Laparoskopik Majör Abdominal Kanser Cerrahisi Sonrası Postoperatif Pulmoner Komplikasyonların Öngörülmesinde ASA ve ARİSCAT Risk İndeksinin Değerlendirilmesi Predicting Postoperative Pulmonary Complications: ASA and ARISCAT risk index

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Abstract

Amaç: Postoperatif pulmoner komplikasyonlar (PPK) postoperatif morbidite ve mortalitenin önemli bir nedenidir. PPK'ların insidansını azaltma çabaları, preoperatif risk değerlendirmesi ile başlar. ARISCAT risk indeksi hastaları düşük, orta ve yüksek riskli olarak sınıflandıran ve postoperatif pulmoner komplikasyonların genel insidansını tahmin etmek için kullanılan bir regresyon modelidir. Çalışmamızda laparoskopik abdominal tümör cerrahisi sonrası pulmoner komplikasyonları öngörmede ASA ve ARISCAT indeksinin etkinliğini değerlendirmeyi amaçladık.


Gereç ve Yöntem: Etik Kurulu onayı sonrası laparoskopik majör abdominal kanser cerrahisi planlanan 100 hasta çalışmaya dâhil edildi. Preoperatif ASA ve ARISCAT skoru, komorbiditeler, intraoperatif sıvı miktarı, ventilasyon parametreleri, pnömoperitoneum basıncı ve operasyon süresi kaydedildi. Hastalar taburcu olana kadar pulmoner komplikasyonlar açısından takip edildi. Hastanede kalış süreleri kaydedildi.


Bulgular: Postoperatif 11 hastada pulmoner komplikasyon gelişti. ASA ve ARISCAT risk grupları arasında PPK insidansı benzer bulundu (p>0,05). ASA ve ARİSCAT risk indeksleri ile PPK arasında anlamlı bir ilişki yoktu (sırası ile p=0,23ve p=0,89). PPK gelişen hastalarda intraoperatif verilen sıvı miktarı anlamlı olarak daha yüksekti (p=0,018).


Cerrahi bölge ile PPK gelişimi arasında anlamlı korelasyon vardı (p=0,012). PPK gelişen hastalarda operasyon süresi ve hastanede kalış süresi daha uzundu (p˂0,05).


Sonuç: Laparoskopik majör abdominal tümör cerrahisinde hem ASA skorunun hem de ARISCAT risk indeksinin postoperatif pulmoner komplikasyonları tahmin etmek için yeterli olmadığını ve cerrahi bölge, uzun operasyon süresi ve intraoperatif kullanılan sıvı hacminin pulmoner komplikasyonlar için önemli bağımsız risk faktörleri olduğunu bulduk.

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References

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