HUBUNGAN KADAR ALBUMIN SERUM TERHADAP KOMPLIKASI PASCA PEMBEDAHAN ABDOMINAL MAYOR PADA ANAK MENURUT KLASIFIKASI CLAVIEN-DINDO

ARIF KURNIA TIMUR, Dr. dr. Akhmad Makhmudi, Sp.B Sp.BA

2017 | Tesis-Spesialis | SP ILMU BEDAH

Latar Belakang: Protein berperan penting dalam proses metabolisme tubuh, kebutuhan optimal protein dalam tubuh dapat digambarkan dari jumlah albumin dalam serum darah. Penelitian tentang pasien dewasa dalam berbagai situasi telah menunjukkan kegunaan protein sebagai prediktor mortalitas. Albumin merupakan protein fase akut negatif, karena konsentrasinya menurun saat terjadi luka dan sepsis. Hipoalbuminemia berhubungan dengan tingkat mortalitas, lama perawatan, dan risiko dirawat kembali setelah pasien keluar dari rumah sakit. Kadar albumin serum berhubungan dengan infeksi pasca operasi dan komplikasi bedah. Albumin pra operasi merupakan prediktor untuk morbiditas yang murah, sederhana dan efektif pada pasien yang menjalani operasi traktus gastrointestinal mayor. Klasifikasi komplikasi pembedahan diperkenalkan Clavien pada 1992, dan dimodifikasi pada 2004 oleh Clavien dan Dindo. Meskipun banyak penelitian tentang hubungan kadar albumin serum terhadap komplikasi pasca operasi, masih sangat sedikit referensi penelitian tentang hubungan kadar albumin serum terhadap komplikasi pasca pembedahan abdominal mayor pada anak. Metode : Desain penelitian ini adalah potong lintang (cross sectional). Data dikumpulkan dari bulan Januari 2012 sampai dengan Desember 2016 di bagian Ilmu Bedah Sub Bagian Bedah Anak RSUP dr.Sardjito Yogyakarta FK UGM. Sampel ditetapkan dengan rumus Lemeshow sehingga didapatkan sampel sebanyak 50 operasi elektif dan 50 operasi emergency . Pengolahan data dilakukan secara komputerisasi dan analisis dengan uji chi-square, T-test, dan multivariate test. Hasil: Nilai albumin serum pra operasi abdominal mayor emergency mempengaruhi derajat komplikasi pasca operasi menurut klasifikasi Clavien-Dindo Peneliti membandingkan rata-rata nilai albumin sebelum dan sesudah operasi mayor abdominal pada kasus operasi elektif dan emergency menggunakan T-test didapatkan nilai p=0.000 sehingga didapatkan nilai statistik yang bermakna, artinya operasi abdominal mayor pada anak menyebabkan penurunan albumin secara bermakna. Analisa statistik multivariate menunjukkan p< 0.05 dengan demikian dapat ditarik kesimpulan bahwa terdapat hubungan antara kadar albumin, LOS, status fisik ASA dan komplikasi pasca operasi menurut Clavien-Dindo. Berdasarkan analisa multivariat, terdapat hubungan antara kadar albumin, LOS, status fisik ASA dan komplikasi pasca pembedahan abdominal mayor pada anak . Kesimpulan: Pembedahan abdominal mayor pada anak menyebabkan penurunan albumin pasca operasi secara signifikan. Terdapat hubungan antara kadar albumin, LOS, status fisik ASA dan komplikasi pasca pembedahan abdominal mayor pada anak

Background:. Proteins play an important role in the body's metabolic processes, the optimal protein requirements in the body can be described from the amount of albumin in blood serum. Research on adult patients in various situations has demonstrated the usefulness of proteins as a predictor of mortality. Albumin is a negative acute phase protein, because its concentration decreases with wounds and sepsis. Hypoalbuminemia is associated with mortality rates, length of care, and risk of being treated again after the patient is discharged from the hospital. Serum albumin levels are associated with postoperative infections and surgical complications. Preoperative albumin is a predictor of cheap, simple and effective morbidity in patients undergoing major gastrointestinal tract surgery. Classification of surgical complications was introduced by Clavien in 1992, and modified in 2004 by Clavien and Dindo. Despite much research on the association of serum albumin levels to postoperative complications, there is very little reference to research on the association of serum albumin levels to postoperative complications following paediatric major abdominal surgery. Methods : The design of this study was cross sectional. Data collected from January 2012 until December 2016 at the Surgery Division of Sub Surgery Division of RSUP dr.Sardjito Yogyakarta FK UGM. The sample is determined by Lemeshow formula so that there are 50 samples of elective operation and 50 emergency operations. Data processing is done by computerization and analysis with chi-square test, T-test, and multivariate test. Result: The serum preoperative serum value of abdominal major emergency affect the degree of postoperative complication according to Clavien-Dindo classification. The researchers compared the mean of albumin value before and after the major abdominal operation in the case of elective and emergency surgery using T-test obtained p value = 0.000 so obtained a significant statistical value, meaning that major abdominal surgery in children leads to a significant reduction in albumin. Multivariate statistical analysis showed that p <0.05 thus can be concluded that there is relationship between albumin level, LOS, ASA physical status and postoperative complication according to Clavien-Dindo. Based on multivariate analysis, there was a relationship between albumin levels, LOS, ASA physical status and postoperative major abdominal complications in children Conclusions: Major abdominal surgery in children significantly reduces postoperative albumin. There was a relationship between albumin levels, LOS, ASA physical status and postoperative major abdominal complications in children

Kata Kunci : albumin, hipoalbuminemia, komplikasi, operasi abdominal mayor, Clavien-Dindo, status fisik ASA