A RETROSPECTIVE ANALYSIS OF ANESTHETIC APPROACHES IN PATIENTS AGED 85 AND ABOVE

Year 2024, Volume: 25 Issue: 3, 341 - 347, 18.07.2024

Merve Ay , Elif Doğan Bakı , Bilge Banu Taşdemir Mecit , Bilal Atilla Bezen

https://doi.org/10.18229/kocatepetip.1330227

Abstract

OBJECTIVE: Due to the changes that occur with aging, the elderly need more medical support. These medical requirements include surgical operations. In our study, we aimed to examine, improve and compare our anesthetic approaches for people aged 85 and above with the current literature.
MATERIAL AND METHODS: A total of 242 patients aged 85 years and above underwent surgery between 01.01.2020 and 01.01.2022 were included in this study. The data of the patients including gender, age, comorbidities, types of anesthesia administered during the surgery, duration of surgery, postoperative ward/intensive care unit (ICU) follow-up periods, intraoperative blood product usage and postoperative mortality were retrospectively analyzed in 3 groups according to the types of anesthesia administered: general, spinal and sedation anesthesia.
RESULTS: Of the patients, 130 of the patients were female and 112 were male. The mean age was 87.95±2.57 years. 93.8% of patients had comorbidities. 65.3% of the patients were applied general anesthesia, 29.8% spinal anesthesia and 4.9% sedation anesthesia. While 30.6% of the patients were admitted to ICU after surgery, 69.4% of them were admitted to the ward. While 88% of the patients were discharged with recovery, 12% died in the first 1 month. While 86.2% general anesthesia and 13.8% spinal anesthesia were applied in patients with mortality, 62.4% general anesthesia, 5.6% sedation and 31.4% spinal anesthesia were applied in those without mortality (p=0.036). Mortality was mostly observed in general surgery patients, patients admitted to intensive care unit, and ASA III patients. Mortality was observed more in those who used blood products compared to those who did not (p<0.001).
CONCLUSIONS: We think that spinal anesthesia should be preferred in appropriate elderly patients and more caution should be exercised in indications for blood product use and postoperative intensive care unit admission.

Keywords

Elderly, Geriatrics, General Anesthesia, Mortality, Spinal anesthesia.

85 YAŞ VE ÜZERİ HASTALARDAKİ ANESTEZİK YAKLAŞIMLARIMIZIN RETROSPEKTİF İNCELENMESİ

Abstract

AMAÇ: Yaşlanma ile birlikte oluşan değişiklikler nedeniyle yaşlılar daha fazla tıbbi desteğe gereksinim duyarlar. Bu tıbbi gereksinimler içerisinde cerrahi operasyonlarda yer almaktadır. Çalışmamızda 85 yaş ve üzeri hastalarda anestezik yaklaşımlarımızı incelemeyi, geliştirmeyi ve güncel literatürle kıyaslamayı amaçladık.
GEREÇ VE YÖNTEM: Ocak 2020 – Ocak 2022 tarihleri arasında 85 yaş ve üzeri olup operasyona alınan 242 hasta çalışmaya dahil edildi. Hastaların cinsiyeti, yaşı, ek hastalıkları, operasyon sırasında uygulanan anestezi tipleri, operasyon süreleri, postoperatif servis/yoğun bakım takip süreleri, intraoperatif kan ürünü kullanımı ve postoperatif mortalite gibi verileri, uygulanan anestezi türlerine göre genel, spinal ve sedasyon anestezisi olmak üzere 3 grupta retrospektif olarak incelendi.
BULGULAR: Hastaların 130’u kadın, 112’si erkekti. Yaş ortalamaları 87,95±2,57 idi. Hastaların % 93,8’inde ek hastalık mevcuttu. Hastaların %65,3’üne genel anestezi, %29,8’ine spinal anestezi ve %4,9’una sedasyon anestezisi uygulandı. Ameliyat sonrası hastaların %30,6’sı yoğun bakıma çıkarken, %69,4’ü servise çıktı. Hastaların %88’i şifa ile taburcu oldu, %12’si ilk 1 ayda exitus oldu. Mortalite görülenlerde %86,2 genel anestezi, %13,8 spinal anestezi uygulandı, mortalite gözlenmeyenlerde %62,4 genel anestezi, %5,6 sedasyon anestezisi, %31,4 spinal anestezi uygulandı (p=0,036). Mortalite en çok genel cerrahi hastalarında, yoğun bakıma çıkan hastalarda ve ASA III hastalarda gözlendi. Kan ürünü kullanılanlarda kullanılmayanlara göre mortalite daha fazla gözlendi (p<0,001).
SONUÇ: Uygun, yaşlı hastalarda spinal anestezinin tercih edilmesi, kan ürünü kullanımı ve postoperatif yoğun bakıma çıkış endikasyonlarında daha dikkatli olunması gerektiğini düşünmekteyiz.

Keywords

Yaşlı, Geriatri, Genel anestezi, Ölüm, Spinal Anestezi.

References

• 1. Sonawane, NV. Ageing Population and Healthy Aging Framework. Nursing Journal of India. 2013;104(2):57.
• 2. Kalache, A, Keller, I. Ageing in the Twenty-first Century. In New Pharmacological Approaches to Reproductive Health and Healthy Ageing: Symposium on the Occasion of the 80th Birthday of Professor Egon Diczfalusy. Berlin, Heidelberg: Springer Berlin Heidelberg 2. p. 17-41.
• 3. Klevmarken, A, Lindgren, B. (Edited by). Simulating an Ageing Population: A Microsimulation Approach Applied to Sweden. In: Klevmarken, A, Lindgren, B. An Ageing Economy in an International Perspective. Emerald Group Publishing Limited. 2008:1-29.
• 4. Kanonidou Z, Karystianou G. Anesthesia for the elderly. Hippokratia. 2007;11(4):175-7.
• 5. Blommers E, Klimek M, Hartholt KA, et al. Perioperative care of the older patient. Z Gerontol Geriatr. 2011;44(3):187-91.
• 6. Yang W, Tao Z, Chen H, et al. Amyand's hernia in elderly patients: diagnostic, anesthetic, and perioperative considerations. J Invest Surg. 2009;22(6):426-9.
• 7. Das S, Forrest K, Howell S. General anaesthesia in elderly patients with cardiovascular disorders: choice of anaesthetic agent. Drugs & Aging. 2010;27(4):265-82.
• 8. Kimmick G, Muss HB. Breast cancer in older patients. Semin Oncol. 2004;31(2):234-48.
• 9. Koç M, Arikan M, Arikan O, Dikmen B. Retrospective Evaluation of Different Methods of Anesthesia For Hip Arthroplasty In Advanced Aged Patients. Ortadoğu Medical Journal. 2012;4(4):182-7.
• 10. Jung HW, Kim KI. Blood Pressure Variability and Cognitive Function in the Elderly. 2013;1(1):29-34.
• 11. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217-23.
• 12. Lee JH, Kim KI, Cho MC. Current status and therapeutic considerations of hypertension in the elderly. Korean J Intern Med. 2019;34(4):687-95.
• 13. Song B, Zhu J. A narrative review of the impact of cerebellar dysfunction and sleep disturbances after general anesthesia in patients with Alzheimer's disease. Ann Palliat Med. 2021;10(6):6919-25.
• 14. Kumar CM, Gopal L, Seet E. Choosing anesthesia options for cataract surgery in patients with dementia. J AnaesthesiolClinPharmacol. 2019;35(1):81-4.
• 15. Seitz DP, Shah PS, Herrmann N, et al. Exposure to general anesthesia and risk of Alzheimer's disease: a systematic review and meta-analysis. BMC Geriatrics. 2011;11:83.
• 16. Seitz DP, Gill SS, Bell CM, et al. Postoperative medical complications associated with anesthesia in older adults with dementia. J AmGeriatrSoc. 2014;62(11):2102-9.
• 17. Cengiz M, Ölmez Kavak G. Preoperative preparation and anesthesia in geriatric patients. Turkiye Klinikleri J Orthop&Traumatol-Special Topics. 2008;1(2):61-8.
• 18. Li G, Warner M, Lang BH, Huang L, Sun LS. Epidemiology of anesthesia-related mortality in the United States, 1999–2005. Anesthesiology. 2009;110(4):759-65.
• 19. Kojima Y, Narita M. Postoperative outcome among elderly patients after general anesthesia. ActaAnaesthesiolScand. 2006;50(1):19-25.
• 20. Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2004;18(4):CD000521.
• 21.Sahin S, Heybeli N, Colak A, et al. Comparison of Different Anesthetic Techniques on Postoperative Outcomes in Elderly Patients with Hip Fracture. Turkiye Klinikleri J Med Sci. 2012;32:623-9.
• 22. Kara I, Celik JB, Oc B, Apillioğullari S, Karabagli H. Comparison of spinal and general anesthesia in lumbar discsurgery. Journal of Neurological Sciences. 2011;28(4):487-96.
• 23. Richman JM, Rowlingson AJ, Maine DN, Courpas GE, Weller JF, Wu CL. Does neuraxial anesthesia reduce intraoperative blood loss?: A meta-analysis. J Clin Anesth. 2006;18(6):427-35.
• 24. Heidari SM, Soltani H, Hashemi SJ, Talakoub R, Soleimani B. Comparative study of two anesthesia methods according to postoperative complications and one month mortality rate in the candidates of hip surgery. J Res Med Sci. 2011;16(3):323-30.
• 25. Haughom BD, Schairer WW, Nwachukwu BU, et al. Does Neuraxial Anesthesia Decrease Transfusion Rates Following Total Hip Arthroplasty?. J Arthroplasty. 2015;30(9):116-20.
• 26. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta- analysis of randomized trials. Br J Anaesth. 2000;84(4):450-5.