GERİATRİK POPÜLASYONDAKİ BENİGN JİNEKOLOJİK CERRAHİLERDE MORBİDİTE VE MORTALİTEYİ BELİRLEYEN FAKTÖRLERİN RETROSPEKTİF DEĞERLENDİRİLMESİ

Abstract

Retrospective Evaluation of Factors Determining Morbidity and Mortality in Benign Gynecologic Surgeries in the Geriatric Population. Hacettepe University, Thesis in Obstetrics and Gynecology, Ankara, 2024. The increasing geriatric population has raised concerns about the risks and outcomes associated with gynecological surgeries. This study presents a retrospective analysis of 716 geriatric patients who underwent benign gynecologic surgeries between 2014 and 2024 at Hacettepe University Hospital’s Department of Obstetrics and Gynecology. Frailty, defined as a syndrome of diminished physiological reserve increasing vulnerability to stress factors, has recently emerged as a crucial parameter in perioperative risk assessments of geriatric patients. In this study, the Laboratory-based Frailty Index (FI LAB) was employed as the frailty scale, while the Clavien-Dindo Classification was used to categorize morbidity (with severe morbidity defined as grade 3 or higher). The impact of various parameters on severe morbidity was evaluated via logistic regression analysis. Frailty index (p=0.003, OR: 2.28), polypharmacy (p=0.002, OR: 3.98), and intensive care unit (ICU) admission (p<0.001, OR: 8.19) were identified as significant risk factors for severe morbidity. Multivariate analysis indicated that polypharmacy (p=0.018, OR: 3.17) and postoperative ICU admission (p<0.001, OR: 6.30) remained significant risk factors. Regarding hospital readmissions, frailty index, polypharmacy and HbA1c (p=0.012, p<0.001 and p=0.045 respectively). No significant factors were found for emergency department visits following discharge. Factors significantly influencing ICU admission included frailty index, age, and polypharmacy in multivariate analysis (p<0.001, p=0.017, and p=0.009, respectively). A statistically significant relationship was found between frailty index and hospital length of stay (r=0.202, p<0.001). We concluded that the FI-Lab may be a useful tool for identifying patients at risk for postoperative complications. However, it should not be used as the sole determinant of surgical decision-making. A comprehensive assessment of multiple factors is necessary for optimizing patient care.