Procena faktora rizika ranih komplikacija urgentnih hirurških intervencija na gastrointestinalnom traktu kod bolesnika starijeg životnog doba
DoktorandMitić-Lakušić, Vesna R.
Članovi komisijeStanojević, Goran
MetapodaciPrikaz svih podataka o disertaciji
Introduction: The study covers the frequency and the most important risk factors related to early postoperative complications experienced by elderly patients who underwent an emergency gastrointestinal surgery. This does not include laparoscopic treatment and traumas. Despite the improved surgical techniques, anesthesiology procedures and postoperative care and reanimation, surgeons do not like to operate on such patients due to the increased risk from both surgical and non-surgical procedures, with the increase of both intra-operative and postoperative mortality rate. The increase of the number of older people in developed countries and the screening program usage for early detection of illnesses leads to an increased number of surgical procedures carried out those who are older than 65. Methods: The research was undertaken on General Surgery Clinic of Nis Clinical Center in the period between 1 September 2015 and 30 August 2017. The research included the patients who were 65 or youg...er (test group) and the patients who were younger than 65. (control group). The patients in both groups underwent gastrointestinal surgical procedures (stomach, small intestine and colon). Gender and age structure were analyzed for all the patients, American Anasthesiologists’ Classification, Physiologic Severity Score and Operative Severity Score, biochemical parameters (CRP procalcitonin, creatinine, urea, proteins etc.), underlying chronical deseases (cardiac, respiratory, kidney etc). BMI, as the measure of the overal obesity degree was determined. The type of surgical intervention was monitored in relation with the type of lesions (benign/malignant desease) and the localization (stomach, small intestine or colon), the length of surgical intervention and the amount of lost blood. In the post-operative procedure the application of medicament therapy was monitored as well as the application of of blood and blood derivate components. The frequnecy of surgical complications was aslo monitored and compared (laparotomy dechicence, dechicence of anastomosis, bleeding, ileus) and also of non-surgical complications (myocardial infarction, cerebrovascular insult, deep vein thrombosis, respiratory and kidney insufficiency etc.) 30 days after the surgical intervention, Kolmogorov-Smirnov test was used for data normality assessment and T-test for the comparison of two groups of data if normal distribution is satisfied. If the arithmetic means and standard deviations, medians and interquartal differences or data distribution were not normal, Mann-Whitney U test was used. For the comparison of three or more groups of data, if the normal distribution was satisfied, ANOVA was used. If normal distribution was not satisfied during the comparison of three or more groups, Kruskal-Wallis test was used. Cox regression analysis was used to determine hazard ratio for each of the tested biochemical parameters. Statistical data processing was carried out in SPSS 16.0 program package (SPSS Inc, Chicago Il, USA). Results: The following distribution of early postoperative complications was determined: dehiscence of anastomosis and intestinal fistula with 20 (41.7%) patients, (multivariate analysis pointed out a higher ASA score and stomach surgeries as the most important risk factors for dehiscence of anastomosis and gastrointestinal fistula), intra-abdominal abscess with 9 (18,8%) patients, septicaemia with 9 (18,8%) patients, deep wound infections with 7 (14,6%) patients and 3 (6,3%) patients with intra-abdominal bleeding. Thre were no gender differences in the experiencing of the complications while the complications were more common after the operation of the pathological processes on stomach. Multivariate analysis highlighted the duration of the procedure, a higher ASA score and diabetis melitus as the most important risk factors for septic complications (sepsis, intra-abdominal abscess and deep wound infections). Conclusion: The research has shown that age is not a risk factor for postoperative complications with emergency gastrointestinal surgeries.