Utjecaj rane kirurgije na značajno smanjenje perioperativnog mortaliteta kod infektivnog endokarditisa

master's thesis

• Title (english): Early valve surgery significantly reduces perioperative mortality in infective endocarditis
• Author: Gloria Šestan
• Mentor: Igor Rudež (mentor)
• Committee member: Hrvoje Gašparović (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Igor Rudež (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Cilj ovog rada bio je usporediti perioperativni mortalitet između skupine bolesnika operiranih u ranoj fazi bolesti, odnosno unutar perioda od 14 dana, i skupine operirane nakon tog perioda te ukazati na značajno manji perioperativni mortalitet u prvoj skupini. Proveli smo retrospektivno opservacijsko kohortno istraživanje u kojem je proučavana populacija bolesnika podvrgnutih operativnom zahvatu u periodu od travnja 2005. do veljače 2018. godine na Zavodu za kardijalnu i transplantacijsku kirurgiju Kliničke bolnice Dubrava. Nakon statističke obrade podataka dobiveni rezultati pokazali su statistički značajnu razliku između uspoređivanih skupina u kategoriji dobi, bubrežne funkcije i hitnosti izvođenja operativnog zahvata. Bolesnici rano operirane skupine bili su značajno mlađi u odnosu na kasno operirane bolesnike (p-vrijednost=0.029). Nadalje, veći broj bolesnika rano operirane skupine imao je bolju bubrežnu funkciju u usporedbi s kasno operiranim bolesnicima kod kojih je primijećena veća učestalost oslabljene bubrežne funkcije i potrebe za hemodijalizom (p-vrijednost=0.028). Prilikom usporedbe hitnosti izvođenja operativnog zahvata rezultati su pokazali da je većina rano operiranih bolesnika bila podvrgnuta hitnoj operaciji dok su bolesnici kasno operirane skupine uglavnom operirani žurno (p-vrijednost<0.001). Rezultati ostalih uspoređivanih varijabli nisu pokazali statistički značajnu razliku. U skupini rano operiranih bolesnika u perioperativnom periodu umrlo je 4 od ukupno 75 bolesnika (5.3%). U skupini kasno operiranih bolesnika bilo je 8 umrlih od ukupno 80 bolesnika (10.0%). Usporedbom perioperativnog mortaliteta navedene dvije skupine nije dobivena statistički značajna razlika (p-vrijednost=0.277).

Abstract (english)

The number of patients operated on during the active phase of infective endocarditis is increasing constantly, mostly due to the rise in complicated situations caused by higher incidence of more virulent microorganisms and infections of indwelling surgical devices. The aim of this study was to asses whether early valve surgery could influence perioperative mortality in adults hospitalized for acute infective endocarditis. We performed a retrospective, cohort, observational study on a large unselected patient population who underwent surgery due to acute infective endocarditis between April 2005 and February 2018 at the Department for Cardiac and Transplant Surgery, University Hospital Dubrava. The results showed a statistically significant difference between the groups in several categories. The patients operated on after a period of 14 days were significantly older (mean 53.4 years) compared to the other group (mean 47.8). Furthermore, a greater number of the late-surgery group patients had moderate renal impairment and recieved hemodialysis in contrast to the early-surgery group, where most patients had normal renal function. There was a statistically significant difference in the urgency category as well (p-value<0.001). As expected, emergent surgeries were more often performed in the early-surgery group, while the late-surgery group mostly underwent urgent procedures. The results in the other categories revealed no statistically significant differences. In the early-surgery group 4 out of 75 (5.3%) patients died in the perioperative period, whereas in the late-surgery group the perioperative mortality rate was 10.0% (8 out of 80 patients). These results are clinically relevant, but display no statistical significance, considering the p-value of only 0.277.

• Keywords: infektivni endokarditis; rana operacija; perioperativni mortalitet; kardijalna kirurgija
• Keywords (english): infective endocarditis; early surgery; perioperative mortality; cardiac surgery
• Language: croatian
• URN:NBN: urn:nbn:hr:105:630359
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Repository: Dr Med - University of Zagreb School of Medicine Digital Repository
• Created on: 2018-12-05 11:25:39