Aysegul PARLAK CİKRİKCİ, Ökkeş Hakan MİNİKSAR, Tevfik HONCA, Ayşe Yeşim GÖÇMEN

Geriatrik Cerrahi Hastalarında Kırılganlık İndeksi D Vitamini Yetersizliği ile İlişkilidir: Prospektif Gözlemsel Çalışma

Amaç: Bu çalışmada elektif cerrahi uygulanan geriatrik hastalarda D vitamini, kırılganlık ve postoperatif sonuçlar arasındaki ilişkiyi araştırmayı amaçladık. Yöntem: Bu prospektif gözlemsel çalışmaya, kalp dışı cerrahi geçir- miş toplam 90 yaşlı hasta dahil edildi. Hastalar kırılganlık indeksi (FI) skoruna göre “Kırılgan olmayan (FI 0), kırılganlık öncesi (FI 1–2) ve kırılgan (FI ≥3)” olarak sınıflandırıldı. Ayrıca hastalar serum D vitamini konsantrasyonuna göre “D vitamini yetersiz grup (n=41) ve D vitamini yeterli grup (n=49)” olmak üzere iki gruba ayrıldı. Hastaların klinik özellikleri ve postoperatif sonuçları gruplar ara- sında karşılaştırıldı. Bulgular: Hastaların ortalama yaşı 75,7 ± 7,6 yıl, yoğun bakım üni- tesine kabul oranı %43,3 ve ameliyat sonrası 30 günlük mortalite oranı %21,1 idi. “D vitamini yetersizliği” grubunda yoğun bakıma yatış anlamlı olarak daha yüksekti (n=24’e karşı n=15, p=0,014). Ayrıca kırılgan hastalar “D vitamini yetersizliği” grubunda anlamlı olarak daha yüksekti (n=19’a karşı n=7, p=0,004). Kırılgan olma- yan hastaların çoğu “D Vitamini yeterli” grubundaydı (n=18’e karşı n=9). Sonuç: Çalışmamızda D vitamini eksikliği olan hastalarda daha yüksek kırılganlık gözlemledik. Ayrıca D vitamini yetersizliği olan ve kırılgan hastalarda postoperatif yoğun bakıma yatış oranı daha yüksekti. Bulgularımız, postoperatif sonuçlarda kırılganlık ve D vi- tamini eksikliğinin önemli bir rol oynadığını göstermektedir.

Frailty Index is Associated with Vitamin D Insufficiency in Geriatric Surgery Patients: A Prospective Observational Study

Objective: In this study, we aimed to investigate the relationship between vitamin D, frailty and postoperative outcomes in geriatric patients undergoing elective surgery. Methods: In this prospective observational study, a total of 90 el- derly patients who had undergone non-cardiac surgery were inc- luded. The patients were classified according to the frailty index (FI) score as “Non-frail (FI 0), Pre-frail (FI 1–2) and Frail (FI ≥3)”. In addition, patients were divided into two groups according to se- rum vitamin D concentration: vitamin D insufficiency group (n=41) and vitamin D sufficiency group (n=49). Clinical characteristics and postoperative outcomes of the patients were compared between the groups. Results: The mean age of the patients was 75.7 ± 7.6 years, the admission rate to Intensive Care Unit (ICU) was 43.3%, and the 30- day mortality rate after surgery was 21.1%. The ICU admission was significantly higher in the “vitamin D insufficiency” group (n=24 versus n=15, p=0.014). In addition, fragility status patients were significantly higher in the “vitamin D insufficiency” group (n=19 versus n=7, p=0.004). Most of the non-frail patients were in the “vitamin D sufficiency” group (n=18 versus n=9). Conclusion: In our study, we observed higher frailty in vitamin D insufficiency patients. In addition, admission to the postoperative ICU was higher in vitamin D insufficiency and frail patients. Our findings show that frailty and vitamin D insufficiency play an im- portant role in postoperative outcomes.

PDF

___

1. Pelavski AD. Perioperative care of the elderly patient. Anesth Analg 2018;127(3):e40.
2. Toker KM, Altıparmak B, Uysal AI, Akarken I, Ugur B. The impact of preoperative frailty on postoperative complications in elderly patients undergoing urological malignancy surgery. Indian J Surg 2020;82(3):421-26.
3. Hewitt J, Long S, Carter B, Bach S, McCarthy K, Clegg A. The prevalence of frailty and its association with clinical outcomes in general surgery: A systematic review and meta-analysis. Age Ageing 2018;47(6):793-800.
4. Miniksar ÖH, Özdemir M. Clinical features and outcomes of very elderly patients admitted to the intensive care unit: A retrospective and observational study. Indian J Crit Care Med 2021;25(6):629-34.
5. Chan R, Ueno R, Afroz A, Billah B, Tiruvoipati R, Subramaniam A. Association between frailty and clinical outcomes in surgical patients admitted to intensive care units: A systematic review and meta-analysis. Br J Anaesth 2022;128:258-71.
6. Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010;210(6):901-8.
7. Andreou A, Lasithiotakis K, Venianaki M. A comparison of two preoperative frailty models in predicting postoperative outcomes in geriatric general surgical patients. World J Surg 2018;42(12):3897-902.
8. Greene-Finestone L, Berger C, De Groh M, et al. 25-Hydroxyvi- tamin D in Canadian adults: Biological, environmental, and behavioral correlates. Osteoporos Int 2011;22(5):1389-99.
9. Feehan J, Phu S, Duque G. Vitamin D and Frailty. In: Musso CG, Jauregui JR, Macías-Núñez JF, Covic A, editors. Frailty and Kidney Disease. Switzerland: Springer, 2021;105.
10. Zhou J, Huang P, Liu P, et al. Association of vitamin D insufficiency and frailty: A systematic review and meta- analysis. Maturitas 2016;94:70-6.
11. Marcos-Pérez D, Sánchez-Flores M, Proietti S. Low vitamin d levels and frailty status in older adults: A systematic review and meta-analysis. Nutrients 2020;12(8):2286.
12. Phusunti S, Suthutvoravut W, Unnanuntana A, Chotiyarnwong P. The prevalence of hypovitaminosis D in patient with frailty hip fracture at a single institution in Thailand. J Med Assoc Thail 2016;99(11):1233–8.
13. Khan SA, Chua HW, Hirubalan P, Karthekeyan RB, Kothandan H. Association between frailty, cerebral oxygenation and adverse post-operative outcomes in elderly patients undergoing non-cardiac surgery: An observational pilot study. Indian J Anaesth 2016;60(2):102-7.
14. Puts MTE, Visser M, Twisk JWR, Deeg DJH, Lips P. Endocrine and inflammatory markers as predictors of frailty. Clin Endocrinol 2005;63(4):403-11.
15. Cigerli O, Parildar H, Unal AD, Tarcin O, Erdal R, Guvener Demirag N. Vitamin D insufficiency is a problem for adult out- patients? A university hospital sample in Istanbul, Turkey. Public Health Nutr 2013;16(7):1306-13.
16. Ganji V, Zhang X, Tangpricha V. Serum 25-Hydroxyvitamin D concentrations and prevalence estimates of hypovitaminosis D in the U.S. population based on assay-adjusted data. J Nutr 2012;142(3):498–507.
17. Soysal P, Stubbs B, Lucato P, et al. Inflammation and frailty in the elderly: A systematic review and meta-analysis. Ageing Res Rev 2016;31:1-8.
18. Ceglia L. Vitamin D and its role in skeletal muscle. Curr Opin Clin Nutr Metab Care 2009;12(6):628-33.
19. Kim J, Lee Y, Won CW, Kye S, Shim JS. Association of serum vitamin D with frailty in older Korean adults. Maturitas 2019;134:15-20.
20. Wong YYE, McCaul KA, Yeap BB, Hankey GJ, Flicker L. Low vitamin D status is an independent predictor of increased frailty and all-cause mortality in older men: The health in men study. J Clin Endocrinol Metab 2013;98(9):3821-8.
21. Buchebner D, Bartosch P, Malmgren L, McGuigan FE, Gerdhem P, Akesson KE. Association between vitamin D, frailty, and progression of frailty in community-dwelling older women. J Clin Endocrinol Metab 2019;104(12):6139-47.
22. Beggs T, Sepehri A, Szwajcer A, Tangri N, Arora RC. Frailty and perioperative outcomes: A narrative review. Can J Anesth 2015;62(2):143-57.
23. Turan A, Hesler BD, You J, et al. The association of serum vitamin D concentration with serious complications after noncardiac surgery. Anesth Analg 2014;119(3):603-12.
24. Xu HW, Shen B, Hu T, Zhao WD, Wu DS, Wang SJ. Preoperative vitamin D status and its effects on short-term clinical outcomes in lumbar spine surgery. J Orthop Sci 2020;25(5):787-92.