Perbandingan antara Charlson Comorbidity Index (CCI) dan Klasifikasi Status Fisik Menurut American Society of Anesthesiologist (ASA) dalam Memprediksi Mortalitas pada Pasien Geriatri yang Menjalani Anestesi di RSUP Dr Sardjito Yogyakarta

RAGIL CATUR NUGROHO, Dr. dr. Djayanti Sari, M.Kes, SpAn-TI, Subsp. An. Ped (K).; Dr. dr. Sudadi, SpAn-TI, Subsp. N.An(K), Subsp. An. R(K),

2024 | Tesis-Spesialis | S2 Anestesiologi

Latar Belakang: Pasien geriatri cenderung memiliki komorbiditas lebih banyak disertai dengan penurunan fungsi fisiologis dan kognitif yang berdampak pada luaran perioperatif. Gabungan antara penurunan fungsi fisiologis terutama perubahan pada farmakodinamik dan farmakokinetik obat-obatan, menyebabkan pemberian obat anestesi mengalami beberapa masalah. Charlson Comorbidity Index (CCI) telah digunakan untuk memprediksi mortalitas berdasarkan penilaian komorbiditas. American Society of Anaesthesiologists (ASA) menyusun klasifikasi status fisiologis untuk memperkirakan status kesehatan pasien berdasarkan penilaian ahli anestesi. Peningkatan skor CCI dan ASA diketahui berbanding lurus dengan peningkatan mortalitas pada pasien geriatri yang menjalani operasi. Oleh karena itu, perbandingan kekuatan prediksi skor CCI dan skor ASA terhadap mortalitas menarik mengingat perbedaan aksesibilitas dan komponen kedua skor.

Tujuan: Membandingkan charlson comorbidity index (CCI) dan klasifikasi status fisik  menurut American Society of Anesthesiologists (ASA) dalam memprediksi mortalitas pada pasien geriatri yang menjalani anestesi di RSUP Dr. Sardjito Yogyakarta.

Metode: Penelitian observasional retrospektif dilakukan pada semua pasien geriatri yang menjalani tindakan anestesi di kamar operasi RSUP Dr Sardjito Yogyakarta pada periode Februari-April 2021. Uji normalitas dilakukan menggunakan Kolmogorov-Smirnov. Analisis bivariat dilakukan uji Chi Square. Nilai p<0>Area Under Curve (AUC) dan uji kalibrasi Hosmer Lemeshow. 

Hasil: Terdapat hubungan signifikan antara skor CCI dengan mortalitas (OR 4,589; CI 95% 1,257-16,747; p=0,021), usia dengan mortalitas (OR 3,181; CI 95% 1,081-9,366; p=0,036). Sementara itu, tidak ditemukan hubungan signifikan antara ASA dengan mortalitas pada pasien geriatri yang menjalani anestesi di RSUP Dr. Sardjito Yogyakarta. Kurva ROC menunjukkan titik potong optimal skor CCI sebesar 2,5 dengan sensitivitas 26,7?n spesifisitas 90,6% (AUC 57,6%, p=0,321, 95% CI 0,409-0,744). 

Kesimpulan: Terdapat hubungan signifikan antara peningkatan skor CCI dengan mortalitas pasien geriatri. Sementara itu, tidak ditemukan adanya hubungan signifikan antara ASA dengan mortalitas pada pasien geriatri yang menjalani tindakan anestesi di RSUP Dr. Sardjito Yogyakarta.

Background: Geriatric patients tend to have more comorbidities accompanied by a decline in physiological and cognitive function, which impact perioperative outcomes. The combination of physiological function decline, especially changes in drug pharmacodynamics and pharmacokinetics, leads to several challenges in anesthesia drug administration. The Charlson Comorbidity Index (CCI) has been utilized to predict mortality based on comorbidity assessment. The American Society of Anesthesiologists (ASA) developed a classification of physiological status to estimate patient health status based on anesthesiologist assessment. Increased ASA and CCI scores are known to correlate with increased mortality in geriatric patients undergoing surgery. Therefore, comparing the predictive strength of CCI and ASA scores for mortality is intriguing considering the differences in accessibility and components of both scores.

Objective: To compare CCI and ASA score in predicting mortality in geriatric patients undergoing anesthesia at Dr. Sardjito Hospital Yogyakarta.

Methods: A retrospective observational study was conducted on all geriatric patients undergoing anesthesia procedures in the operating room of Dr. Sardjito Hospital Yogyakarta during the period of February-April 2021. Normality tests were performed using Kolmogorov-Smirnov. Bivariate analysis was conducted using the Chi-Square test. A p-value <0>

Results: There was a significant association between CCI score (OR 4.589; 95% CI 1.257-16.747; p=0.021) with mortality and age with mortality (OR 3.181; 95% CI 1.081-9.366; p=0.036), while no significant association was found between mortality and ASA in geriatric patients undergoing anesthesia at Dr. Sardjito Hospital Yogyakarta. The ROC curve showed an optimal CCI score cutoff point of 2.5 with sensitivity of 26.7% and specificity of 90.6% (AUC 57.6%, p=0.321, 95% CI 0.409-0.744).

Conclusion: The CCI score is significantly associated with an increased risk of mortality. Meanwhile, no significant relationship was found between ASA and mortality in geriatric patients undergoing anesthesia at RSUP Dr. Sardjito Yogyakarta.

Kata Kunci : Geriatrics, Anaesthesia, Charlson comorbidity index (CCI), American Society of Anaesthesiologists (ASA)