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
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.
References
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24. Chandler D, Mosieri C, Kallurkar A, Pham AD, Okada LK, Kaye RJ, Cornett EM, Fox CJ, Urman RD, Kaye AD. Perioperative strategies for the reduction of postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol. 2020 Jun;34(2):153-166. doi: 10.1016/j.bpa.2020.04.011. Epub 2020 Apr 23. PMID: 32711826.
25. Canet J, Gallart L. Predicting postoperative pulmonary complications in the general population. Curr Opin Anaesthesiol 2013;26(2):107–15. doi: 10.1097/ACO.0b013e32835e8acd.
26. Langeron O, Carreira S, le Saché F, Raux M. Postoperative pulmonary complications updating. Ann Fr Anesth Reanim 2014;3(7-8):480-3. doi: 10.1016/j.annfar.2014.07.741.
27. Shin CH, Long DR, McLean D, Grabitz SD, Ladha K, Timm FP, et al. Effects of Intraoperative Fluid Management on Postoperative Outcomes: A Hospital Registry Study. Ann Surg 2018; 267(6):1084-1092. doi: 10.1097/SLA.0000000000002220.
28. Brandstrup B. Finding the right balance. New England Journal of Medicine 2018;378(24):2335-2336. DOI: 10.1056/nejme1805615.
29. Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med 2018; 378:2263-2274. DOI: 10.1056/NEJMoa1801601.
30. Timothy E. Miller, Paul S. Myles; Perioperative Fluid Therapy for Major Surgery. Anesthesiology 2019;130:825–832 doi: https://doi.org/10.1097/ALN.0000000000002603
31. Gupta R, Gan TJ. Peri-operative fluid management to enhance recovery. Anaesthesia2016; 71 Suppl 1:40-5. doi: 10.1111/anae.13309.
32. Miller TE, Myles PS. Perioperative Fluid Therapy for Major Surgery. Anesthesiology. 2019; 130:825–832 doi: https://doi.org/10.1097/ALN.0000000000002603.
33. Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surgical Endoscopy2002;16(7):1121-43. doi: 10.1007/s00464-001-9166-7.
34. Goldfarb M, Brower S, Schwaitzberg SD. Minimally invasive surgery and cancer: Controversies part 1. Surg Endosc. 2010;24(2):304–34.
35. Han SA, Lee WY, Park CM, Yun SH, Chun HK. Comparison of immunologic outcomes of laparoscopic vs open approaches in clinical stage III colorectal cancer. Int J Colorectal Dis. 2010; 25(5):631-8. doi: 10.1007/s00384-010-0882-0.
36. Ng CSH, Whelan RL, Lacy AM, Yim APC. Is minimal access surgery for cancer associated with immunologic benefits? World Journal of Surgery. 2005; 29(8):975-81. doi: 10.1007/s00268-005-0029-6.
2. Taylor A, DeBoard Z, Gauvin JM. Prevention of Postoperative Pulmonary Complications. Surg Clin North Am 2015; 95(2):237–54. http://dx.doi.org/10.1016/j.suc.2014.11.002.
3. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118(3):317–34.
4. Lawrence VA, Hilsenbeck SG, Mulrow CD, Dhanda R, Sapp J, Page CP. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med. 1995;10(12):671–8.
5. Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med. 2006;21(2):177–80.
6. Yang CK, Teng A, Lee DY, Rose K. Pulmonary complications after major abdominal surgery: National Surgical Quality Improvement Program analysis. J Surg Res 2015;198(2):441–9. Available from: http://dx.doi.org/10.1016/j.jss.2015.03.028.
7. Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Ruiz RM, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators. JAMA Surg. 2017;152(2):157–66.
8. Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, Sabaté S, Mazo V, Briones Z, Sanchis J; ARISCAT Group. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010 Dec;113(6):1338-50. doi: 10.1097/ALN.0b013e3181fc6e0a.
9. Ávila AC de, Fenili R. Incidência e fatores de complicações pulmonares pós-operatórias em pacientes submetidos à cirurgias de tórax e abdome. Rev Col Bras Cir. 2017;44(3):284–92.
10. Antoniou S, A, Antoniou G, A, Koch O, O, Köhler G, Pointner R, Granderath F, -A: Laparoscopic versus Open Obesity Surgery: A Meta-Analysis of Pulmonary Complications. Dig Surg 2015;32:98-107. doi: 10.1159/000371749.
11. McAlister FA, Bertsch K, Man J, Bradley J, Jacka M. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med. 2005;171(5):514–7.
12. Grocott MP. Standardisation of perioperative outcome measures. European Journal of Anaesthesiology. 2015 Feb;32(2):83-84. DOI: 10.1097/eja.0000000000000156.
13. Jammer I, Wickboldt N, Sander M, Smith A, Schultz MJ, Pelosi P, Leva B, Rhodes A, Hoeft A, Walder B, Chew MS, Pearse RM; European Society of Anaesthesiology (ESA) and the European Society of Intensive Care Medicine (ESICM); European Society of Anaesthesiology; European Society of Intensive Care Medicine. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol. 2015 Feb;32(2):88-105. doi: 10.1097/EJA.0000000000000118.
14. Gupta S, Fernandes RJ, Rao JS, Dhanpal R. Perioperative risk factors for pulmonary complications after non-cardiac surgery. J Anaesthesiol Clin Pharmacol. 2020;36(1):88-93. doi:10.4103/joacp.JOACP_54_19
15. Mazo V, Sabaté S, Canet J, Gallart L, De Abreu MG, Belda J, et al. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology. 2014;121(2):219–31.
16. Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL. Medical Complications and Outcomes After Hip Fracture Repair. Arch Intern Med. 2002;162(18):2053–2057. doi:10.1001/archinte.162.18.2053.
17. Canet J, Sabaté S, Mazo V, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P; PERISCOPE group. Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: A prospective, observational study. Eur J Anaesthesiol 2015;32(7):458-70. doi: 10.1097/EJA.0000000000000223.
18. Lee CZ, Kao LT, Lin HC, Wei PL. Comparison of clinical outcome between laparoscopic and open right hemicolectomy: a nationwide study. World J Surg Oncol. 2015 Aug 15;13:250. doi: 10.1186/s12957-015-0666-7. PMID: 26271770.
19. Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C. The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest. 2001 Sep;120(3):971-8. doi: 10.1378/chest.120.3.971.
20. Kupeli E, Er Dedekarginoglu B, Ulubay G, Oner Eyuboglu F, Haberal M. American Society of Anesthesiologists Classification Versus ARISCAT Risk Index: Predicting Pulmonary Complications Following Renal Transplant. Exp Clin Transplant. 2017 Feb;15(Suppl 1):208-213. doi: 10.6002/ect.mesot2016.P89.
21. Wood CB, Shinn JR, Rees AB, et al. Existing Predictive Models for Postoperative Pulmonary Complications Perform Poorly in a Head and Neck Surgery Population. Journal of Medical Systems. 2019 Aug;43(10):312. DOI: 10.1007/s10916-019-1435-x.
22. Griffiths S V., Conway DH, Sander M, Jammer I, Grocott MPW, Creagh-Brown BC. What are the optimum components in a care bundle aimed at reducing post-operative pulmonary complications in high-risk patients? Perioper Med 2018;7:7doi: 10.1186/s13741-018-0084-9.
23. Odor PM, Bampoe S, Gilhooly D, Creagh-Brown B, Ramani Moonesinghe S. Perioperative interventions for prevention of postoperative pulmonary complications: Systematic review and meta-analysis. The BMJ 2020;368:m540doi: https://doi.org/10.1136/bmj.m540.
24. Chandler D, Mosieri C, Kallurkar A, Pham AD, Okada LK, Kaye RJ, Cornett EM, Fox CJ, Urman RD, Kaye AD. Perioperative strategies for the reduction of postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol. 2020 Jun;34(2):153-166. doi: 10.1016/j.bpa.2020.04.011. Epub 2020 Apr 23. PMID: 32711826.
25. Canet J, Gallart L. Predicting postoperative pulmonary complications in the general population. Curr Opin Anaesthesiol 2013;26(2):107–15. doi: 10.1097/ACO.0b013e32835e8acd.
26. Langeron O, Carreira S, le Saché F, Raux M. Postoperative pulmonary complications updating. Ann Fr Anesth Reanim 2014;3(7-8):480-3. doi: 10.1016/j.annfar.2014.07.741.
27. Shin CH, Long DR, McLean D, Grabitz SD, Ladha K, Timm FP, et al. Effects of Intraoperative Fluid Management on Postoperative Outcomes: A Hospital Registry Study. Ann Surg 2018; 267(6):1084-1092. doi: 10.1097/SLA.0000000000002220.
28. Brandstrup B. Finding the right balance. New England Journal of Medicine 2018;378(24):2335-2336. DOI: 10.1056/nejme1805615.
29. Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med 2018; 378:2263-2274. DOI: 10.1056/NEJMoa1801601.
30. Timothy E. Miller, Paul S. Myles; Perioperative Fluid Therapy for Major Surgery. Anesthesiology 2019;130:825–832 doi: https://doi.org/10.1097/ALN.0000000000002603
31. Gupta R, Gan TJ. Peri-operative fluid management to enhance recovery. Anaesthesia2016; 71 Suppl 1:40-5. doi: 10.1111/anae.13309.
32. Miller TE, Myles PS. Perioperative Fluid Therapy for Major Surgery. Anesthesiology. 2019; 130:825–832 doi: https://doi.org/10.1097/ALN.0000000000002603.
33. Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surgical Endoscopy2002;16(7):1121-43. doi: 10.1007/s00464-001-9166-7.
34. Goldfarb M, Brower S, Schwaitzberg SD. Minimally invasive surgery and cancer: Controversies part 1. Surg Endosc. 2010;24(2):304–34.
35. Han SA, Lee WY, Park CM, Yun SH, Chun HK. Comparison of immunologic outcomes of laparoscopic vs open approaches in clinical stage III colorectal cancer. Int J Colorectal Dis. 2010; 25(5):631-8. doi: 10.1007/s00384-010-0882-0.
36. Ng CSH, Whelan RL, Lacy AM, Yim APC. Is minimal access surgery for cancer associated with immunologic benefits? World Journal of Surgery. 2005; 29(8):975-81. doi: 10.1007/s00268-005-0029-6.
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04.09.2022
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