GKD Anest Yoð Bak Dern Derg. 2014; 20(2): 106-112 | DOI: 10.5222/GKDAD.2014.106

Hastanemizde Kalp Cerrahisi Geçiren Hastalarda Postoperatif Mortalite ve Morbiditenin EuroSCORE ile deðerlendirilmesi

Sinan Týraþ, Türkan Kudsioðlu, Zeliha Alýcýkuþ, Nihan Yapýcý, Filiz Ýzgi Coþkun, Yasemin Altuntaþ, Soner Arslantürk, Zuhal Aykaç
Siyami Ersek Göðüs Kalp Ve Damar Cerrahisi Merkezi Eah, Anesteziyoloji Ve Reanimasyon Kliniði, Ýstanbul

AMAÇ: Çalýþmamýzda açýk kalp cerrahisi geçiren hastalarýn preoperatif özelliklerinin, yandaþ hastalýklarýnýn, ekstübasyon sürelerinin mortalite ile morbiditeye etkisini ve EuroSCORE ile iliþkisini deðerlendirmeyi amaçlandýk.
YÖNTEMLER: Dr. Siyami Ersek Göðüs Kalp ve Damar Cerrahisi Hastanesinde hastane bilimsel kurul onayý alýndýktan sonra, 2012-2013 yýllarý arasýnda açýk kalp cerrahisi geçirecek17-82 yaþlarýnda 668 hasta prospektif olarak takip edildi. Hasta özellikleri, yandaþ hastalýklar, ameliyat tipi, kros klemp ve pompa süreleri, inotrop ilaç ve intraaortik balon kullanýmý, koroner anastomoz sayýlarý, ekstübe edilme, yoðun bakýmda ve hastanede kalýþ süreleri ve EuroSCORE deðerleri kaydedildi ve karþýlaþtýrýldý.
BULGULAR: Gerçekleþen mortalite (% 3,1) ile EuroSCORE mortalite oranlarý (1,73±1,26) arasýnda istatistiksel olarak anlamlý farklýlýk görüldü(p<0,01). Kaybedilen hastalarýn EuroSCORE ile öngörülen mortalite oranlarý belirgin olarak yüksekti (3,71±3,01). EuroSCORE mortalite oraný 1,75 ve daha yüksek olan olgularda; mortaliteyi öngörme duyarlýlýðý % 80.95; pozitif kestirim deðeri %8.54 ve negatif kestirim deðeri % 99.15 olarak saptandý. Receiver Operating Characteristic(ROC) eðrisi altýnda ölçülen alan % 78.8, standart hatasý % 4,7 idi.
SONUÇ: Hastalarýn preoperatif risk faktörleri ve cerrahi ile geliþebilecek komplikasyonlarýn iyi analiz edilmesi mortalite ve morbiditenin azaltýlmasýna katký saðlayacaktýr. Çalýþmamýzda hastanemiz hasta popülasyonunda mortalite ve morbiditeyle iliþkili faktörlerin, literatürdeki bulgularla benzer olduðunu gözlemledik. EuroSCORE risk skorlama sisteminin uygulanabilir ve güvenilir olduðunu, yüksek riskli hastalarýn belirlenerek uygun anestezi ve yoðun bakým yönetiminin önemli olduðu kanýsýna vardýk.

Anahtar Kelimeler: kardiyak cerrahi, EuroSCORE risk skorlarý, kardiyak anestezi

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The evaluation of postoperative mortality and morbidity with EuroSCORE in patients who underwent cardiac surgery in our hospital

Sinan Týraþ, Türkan Kudsioðlu, Zeliha Alýcýkuþ, Nihan Yapýcý, Filiz Ýzgi Coþkun, Yasemin Altuntaþ, Soner Arslantürk, Zuhal Aykaç
Siyami Ersek Thoracic And Cardiovasculary Center Hospital, Department Of Anesthesiology And Reanimation, Istanbul

OBJECTIVE: The aim of our study was to evaluate the effect of preoperative patient characteristics, concomitant comorbidities and extubation time on postoperative mortality and morbidity; and the corelation with EuroSCORE.
METHODS: After Local Scientific Comnittee approval, 668 patients, ages between 17- 82 who were scheduled for open cardiac surgery were included in this prospective study in 2012-1013 years in Siyami Ersek Thoracic and Cardiovasculary Center Hospital. Patient characteristic, concomitant comorbidities, type of surgery, cross-clemp and cardiopulmonary bypass times, the use of inotropic agents and insertion of intraaortic baloon pump, the number of coronary anastomosis, extubation time, time of intensive care and hospital stay and the EuroSCORE scores were recorded and compared.
RESULTS: There were observed to difference significantly between actual mortality rates (% 3,1) and predicted mortality by EuroSCORE (1,73±1,26) (p<0,01).The predicted mortality rates by EuroSCORE were significantly elevated(3,71±3,01) in patients who died. In patients with preoperative scores over 1.75, the sensitivity of EuroSCORE in predicted mortality was %80.95; positive cut-off value was % 8.54 and negative cut-off value was % 99.15. The measured area under the Receiver Operating Characteristic(ROC) curve was % 78.8 and standart deviation was % 4.7.
CONCLUSION: A throughout analysis of risc factors and possible complications of surgery may help to reduce postoperative mortality and morbidity. We observed the factors related to mortality and morbidity in our patient population are similar to the literature the EuroSCORE risc scoring system can be applied. Also the management of intraoperative anesthesia and postoperative intensive care are important factors in this issue.

Keywords: cardiac surgery, EuroSCORE risk scores, cardiac anesthesia

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