Factors Affecting Prolonged Stay in Postoperative Period in General Surgery Intensive Care Unit

Yıl 2019, , 108 - 111, 20.12.2019

Mehmet Üstün , Gizem Kılınç , Avni Can Karaca , Halit Batuhan Demir , Nimet Şenoğlu , Cengiz Aydın

https://doi.org/10.33713/egetbd.590564

Cited By: 1

Öz

Aim:

Prolonged
stay in intensive care unit is associated with a high risk of mortality.
Predictability of it is important to reduce mortality. The aim of this study is
to determine the factors affecting prolonged stay in secondary general surgery
intensive care unit.

Materials
and Methods:

Between
January 2014 and October 2017, 68 patients with prolonged stay undergoing
general surgery ICU follow-up in the postoperative period after the general surgical
procedure and the same number of randomly selected patients with similar
characteristics were compared in two groups

Results:

The
median age of the patients with prolonged stay was 69,00 (22,50) and the median
age of the patients in the control group was 59,00 (14,75) (p < 0,001).In prolonged stay group, 59 patients underwent abdominal
emergency surgery, and 9 patients underwent abdominal elective surgery. The
number of patients undergoing abdominal emergency procedures in the control
group was 23, and the number of patients undergoing abdominal elective
procedure was 45 ( p=0,001). Fourty eight
of the patients in the prolonged stay
group
had mortality, 7 of the patients
in the control group had mortality (p=0,001).  As
a result of multivariate analysis; in the prolonged stay group, emergency
abdominal surgical procedure rate (p <0.001) (Odds ratio:12.983), age (p =
0.006) (Odds ratio:0.96) and mortality rate (p <0.001) (Odds ratio: 20,91)
was found to be statistically significant.

Conclusion: .

Emergency
abdominal surgical procedure, age and high mortality rate are associated with
prolonged stay.

Anahtar Kelimeler

prolonged stay, intensive care unit, general surgery

Genel Cerrahi Yoğun Bakımda Postoperatif Dönemde Uzamış Yatış Süresine Etki Eden Faktörler

Öz

Amaç:

Yoğun
bakımda uzamış yatış süresi, yüksek mortalite riski ile ilişikilidir. Bunu
öngörmek, mortaliteyi azaltmak amacıyla önemlidir. İkinci basamak genel cerrahi yoğun
bakımda uzamış yatış süresine etki eden faktörleri saptamayı amaçladık.

 

Gereç ve Yöntem:

Ocak
2014 - Ekim 2017 tarihleri arasında, genel cerrahi prosedür sonrası
postoperatif dönemde genel cerrahi yoğun bakım takibine alınan hastalardan
uzamış yatış süresine sahip 68 hasta ve bu hastalar ile benzer özellikte
randomize olarak seçilmiş aynı sayıdaki hastalar iki grup şeklinde
karşılaştırmalı olarak incelendi

 

Bulgular:

Uzamış
yatış süresi olan hastaların median yaşı 69,00(22,50) iken kontrol
grubundaki hastaların median yaşı 59,00(14,75) idir (p < 0,001). Uzamış yatış süresi grubundaki hastalardan 59 tanesine
abdominal acil cerrahi prosedür, 9 tanesine abdominal elektif cerrahi prosedür,
uygulandı. Kontrol grubundaki hastalardan abdominal acil prosedür uygulanan
hasta sayısı 23, abdominal elektif prosedür uygulanan hasta sayısı 45 idi (
p=0,001). Uzamış yatış süresi grubundaki hastalardan 48’inde mortalite
gelişirken, diğer gruptaki hastaladan 7’sinde mortalite gelişmiştir (p=0,001). Yapılan multivariate analizleri sonucunda; uzamış yatış
grubunda acil abdominal cerrahi prosedür uygulaması (p<0,001) (Odds
ratio:12.983), yaş ( p= 0.006) (Odds ratio:0.96) , mortalite  oranı (p<0,001) (Odds ratio:20,91) istatistiksel olarak anlamlı yüksek
bulunmuştur.

Sonuç:

Acil
abdominal cerrahi prosedür uygulaması, yaş ve yüksek mortalite oranı, uzamış
yatış süresi ile ilişkilendirilmiştir.

Anahtar Kelimeler

uzamış yatış, yoğun bakım, genel cerrahi

Kaynakça

• Referans 1. Combes A, Costa MA, Trouillet JL, Baudot J, Mokhtari M, Gibert C et al. Morbidity, mortality, and quality-of-life outcomes of patients requiring > or = 14 days of mechanical ventilation. Crit Care Med 2003;31:1373-81.
• Referans 2. Wong DT, Gomez M, McGuire GP, Kavanagh B. Utilization of intensive care unit days in a Canadian medical-surgical intensive care unit. Crit Care Med 1999;27:1319-24.
• Referans 3. Heyland DK, Konopad E, Noseworthy TW, Johnston R, Gafni A. Is it ’worthwhile’ to continue treating patients with a prolonged stay (>14 days) in the ICU? An economic evaluation. Chest 1998;114:192-8.
• Referans 4. Weissman C: Analyzing the impact of long-term patients on ICU bed utilization. Intensive Care Med 2000, 26:1319-1325.
• Referans 5. Martin CM, Hill AD, Burns K, Chen LM: Characteristics and outcomes for critically ill patients with prolonged intensive care unit stays.
• Referans 6. Trottier V, McKenney MG, Beninati M, Manning R, Schulman CI: Survival after prolonged length of stay in a trauma intensive care unit. J Trauma 2007, 62:147-150.
• Referans 7. Arabi Y, Venkatesh S, Haddad S, Al Shimemeri A, Al Malik S. A prospective study of prolonged stay in the intensive care unit: predictors and impact on resource utilization. Int J Qual Health Care. 2002 Oct;14(5):403-10.
• Referans 8. Zampieri FG, Ladeira JP, Park M, Haib D, Pastore CL, Santoro CM et al. Admission factors associated with prolonged (>14 days) intensive care unit stay. J Crit Care. 2014 Feb;29(1):60-5
• Referans 9. Chang CJ, Tam HP, Ko WJ, Tsai PR. Predicting hospital mortality in adult patients with prolonged stay (>14 days) in surgical intensive care unit. Minerva Anestesiol. 2013 Aug;79(8):843-52. Epub 2013 May 23.
• Referans 10. Higgins TL, McGee WT, Steingrub JS, et al. Early indicators of prolonged intensive care unit stay: impact of illness severity, physician staffing, and pre-intensive care unit length of stay. Crit Care Med 2003;31:45–51.
• Referans 11. Kramer AA, Zimmerman JE. A predictive model for the early identification of patients at risk for a prolonged intensive care unit length of stay. BMC Med Inform Decis Mak. 2010 May 13;10:27
• Referans 12. Bickenbach J, Fries M, Rex S, Stitz C, Heussen N, Rossaint R et al. Outcome and mortality risk factors in long-term treated ICU patients: a retrospective analysis, Minerva An- estesiol 2011;77:427-38.