FAKTOR RESIKO KEBOCORAN ANASTOMOSIS PASKA RESEKSI ANASTOMOSIS USUS PADA KASUS TRAUMA DI RSUP DR. SARDJITO YOGYAKARTA TAHUN 2011-2016

RAYHAN FAUZIE, Prof.Dr.Marijata Sp.B -KBD

2017 | Tesis-Spesialis | SP ILMU BEDAH

Pendahuluan : Kebocoran anastomosis merupakan komplikasi operasi usus yang berbahaya. Kerusakan pada anastomosis meningkatkan morbiditas, mortalitas, waktu perawatan dan biaya. Definisi kebocoran anastomosis adalah kebocoran isi lumen dari sambungan di antara dua organ berongga. Penyembuhan anastomosis usus umumnya cepat jika tanpa ada komplikasi. Faktor local terdiri vaskularisasi, teknik pembedahan, kontaminasi bakteri, pengistirahatan usus, waktu operasi, sepsis abdominal (peritoneal sepsis), dan letak anastomosis. Faktor sistemik antara lain status nutrisi, anemia, hipovolemia, diabetes mellitus, obat-obatan, penyakit sistemik, penyalahgunaan rokok dan alkohol, status ASA, gender, dan skor trauma. Tujuan : Untuk mengetahuai seberapa besar pengaruh faktor risiko terhadap kejadian kebocoran anastomosis usus paska reseksi pada kasus trauma, penulis melakukan penelitian retrospective cohort Metode dan Hasil : Analisis data menggunakan chi square dilakukan untuk menunjukkan hubungan antara tiap faktor risiko dengan terjadinya kebocoran anastomosis. Untuk mengetahui pengaruh semua faktor risiko terhadap kejadian kebocoran reseksi anastomosis, penulis melakukan uji regresi logistik ganda. Hasil : Didapatkan hasil yang tidak signifikan pada tiap faktor risiko yang diuji. Faktor risiko adalah riwayat hipotensi, nilai albumin, skoring ASA, jarak waktu trauma dan operasi, jumlah transfusi darah, lama waktu operasi, dan jenis trauma. Saat pengaruh semua faktor risiko dibandingkan terhadap kejadian kebocoran reseksi anastomosis didapatkan hasil yang tidak signifikan. Kesimpulan : Faktor resiko nilai albumin, tranfusi darah, skor ASA, jarak waktu trauma dan operasi, lama waktu operasi, jenis trauma, riwayat hipotensi berpengaruh tetapi tidak bermakna secara statistik terhadap kejadian kebocoran pasca reseksi anastomosis usus pada kasus trauma di RSUP Dr. Sardjito Yogyakarta tahun 2011-2016.

Introduction : Anastomotic leakage is a dangerous complication of the intestine. Damage to the anastomosis increases the morbidity, mortality, length of care and cost of treatment.Anastomotic leakage is defined as a leak in the connection between two hollow viscous organs. Intestinal anastomosis recovery is commonly rapid in the absence of complications. Local factors such as vascularisation, surgery technique, bacterial contamination, bowel resting, surgery duration, abdominal or peritoneal sepsis, and anastomosis location. Systemic factors include nutritional status, anemia, hypovolemia, diabetes mellitus, use of drugs, systemic disease, alcohol and tobacco abuse , ASA status, and trauma score. Objective : To evaluate the influence of risk factors against intestinal anastomotic leakage in post traumatic resection, a retrospective cohort research was performed. Methods : Data analysis was performed with chi square to show the association between each risk factor s and anastomotic leakage. The risk factors tested were history of hypotension, albumin levels, ASA scoring, the delay between trauma and surgery, number of blood transfusions, surgery duration and types of trauma. To understand the effects of all risk factors against anastomotic resection leakage, the writer employs multiple logistic regression which also shows insignificant results. Results : Results were obtained and showed no significance difference. The risk factors tested were history of hypotension, albumin levels, ASA scoring, the delay between trauma and surgery, number of blood transfusions, surgery duration and types of trauma. Insignificant results were also found when the effects of all risk factors were compared against anastomotic resection leakage. Summary : It can be concluded based on the risk factors such as albumin levels, number of blood transfusion, ASA score, the delay between trauma and surgery, type of trauma, and history of hypotension has an influence but statistically has no significance in post resection anastomotic leakage in trauma within Sardjito General Hospital between 2011 and 2016.

Kata Kunci : Kata Kunci :Kebocoran, anastomosis, gaster, ileum, colon, rectum, albumin, trasnfusi, ASA, operasi, trauma, hipotensi.