A retrospective analysis of the distribution of nosological units, the degree of surgical risk and the severity of hypovolemic disorders in patients with urgent abdominal’s pathology
Summary. Aim — to identify statistically significant groups of patients and degree’s criteria of the group’s severity. Object and methods. Patients with acute abdominal pathology who had urgent laparatomy about 2 hours from the start of treatment, the statistically significant characteristics of the average age, time from the onset of the disease, the degree of surgical risk were assessed on a POSSUM scale, baseline level of hypovolemia/dehydration according to P.G. Shelestyuk and type of surgery. Results. The general structure of the inclusion group is formed acute intestinal obstruction, perforated gastric and duodenal ulcer, strangulated hernia. Significant (p<0.05) differences were determined between 2011 and 2015 for the average age (57.5 (Me 20–75) and (64 (Me 20–90), respectively), late hospitalization (64±9.4 and 38±5.4%, respectively). Also it was established an increase of patients with moderate and high surgical risk on the POSSUM scale, which coincides with the presence of the initial moderate hypovolemia/II degree of dehydration according to P.G. Shelestyuk. Conclusions. There is a tendency to a significant increase in the average age and the prevalence of elderly patients, increase the severity of surgical risk and late hospitalization, the background of development in 50% of patients with moderate hypovolemia.
- Bereznitskiy Ya.S. (2008) Standarti organIzatsIYi ta profesIyno orientovani protokoli nadannya nevIdkladnoyi dopomogi hvorim z hirurgichnoyu patologieyu organiv zhivota. V kn.: Ya.S. Bereznitskiy (red.) Standarti organizatsiyi ta profesiyno orientovani protokoli nadannya nevidkladnoyi dopomogi hvorim z hIrurgichnoyu patologieyu organiv zhivota ta grudnoyi klitki. Dnipro-VAL, Dnipropetrovsk, s. 42–256.
- Dindo D., Demartines N., Clavien P. (2004) Classification of surgical complications a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg., 240: 205–213.
- NCEPOD (2016) Knowing the risk. A review of the peri-operative care of surgical patients (https://www.ncepod.org.uk/2011report2/downloads/POC_fullreport.pdf).
- NELA (2018) Update to the high-risk patient released by RCS England (https://www.niaa.org.uk/RCS-Update-The-High-Risk-Surgical-Patient-Released).
- NICE (2013) Intravenous fluid therenous fluid therapapy in adults in hospital (https://www.nice.org.uk/guidance/cg174/resources/intravenous-fluid-therapy-in-adults-in-hospital-pdf-35109752233669).
- The Royal College of Surgeons of England (2011) Emergency Surgery: Standards for unscheduled care. RCSENG — Professional Standards and Regulation, London, 78 р.