Ortopedik cerrahi geçiren yaşlı hastalarda yaş ve preoperatif yatış süresinin Deliryum üzerine etkisi
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Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmanın amacı ortopedik cerrahi geçiren yaşlı hastaların, yaşları ve operasyon öncesi hastanede kalış süresi ile deliryum arasındaki ilişkinin belirlenmesidir. Trakya Üniversitesi Tıp Fakültesi Ortopedi Kliniğine yatırılan 65 yaş ve üzeri 218 hasta çalışmaya alındı. Çalışmaya alınan hastaların yaşları, kronik hastalıkları,kullandıkları ilaçları, operasyon öncesi hastanede kalış süreleri,psikiyatri konsültasyon ihtiyacı, başvuruşekilleri (acil/poliklinik),hemoglobin değerleri,operasyondaki kanama miktarı, peroperatifve postoperatifkan transfüzyon ihtiyacı, anestezi ve cerrahi tipleri, operasyon süresi, yoğunbakım ünitesi yatışı, operasyonun kaçıncı gününde mobilize olduğu, deliryum varlığıkaydedildi. Çalışmada Deliryum Değerlendirme Ölçeği,Kısa Konfüzyon DeğerlendirmeMetodu ve Yoğun Bakım Deliryum Tarama Kontrol Listesikullanıldı. Kalça operasyonu geçiren hastalarda deliryumoranını daha yüksek saptadık. Genelanestezi alanve yoğun bakım yatışı olanhastalarda daha sıkdeliryum geliştiği görüldü.Demansıve karaciğer hastalığıolanlarındeliryum gelişme oranı daha yüksek bulundu. Acilbaşvuru yapan hastalarda poliklinik başvurusu yapan hastalarakıyasla deliryum oranı dahayüksek saptandı. Artan yaşın deliryumu artırdığını, deliryum varlığının da mortaliteyiartırdığını gözlemledik. Düşük hemoglobin değerlerinin deliryumu artırdığı görüldü, postoperatif kan transfüzyonu yapılan hastalarda daha sık deliryum gözlendi.Deliryumgelişen hastaların operasyon sonrası mobilizasyon süresiortalaması daha yüksek saptandı.Operasyon öncesi hastanede kalış süresi arttıkça, deliryumdaha sık görüldü. Bu çalışma ile anlamlı bulunan risk faktörlerinin saptanıp değerlendirilmesi,mümkün olduğunca en aza indirgenmesi, operasyon öncesi hastanede kalış süresininuzatılmaması önerilebilir. Özellikle acil operasyon gereken yaşlı hastalarda mevcuthastalıkları için konsültasyonların hızlandırılmasının ve ameliyat sonrası erkenmobilizasyon sağlanmasının deliryum gelişmesini ve mortaliteyi azaltacağı kanaatindeyiz.
The aim of this study is to determine the relationship between delirium and the ageof elderly patients who underwent orthopedic surgery, and the length of hospital stay beforethe operation. 218 patients aged 65 and over who were hospitalized in Trakya University MedicalFaculty Orthopedics Clinic were included in the study. The age of the patients included inthe study, their chronic diseases, the medications they used, the pre-operative hospital stay,the need for psychiatric consultation, the application methods (emergency / outpatientclinic), hemoglobin values, the amount of bleeding in the operation, the need forperoperative and postoperative blood transfusion, the types of anesthesia and surgery, theduration of the operation. The intensive care unit hospitalization, the day of the operationmobilized, and the presence of delirium were recorded. Delirium Rating Scale, Brief Confusion Assessment Method and Intensive Care Delirium Screening Checklist were usedin the study. We found a higher rate of delirium in patients who underwent hip surgery. It wasobserved that delirium developed more frequently in patients who received generalanesthesia and were hospitalized in intensive care. Thosewith dementia and liver diseasewere found to have a higher rate of delirium development. The delirium rate was found tobe higher in patients who applied for emergency compared to patients who applied to anoutpatient clinic. We observed that increasingage increases delirium and the presence ofdelirium increases mortality. It was observed that low hemoglobin values increaseddelirium, delirium was observed more frequently in patients who received postoperativeblood transfusion. The mean duration of mobilization after the operation was found to behigher in patients who developed delirium. Delirium was seen more frequently as theduration of hospitalization before the operation increased. With this study, it may be suggested to identify and evaluate risk factors that arefound to be significant, to minimize them as much as possible, and not to extend the pre-operative hospital stay. We believe that accelerating consultations for existing diseases andproviding early postoperative mobilization, especially in elderly patients requiring urgentsurgery, will reduce the development of delirium and mortality.
The aim of this study is to determine the relationship between delirium and the ageof elderly patients who underwent orthopedic surgery, and the length of hospital stay beforethe operation. 218 patients aged 65 and over who were hospitalized in Trakya University MedicalFaculty Orthopedics Clinic were included in the study. The age of the patients included inthe study, their chronic diseases, the medications they used, the pre-operative hospital stay,the need for psychiatric consultation, the application methods (emergency / outpatientclinic), hemoglobin values, the amount of bleeding in the operation, the need forperoperative and postoperative blood transfusion, the types of anesthesia and surgery, theduration of the operation. The intensive care unit hospitalization, the day of the operationmobilized, and the presence of delirium were recorded. Delirium Rating Scale, Brief Confusion Assessment Method and Intensive Care Delirium Screening Checklist were usedin the study. We found a higher rate of delirium in patients who underwent hip surgery. It wasobserved that delirium developed more frequently in patients who received generalanesthesia and were hospitalized in intensive care. Thosewith dementia and liver diseasewere found to have a higher rate of delirium development. The delirium rate was found tobe higher in patients who applied for emergency compared to patients who applied to anoutpatient clinic. We observed that increasingage increases delirium and the presence ofdelirium increases mortality. It was observed that low hemoglobin values increaseddelirium, delirium was observed more frequently in patients who received postoperativeblood transfusion. The mean duration of mobilization after the operation was found to behigher in patients who developed delirium. Delirium was seen more frequently as theduration of hospitalization before the operation increased. With this study, it may be suggested to identify and evaluate risk factors that arefound to be significant, to minimize them as much as possible, and not to extend the pre-operative hospital stay. We believe that accelerating consultations for existing diseases andproviding early postoperative mobilization, especially in elderly patients requiring urgentsurgery, will reduce the development of delirium and mortality.
Açıklama
Anahtar Kelimeler
Deliryum, Geriatrik hasta, Ortopedik cerrahi, Preoperatif hastanede kalış süresi, Delirium, Geriatric patient, Orthopedic surgery, Preoperative hospital stay
