Faktor Prognosis Pasien Peritonitis Post Laparotomi di RSUD Patut Patut Patju Lombok Barat NTB 2018-2019

NANANG WIDODO, Dr. dr. A. Yuda Handaya, Sp.B-KBD, FINACS

2019 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Latar belakang. Peritonitis adalah kegawatdaruratan tersering dalam bidang bedah dan menjadi penyebab kematian non trauma terbesar di ruang gawat darurat. Tertundanya operasi dapat menyebabkan kematian. Tujuan. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang mempengaruhi mortalitas pada pasien peritonitis post laparotomi serta mengetahui hubungan faktor prognosis dengan mortalitas pada pasien peritonitis post laparotomi di RSUD Patut Patuh Patju, Kabupaten Lombok Barat. Metode. Penelitian ini menggunakan metode Nested Case Control. Penelitian dilakukan di RSUD Patut Patuh Patju, Lombok Barat. Subjek penelitian adalah rekam medik pasien peritonitis umum yang dilakukan operasi laparotomi Januari 2018 sampai Maret 2019. Subjek sebanyak 35 data rekam medik yang dipilih secara consecutive sampling. Variabel terikat adalah mortalitas pascaoperasi. Variabel bebas yaitu usia, jenis kelamin, onset, status gizi, diagnosis, sepsis, kultur, terapi inisial dan terapi definitive, lama (LOS) rawat inap dan lama (LOS) post operasi. Analisis data menggunakan univariat, bivariat dan multivariat Hasil. Tiga puluh lima pasien yang diteliti lebih banyak pasien laki-laki 80%. Kelompok umur paling banyak usia diatas sama dengan 40 tahun 62,86%. Pada penelitian ini onset terbanyak kurang dari sama dengan 24 jam sebanyak 45,71%. Status gizi pasien peritonitis 65,7% adalah normal. Penyebab paling banyak peritonitis adalah perforasi gaster sebesar 31,4% kasus. Pasien yang mengalami sepsis sebesar 37,1% kasus. Kultur hanya dilakukan pada 17,1% pasien penelitian. Terapi inisial dilakukan pada 65,7% kasus sedangkan terapi definitih hanya 17,1% kasus saja. Lama rawat inap pasien rata2 diatas 5 hari yaitu 91,4% pasein namun lama rawat inap setelah operasi yg lebih dari 5 hari hanya 74,3% kasus. Jumlah kasus pasien meninggal 6 pasien jumlah pasien konrol 29 pasien. Status gizi menunjukan hubungan signifikan dengan outcome p=0,001. Penyebab peritonitis juga signifikan dengan nilai p=0,024. Lama rawat inap juga signifikan terhadap output p=0,003. Lama rawat inap post op juga signifikan terhadap outcome dengan nilai p=0,027. Pada analisis multivariat diagnosis dan lama rawat inap post op mempunyai hubungan yang signifikan dengan masing-masing p=0,021 dan p=0,048. Kesimpulan. Terdapat faktor prognosis yang memiliki pengaruh signifikan antara lain status gizi, diagnosis penyebab peritonitis, LOS ranap dan LOS post op. Berdasarkan analisis multivariat diagnosis penyebab peritonitis dan LOS post op mempunyai hubungan paling kuat dalam mempengaruhi keluaran dan mortalitas pasien peritonitis post laparotomi di RSUD Patut Patuh Patju Lombok Barat NTB 2018-2019.

Background. Peritonitis is the most frequent emergency in the field of surgery and is the largest cause of non-traumatic death in the emergency room. Delayed surgery can cause death. Aim. This study aims to determine the factors that affect mortality in patients with post laparotomy peritonitis and find out the relationship between prognosis factors and mortality in post laparotomy peritonitis patients at Patut Patuh Patju Hospital, West Lombok Regency. Method. This study uses the Nested Case Control method. The study was conducted at Patut Patuh Patju Hospital, West Lombok Regency. The research subjects were medical records of general peritonitis patients who underwent laparotomy surgery January 2018 to March 2019. The subjects were 35 medical record data selected by consecutive sampling. The dependent variable is postoperative mortality. Independent variables are age, sex, onset, nutritional status, diagnosis of causes of peritonitis, sepsis, culture, inisial therapy, definitive therapy, LOS inpatient care and postoperative LOS. Data analysis using univariate, bivariate and multivariate. Results. Thirty-five patients studied had more male patients 80%. The most age group above the age of 40 years (62.86%). In this study the highest onset was less than the same as 24 hours as much as 45.71%. Nutritional status of peritonitis patients 65.7% is normal. The most common cause of peritonitis is gastric perforation of 31.4% of cases. Patients with sepsis were 37.1% of cases. Culture was carried out in 17.1% of the study patients. Inisial therapy was carried out in 65.7% of cases while definitive therapy was 17.1% of cases. The length of stay of patients averaged over 5 days, namely 91.4% of patients but the length of stay after more than 5 days of surgery was 74.3% of cases. The number of cases of patients died 6 patients (17.1%) and the number of patients lived 29 patients. Nutritional status showed a significant relationship with outcome p = 0.001. The cause of peritonitis was also significant with a value of p = 0.024. Duration of hospitalization (LOS inpatient care) was also significant for outcome p = 0.003. The duration of post op hospitalization was also significant for the outcome with a value of p = 0.027. The multivariate diagnosis and post op hospitalization (postoperative LOS) analysis had a significant relationship with each p = 0.021 and p = 0.048. Conclusion. There are prognosis factors that have a significant influence on mortality, including nutritional status, diagnosis of causes of peritonitis, LOS inpatient care and postoperative LOS. Based on multivariate analysis, the diagnosis of causes of peritonitis and postoperative LOS has the strongest relationship in influencing the output and mortality of post laparotomy peritonitis patients in Patut Patuh Patju General Hospital West Lombok NTB 201-2019

Kata Kunci : peritonitis, mortality, onset, nutritional status, sepsis, LOS