-13.
- Tabesh H, Tafti HA, Ameri S, et al. Evaluation of quality of life after cardiac surgery in high-risk patients. Heart Surg Forum 2014; 17 (6): 277-81.
- Prieto L, Alonso J, Ferrer M, et al. Are results of the SF-36 health survey and the Nottingham Health Profile similar? A comparison in COPD patients. Quality of Life in COPD Study Group. J Clin Epidemiol 1997; 50 (4): 463-73.
- Kücükdeveci AA, McKenna SP, Kutlay S, et al. The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehabil Res 2000; 23 (1): 31-8.
- Kurfirst V, Mokráček A, Krupauerová M, et al. Health-related quality of life after cardiac surgery--the effects of age, preoperative conditions and postoperative complications. J Cardiothorac Surg 2014; 9 (1): 46.
- Westerdahl E, Jonsson M, Emtner M. Pulmonary function and health-related quality of life 1-year follow up after cardiac surgery. J Cardiothorac Surg 2016; 11 (1): 99.
- Wong DH, Weber EC, Schell MJ, et al. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg 1995; 80 (2): 276-84.
- Djokovic JL, Hedley-Whyte J. Prediction of outcome of surgery and anesthesia in patients over 80. JAMA 1979; 242 (21): 2301-6.
- Thorsen H, McKenna S, Tennant A, et al. Nottingham health profile scores predict the outcome and support aggressive revascularisation for critical ischaemia. Eur J Vasc Endovasc Surg 2002; 23 (6): 495-9.
- Peric VM, Borzanovic MD, Stolic RV, et al. Severity of angina as a predictor of quality of life changes six months after coronary artery bypass surgery. Ann Thorac Surg 2006; 81 (6): 2115-20
- Steffens D, Beckenkamp PR, Hancock M,et al. Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer. Br J Sports Med 2018; 52 (5): 344.
- Hwang D, Shakir N, Limann B, et al. Association of sleep-disordered breathing with postoperative complications. Chest 2008; 133 (5): 1128–34.
- Kim ES, Kim YT, Kang CH, et al. Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD. Int J Chron Obstruct Pulmon Dis 2016; 11 (1): 1317-26.
- Chocron S, Etievent JP, Viel JF, et al. Preoperative quality of life as a predictive factor of 3-year survival after open heart operations. Ann Thorac Surg 2000; 69 (3): 722-7.
- Jokinen JJ, Hippeläinen MJ, Hänninen T, et al. Prospective assessment of quality of life of octogenarians after cardiac surgery: factors predicting long-term outcome. Interact Cardiovasc Thorac Surg. 2008; 7 (5): 813-8.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Eylül 2019 |
| Gönderilme Tarihi | 19 Nisan 2018 |
| Yayımlandığı Sayı | Yıl 2019 |