Study on factors affecting mortality in nonagenarian patients in orthopaedic surgery

Background: With medicine advancing, population is aging in the world. We encounter elderly patients in operating rooms more often. In this study, the aim was to investigate mortality and morbidity rates of patients 90 years of age or older within 1 year from the date of operation due to fractures.Methods: The study was performed retrospectively in the 3rd stage health institution. All patients that had fracture operation in the operating rooms of the orthopaedics department between 2011 and 2017 and that were 90 years or older on the day of operation were included in the study. Patients who were operated twice were excluded from the study.Results: Around 83 patients of which were included in the study. The mean age of the patients was 92.89±2.84. In-hospital mortality rate was 8.4%. The mortality rate within 3 months from the operation was 18.1%, 25.3% within 1 year, and 61.4% within 5 years or above. Author found that the mean survival period for the total of the surviving patients was 23.87±18.96 months. Author found that there was a meaningful causation between morbidity developing post-operation and in-hospital mortality, 3-month mortality, and 1-year mortality (p<0.05).Conclusions: Author think that it was important to recognize the fact that despite being more vulnerable, patients 90 years of age or older have a significant life expectancy post-hospital discharge. Author think that post-operation acute morbidity affects mortality rates and it was important to avoid factors that may cause acute morbidity in patients 90 years of age and older.

The relationship between neutrophil to lymphocyte ratio and postoperative pain in total knee and hip arthroplasty / Relação entre a proporção neutrófilo/linfócito e a dor pós-operatória em artroplastia total de joelho e quadril

Abstract Background and objectives: Neutrophil to lymphocyte ratio is a simple, cost-effective and easily applicable inflammation indicator that is being used frequently in mortality, morbidity and prognosis studies in the recent years. We evaluated the relationship between neutrophil to lymphocyte ratio and postoperative pain in patients undergoing total hip arthroplasty and total knee arthroplasty. Material and methods: We included 101 patients who preferred spinal anesthesia and intravenous patient-controlled analgesia in accordance and divided them into two groups, total hip arthroplasty and total knee arthroplasty. We recorded demographic information, duration of operation, length of hospital stay, analgesics consumption, neutrophil to lymphocyte ratio results and postoperative pain using Visual Analog Scale. Results: The morphine consumption of the patients was as follows in group total hip arthroplasty and total knee arthroplasty: at the 4th hour: 7.38 mg, 7.80 mg; 8th hour: 12.19 mg, 13.29 mg; 12th hour: 16.94 mg, 19.18 mg; 24th hour: 25.97 mg, 27.98 mg; 48th hour: 36.38 mg, 39.59 mg. The Visual Analog Scale scores of the patients was as follows in group total hip arthroplasty and total knee arthroplasty: at the 4th hour: 4.10, 4.51; 8th hour: 3.02, 3.43; 12th hour: 2.29, 2.55; 24th hour: 1.90, 1.87; 48th hour: 1.08, 1.13. In group total hip arthroplasty, we found a statistically significant association between postoperative neutrophil to lymphocyte ratio and the Visual Analog Scale values on the 48th hour in a positive direction (r = 0.311; P = 0.031; P < 0.05). Conclusion: Neutrophil to lymphocyte ratio can be accepted as a relatively objective method for the diagnosis of postoperative pain.

Resumo Justificativa e objetivos: A proporção entre neutrófilo/linfócito é um indicador de inflamação simples, custo-efetivo e de fácil aplicação que vem sendo usado com frequência em estudos de mortalidade, morbidade e prognóstico nos últimos anos. Avaliamos a relação entre a proporção neutrófilo/linfócito e a dor pós-operatória em pacientes submetidos à artroplastia total de quadril e artroplastia total de joelho. Material e métodos: No total, 101 pacientes que preferiram a raquianestesia e a analgesia venosa controlada pelo paciente foram incluídos e divididos em dois grupos neste estudo: artroplastia total de quadril e artroplastia total de joelho. Os dados demográficos e os tempos de operação, internação hospitalar e consumo de analgésicos e os resultados da proporção neutrófilo/linfócito e da dor pós-operatória foram registrados usando uma escala visual analógica. Resultados: O consumo de morfina dos pacientes submetidos à artroplastia total de quadril e artroplastia total de joelho nas horas 4, 8, 12, 24 e 45 foi de, respectivamente: 7,38 mg e 7,80 mg; 12,19 mg e 13,29 mg; 16,94 mg e 19,18 mg; 25,97 mg e 27,98 mg; 36,38 mg e 39,59 mg. Os escores obtidos na escala visual analógica dos pacientes submetidos à artroplastia total de quadril e artroplastia total de joelho nas horas 4, 8, 12, 24 e 48 foram, respectivamente: 4,10 e 4,51; 3,02 e 3,43; 2,29 e 2,55; 1,90 e 1,87; 1,08 e 1,13. Na artroplastia total do quadril, uma associação estatisticamente significativa foi encontrada entre a proporção neutrófilo/linfócito no pós-operatório e os valores da escala visual analógica na 48ª hora em uma direção positiva (r = 0,311; p = 0,031; p < 0,05). Conclusão: A proporção neutrófilo/linfócito pode ser aceita como um método relativamente objetivo para o diagnóstico da dor pós-operatória.

Patient state index and cerebral blood flow changes during shoulder arthroscopy in beach chair position / Patient State Index e alterações do fluxo sanguíneo cerebral durante artroscopia do ombro em posição de cadeira de praia

Abstract Background and objectives: The aim of the study were to demonstrate the possible hemodynamic changes and cerebral blood flow alterations in patients who were positioned from supine to beach chair position; and to detect if the position change causes any cortical activity alteration as measured by the 4-channeled electroencephalography monitor. Methods: 35 patients were included. Before the induction, mean arterial pressure and patient state index values were recorded (T0). After the intubation, doppler-ultrasonography of the patients’ internal carotid and vertebral arteries were evaluated to acquire cerebral blood flow values from the formula. In supine position, mean arterial pressure, patient state index and cerebral blood flow values were recorded (T1) and the patient was positioned to beach chair position. After 5 min all measurements were repeated (T2). Measurements of patient state index and mean arterial pressure were repeated after 20 (T3), and 40 (T4) min. Results: There was a significant decrease between T0 and T1 in heart rate (80.5 ± 11.6 vs. 75.9 ± 14.4 beats/min), MAP (105.8 ± 21.9 vs. 78.9 ± 18.4 mmHg) and PSI (88.5 ± 8.3 vs. 30.3 ± 9.7) (all p < 0.05). Mean arterial pressure decreased significantly after position change, and remained decreased, compared to T1. The overall analysis of patient state index values (T1-T4) showed no significant change; however, comparing only T1 and T2 resulted in a statically significant decrease in patient state index. There was a significant decrease in cerebral blood flow after beach chair position. Conclusion: Beach chair position was associated with a decrease in cerebral blood flow and patient state index values. Patient state index was affected by the gravitational change of the cerebral blood flow; however, both factors were not directly correlated to each other. Moreover, the decrease in patient state index value was transient and returned to normal values within 20 min.

Resumo Justificativa e objetivos: Demonstrar as possíveis alterações hemodinâmicas e do fluxo sanguíneo cerebral (FSC) em pacientes que foram posicionados de supinação para cadeira de praia (CP) e detectar se a mudança de posição causa alguma alteração na atividade cortical como mensurado pelo monitor de EEG com quatro canais. Métodos: Foram incluídos 35 pacientes. Antes da indução, os valores da PAM e do IEP foram registrados (T0). Após a intubação, ultrassonografias com Doppler da carótida interna e artérias vertebrais dos pacientes foram avaliadas para adquirir os valores do FSC a partir da fórmula. Em supinação, os valores da PAM, IEP e FSC foram registrados (T1) e o paciente foi posicionado em CP. Após cinco minutos, todas as mensurações foram repetidas (T2). As mensurações do IEP e PAM foram repetidas após 20 (T3) e 40 minutos (T4). Resultados: Houve uma diminuição significativa entre T0 e T1 na FC (80,5 ± 11,6 vs. 75,9 ± 14,4 bpm), PAM (105,8 ± 21,9 vs. 78,9 ± 18,4 mmHg) e IEP (88,5 ± 8,3 vs. 30,3 ± 9,7) (p < 0,05 para todos). A PAM diminuiu significativamente após a mudança de posição e permaneceu diminuída em relação a T1. A análise global dos valores do IEP (T1-T4) não mostrou mudança significativa, mas a comparação de apenas T1 e T2 resultou em redução estatisticamente significativa do IEP. Houve redução significativa do FSC após o posicionado em CP. Conclusão: O posicionado em CP foi associado à diminuição do FSC e dos valores do IEP. O IEP foi afetado pela mudança gravitacional do FSC; no entanto, ambos os fatores não estavam diretamente correlacionados. Além disso, a diminuição do valor do IEP foi transitória e voltou aos valores normais dentro de 20 minutos.