Turkiye Klinikleri Journal of Nursing Sciences

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Kırılganlığın Tek Taraflı Primer Total Diz Artroplastisi Sonrası Erken Dönem Hasta Sonuçlarına Etkisinin Belirlenmesi: Tanımlayıcı-Kesitsel Bir Çalışma
Determining the Impact of Frailty on Short-Term Outcomes After Unilateral Primary Total Knee Arthroplasty: A Descriptive-Cross Sectional Survey
Çiğdem CANBOLAT SEYMANa , Yasemin ŞARAb
aHacettepe Üniversitesi Hemşirelik Fakültesi, Cerrahi Hastalıkları Hemşireliği ABD, Ankara, Türkiye
bSelçuk Üniversitesi Hemşirelik Fakültesi, Cerrahi Hastalıkları Hemşireliği ABD, Konya, Türkiye
Turkiye Klinikleri J Nurs Sci. 2023;15(2):291-8
doi: 10.5336/nurses.2022-93834
Article Language: TR
Full Text
ÖZET
 Amaç: Kırılganlık ilerleyen yaşla birlikte fizyolojik kapasitede azalma, stres intoleransı, güçsüzlük, fiziksel aktivitede ve beden kitle indeksinde azalma gibi olumsuz sağlık sonuçlarını içeren geriatrik bir sendromdur. Artroplasti hastalarının ise, osteoartrite bağlı yakınmalar nedeniyle 60'lı yaşlarda ameliyat için başvurdukları bilinmektedir. Bu araştırmada, yaşlı ve kırılgan olma ihtimalleri oldukça yüksek bir grup olan total diz artroplastisi hastalarında kırılganlığın erken dönem hasta sonuçlarına etkisini belirlemek amaçlanmıştır. Gereç ve Yöntemler: Tanımlayıcı, kesitsel türde yapılan bu çalışma, bir üniversite hastanesinin ortopedi ve travmatoloji kliniğinde Ekim 2021-Mart 2022 tarihleri arasında, 127 hasta üzerinde yürütülmüştür. Araştırmanın verileri Kişisel Bilgiler Formu, ASA skorlaması, Charlson Komorbidite İndexi ve FRAIL ölçeği aracılığıyla toplanmıştır. Tanımlayıcı istatistikler, ki kare, Mann Whitney U, Kruskal Wallis ve Independent Sample t testleri kullanılarak veriler analiz edilmiştir. Ayrıca postoperatif hasta sonuçlarını kötüleştiren risk faktörlerini belirlemek için bivariate lojistik regresyon analizi kullanılmıştır. Bulgular: Yaş ortalamaları 66,8 ve beden kitle indeksi ortalamaları 31,3 kg/m2 olan hastaların %52'si sağ diz TDA geçirmiş, %79,5'i kadın, %87,4'ünün kronik hastalıkları mevcut ve %74'ünün kırılgan olduğu bulunmuştur. Araştırmaya katılan hastaların %26,8'i postoperatif erken dönem yaşadıkları sorunlara bağlı 7 günden uzun süre (X±SS: 10,8±4,8 gün) hastanede yatmıştır. Aynı zamanda FRAIL ölçek puanı arttıkça hastanede kalma sürelerinin, yoğun bakıma yatma oranlarının, postoperatif ağrı düzeylerinin arttığı ve postoperatif ilk mobilizasyon zamanlarının anlamlı olarak daha uzun olduğu saptanmıştır. Sonuç: Kırılganlığın primer unilateral total diz artroplastisi sonrası erken dönem olumsuz hasta sonuçları için tahmin edici/belirleyici olduğu ortaya konmuştur. Bu nedenle kırılganlığın preoperatif dönemde belirlenmesi ve gerekli önlemlerin alınması postoperatif erken dönem hasta sonuçlarını optimize edecektir.

Anahtar Kelimeler: Kırılganlık; artroplasti; postoperatif; hasta sonuçları
ABSTRACT
 Objective: Frailty is a geriatric syndrome that describes all of the negative health consequences such as a decrease in physiological capacity, stress intolerance, weakness, low physical activity and a decrease in body mass index with advancing age. It is known that arthroplasty patients apply for surgery in their 60s because of complaints related to osteoarthritis. In this study, it was aimed to determine the effect of frailty on shortterm patient outcomes in total knee arthroplasty (TKA) patients, who are elderly and have a high probability of being frail. Material and Methods: This descriptive, cross-sectional study was conducted on 127 patients in the orthopedics and traumatology clinic of a university hospital between October 2021 and March 2022. The data of the study were collected with Personal Information Form, ASA score Charlson Comorbidity İndex ve FRAIL questionnaire. Data were analyzed using descriptive statistics, chi-square test, Mann Whitney U test, Kruskal Wallis and Independent Sample t-test. Furthermore, bivariate logistic regression analysis was used to identify risk factors that worsened postoperative patient outcomes. Results: Patients with an mean age of 66,8 and an mean body mass index of 31,3 kg/m2 ; it was found that 52% of the patients had right knee TKA, 79,5% were women, 87,4% had chronic diseases and 74% were frail. 26,8% of the patients participating in the study were hospitalized for more than 7 days due to the problems they experienced in the early postoperative period (X±SS: 10,8±4,8 day). At the same time, as the FRAIL scale score increased, it was determined that the length of hospital stay, the rate of intensive care unit stay and the postoperative pain levels were higher, and the first postoperative mobilization times were longer. Conclusion: Frailty has been shown to be a predictor/determinant for early adverse patient outcomes after primary unilateral total knee arthroplasty. Therefore, determining frailty in the preoperative period and taking necessary precautions will optimize early postoperative patient outcomes.

Keywords: Frailty; arthroplasty; postoperative; patients outcomes
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