AKUT KARIN PATOLOJİLERİ İLE ACİL SERVİSE BAŞVURAN GERİATRİK HASTALARDA PROGNOZU ÖNGÖRMEDE KLİNİK KIRILGANLIK ÖLÇEĞİ'NİN ETKİNLİĞİNİN DEĞERLENDİRİLMESİ: PROSPEKTİF ÇALIŞMA

Year 2023, , 36 - 42, 03.01.2023

Hatice Şeyma Akça , Serdar Özdemir , Abdullah Algın , Evrim Kar , İbrahim Altunok

https://doi.org/10.18229/kocatepetip.985311

Cited By: 2

Abstract

AMAÇ: Klinik kırılganlık indeksi, 1 (çok iyi) ile 9 (ölümcül hasta) arasında değişen bir kırılganlık puanı oluşturmak amacı ile işlev, komorbidite ve biliş dahil olmak üzere belirli alanları değerlendirir. Bu çalışmanın amacı, akut abdominal patolojileri olan geriatrik hastalarda mortaliteyi öngörmede klinik kırılganlık indeksinin etkinliğini araştırmaktır.
GEREÇ VE YÖNTEM: 01.10.2020 - 31.03.2021 tarihleri arasında acil servise akut abdomen patolojisi ile başvuran 65 yaş üstü hastalar çalışmaya alındı. Klinik kırılganlık indeksi hesaplanıp kaydedildi ve 1’den 9’a kadar gruplara ayrıldı. İstatistiksel analiz SPSS 22.0 ile gerçekleştirildi.
BULGULAR: Çalışmamıza 151 hasta dahil edildi ve hastaların %53’ü kadın hasta idi. Yaş ortalaması 75,57±8,078 olup; 22(14,56%) hasta ex oldu. Hastalarımızın klinik kırılganlık indeksi incelemesinde mortal olan grupta CFS istatistiksel anlamlı olarak daha yüksek düzeyde tespit edildi (p<0,001). Hastalarımızın 83 (%55)’ü opere edildi. Opere olan ve opere olmayan grupta klinik kırılganlık indeksinin mortalite ile ilişkisi bakımından istatistiksel olarak anlamlı fark gözlenmemiştir (p=0,613). Yaşın 75 ve üzeri olmasını kriter olarak eklediğimizde mortaliteyi predikte etmede klinik kırılganlık indeksi ile mortalite arasında istatistiksel fark olup olmadığı da araştırıldı. Eğri altında kalan alanlar (EAA) karşılaştırıldığında ise, kırılganlık indeksi ile 75 yaş üstü kriteri ile birlikte olan kırılganlık indeksinde istatistiksel olarak anlamlı fark görülmedi. (Eğri altında kalan alan kırılganlık indeksi ve kırılganlık indeksi-yaş p=0.597, de Longe quality test).
SONUÇ: Klinik kırılganlık indeksi yüksekliği ve klinik kırılganlık indeksi-yaş, mortalite ile genellikle ilişkilidir fakat opere edilmeme, medikal tedavinin yeterli olacağı düşüncesi ya da komorbiditeler nedeni ile risk bilgilendirilmesi nedenli olarak bu durum ortaya çıkabilmektedir. Geriatrik hastalarda kırılganlık indeksi yüksekliği operasyon kararında tek başına yeterli olmayabilir.

Keywords

Geriatrik hastalar, Kırılganlık indeksi, Cerrahi, Geriatrics, Fraility index, Surgery

EVALUATION OF THE EFFICACY OF THE CLINICAL FRAILTY SCALE IN THE PREDICTION OF PROGNOSIS IN GERIATRIC PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH ACUTE ABDOMINAL PATHOLOGIES: A PROSPECTIVE STUDY

Abstract

OBJECTIVE: The CFS (Clinical Frailty Score) evaluates specific domains including function, comorbidity, and cognition to generate a frailty score ranging from 1 (very fit) to 9 (terminally ill). The aim of this study was to investigate the efficacy of CFS in the prediction of mortality in geriatric patients with acute abdominal pathologies.
MATERIAL AND METHODS: Patients over 65 years who presented to the emergency department with acute abdominal pathologies between October 1, 2020 and March 31, 2021 were included in the study. Clinical Frailty Score was calculated and categorized into groups from 1 to 9. Statistical analyses were performed using SPSS version 22.0.
RESULTS: The study included 151 patients, of whom 53% were female. The mean age was 75.57±8.078 years. Twenty-two (14.56%) patients died. Clinical Frailty Score was found to be statistically significantly higher in the non-survivor group (p<0.001). Eighty-three (55%) of the patients underwent surgery. There was no statistically significant relationship between Clinical Frailty Score and mortality in the operated and non-operated groups (p=0.613). We added an age of 75 and over as a criterion (Clinical Frailty Score -age) and compared its predictive ability for mortality with CFS. There was no statistically significant difference between Clinical Frailty Score and Clinical Frailty Score-age in terms of the area under the curve values in the prediction of mortality (the area under the curve Clinical Frailty Score and Clinical Frailty Score-age p=0.597, DeLong quality test).
CONCLUSIONS: High Clinical Frailty Score and Clinical Frailty Score-age are generally associated with mortality, but this may occur due to non-operation, the thought that medical treatment will be sufficient, or risk information due to comorbidities. In geriatric patients, an increased Clinical Frailty Score may not be sufficient alone in making a surgery decision.

Keywords

Geriatrics, Fraility index, Surgery

References

• 1. Katlic M.R., Coleman J (Edited by). In: Rosenthal R., Zenilman M., Katlic M. (eds) Principles and Practice of Geriatric Surgery. 3rd edition, Springer, Cham: Principles of Geriatric Surgery, 2020: 3-23.
• 2. Jones TS, Dunn CL, Wu DS, Cleveland JC, Kile D, Robinson TN. Relationship between asking an older adult about falls and surgical outcomes. JAMA Surg. 2013;148(12):1132-8.
• 3. Robinson TN, Eiseman B, Wallace J, et al. Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg. 2009;250(3):449–55.
• 4. Fried LP, Tangen CM, Walston J, et al. Cardiovascular health study collaborative research group. Frailty in older adults: evidence fora phenotype. J GerontolA Biol Sci Med Sci. 2001;56(3):146–56.
• 5. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489-95.
• 6. Church S, Rogers E, Rockwood K, Theou O. A scoping review of the Clinical FrailtyScale. BMC Geriatr. 2020;20:393.
• 7. Manku K, Bacchetti P, Leung JM. Prognostic significance of postoperative in-hospitalcomplications in elderly patients. I. Long-term survival. Anesth Analg. 2003;96:583–9.
• 8. Dewan SK, Zheng SB, Xia SJ. Preoperative geriatric assessment: comprehensive, multidisciplinary and proactive. Eur J Intern Med. 2012;23(6):487-94.
• 9. Sprung J, Gajic O, Warner DO. Review article: age related alterations in respiratory function -anesthetic considerations. Can J Anaesth. 2006;53:1244–57.
• 10. Poh AWY, Teo SP. Utility of Frailty Screening Tools in Older Surgical Patients. Ann Geriatr Med Res. 2020;24(2):75-82.
• 11. Afilalo J, Lauck S, Kim DH et al. Frailty in older Adults undergoing aortic valve replacement: The FRAILTY-AVR study. J Am Coll Cardiol. 2017;70:689–700.
• 12. Rodrigues MK, Marques A, Lobo DML, Umeda KII, Oliveira MF. Pre-frailty increases therisk of adverse events in older patients undergoing cardiovascular surgery. Arq Bras Cardiol. 2017;109(4):299–306.
• 13. Tse G, Gong M, Nunez J, et al. Frailty and Mortality Outcomes After Percutaneous Coronary Intervention: A Systematic Reviewand Meta-Analysis. Journal of the American Medical Directors Association. 2017;18(12):1097.e10.
• 14. Hamonangan R, Wijaya IP, Setiati S, Harimurti K. Impact of frailty on the first 30 days of majorcardiac events in elderly patients with coronary artery disease undergoing elective Percutaneous Coronary Intervention. Acta MedicaIndonesiana. 2016;48(2):91-98.
• 15. Okabe H, Ohsaki T, Ogawa K, et al. Frailty predicts severe postoperative complications after elective colorectal surgery. The American Journal of Surgery. 2019;217(4):677-681.
• 16. Visser L, Banning LBD, El Moumni M, Zeebregts CJ, Pol RA. The effect of frailty on outcome after vascular surgery. Eur J VascEndovasc Surg. 2019;58(5):762–9.
• 17. Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in oldersurgical patients: a systematic review. BMC Geriatr. 2016;16(1):157.
• 18. Aucoin SD, Hao M, Sohi R, et al. Accuracy and Feasibility of Clinically Applied Frailty Instruments before Surgery: A Systematic Review and Meta-analysis. Anesthesiology 2020;133:78-95.
• 19. Basic D, Shanley C. Frailty in an Older Inpatient Population: Using the Clinical Frailty Scaleto Predict Patient Outcomes. Journal of Aging and Health. 2015;27(4):670-85.
• 20. Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J GerontolA Biol Sci Med Sci. 2007;62(7):738-743.
• 21. Darvall JN, Loth J, Bose Tet al. Accuracy of the Clinical Frailty Scale for perioperative frailty screening: a prospective observational study. Can J Anesth. 2020(67):694–705.
• 22. Hewitt J, Carter B, McCarthy K et al. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age and Ageing. 2019;48(3): 388-94.
• 23. Li Y, Pederson JL, Churchill TA et al. Impact of frailty on outcomes after discharge in older surgicalpatients: a prospective cohort study. CMAJ. 2018:190;(7):184-190.
• 24. Hewitt J, Moug SJ, Middleton M, Chakrabarti M, Stechman MJ, McCarthy K. Older Persons Surgical Outcomes Collaboration.Prevalence of frailty and its association with mortality in general surgery. Am J Surg. 2015;209:254-9.
• 25. Reiss R, Deutsch AA, Nudelman I, Gutman H. Multifactorial analysis of prognostic factorsin emergency abdominal surgery in patients above 80 years. Analysis of 154 consecutivecases. Int Surg. 1989;74(2):93–6.