Hubungan Usia saat Operasi dan Durasi Operasi terhadap Kesintasan pada Neonatus Dengan Obstruksi Duodenum Kongenital di RSUP Dr Sardjito Yogyakarta
Achmad Reza Kurniawan, Dr. dr. Akhmad Makhmudi, Sp.B, Sp.BA, Subs. D.A. (K).; dr. Andi Dwihantoro, Sp.B., Sp.BA., Subsp.D.A (K)
2025 | Tesis-Spesialis | S2 Ilmu Bedah Anak
Latar Belakang: Obstruksi duodenum kongenital
merupakan penyebab obstruksi intestinal pada neonatus yang memerlukan tindakan
operatif. Luaran klinis pascaoperasi dipengaruhi oleh berbagai faktor
perioperatif, termasuk usia saat operasi dan durasi operasi.
Tujuan: Mengetahui cut-off optimal usia saat
operasi, pengaruh durasi operasi terhadap kesintasan, serta faktor lain yang
memengaruhi kesintasan neonatus dengan obstruksi duodenum kongenital.
Metode: Penelitian kohort retrospektif pada
65 neonatus dengan obstruksi duodenum kongenital yang menjalani operasi di RSUP
Dr. Sardjito Yogyakarta selama periode Juni 2020 – Juni 2025. Variabel dependen
adalah kesintasan pasien. Variabel independen meliputi jenis kelamin, usia
kehamilan, berat badan lahir, usia saat operasi, sepsis neonatorum, kelainan
kongenital penyerta, tipe dan letak obstruksi, penyebab obstruksi, prosedur
operasi, serta durasi operasi. Analisis menggunakan kurva ROC, Kaplan–Meier,
dan regresi Cox.
Hasil: Cut-off usia operasi optimal adalah
3,5 hari (AUC 0,589). Kesintasan lebih baik pada neonatus yang dioperasi
>3,5 hari (p=0,030), namun tidak signifikan pada regresi Cox (HR 2,197;
p=0,062). Durasi operasi memiliki cut-off 197,5 menit (AUC 0,695) dan
berhubungan signifikan dengan kesintasan. Durasi operasi ?197,5 menit
meningkatkan risiko kematian 2,6 kali (HR 2,648; p=0,026). Faktor praoperatif
dan faktor pembedahan lainnya tidak menunjukkan hubungan signifikan dengan
kesintasan. Berat lahir rendah dan kelainan kongenital penyerta menunjukkan
kecenderungan meningkatkan risiko kematian.
Kesimpulan: Durasi operasi berpengaruh signifikan
terhadap kesintasan neonatus dengan obstruksi duodenum kongenital. Penentuan
waktu operasi perlu mempertimbangkan stabilitas klinis pasien, sedangkan durasi
pembedahan perlu diminimalkan melalui perencanaan operatif yang optimal.
Background:
Congenital duodenal obstruction is a cause of intestinal obstruction in
neonates that requires surgical intervention. Postoperative clinical outcomes
are influenced by various perioperative factors, including age at surgery and
operative duration.
Objective: To
determine the optimal cut-off point for age at surgery, evaluate the effect of
operative duration on survival, and identify other factors influencing survival
in neonates with congenital duodenal obstruction.
Methods: This
retrospective cohort study included 65 neonates with congenital duodenal
obstruction who underwent surgery at Dr. Sardjito General Hospital, Yogyakarta,
from June 2020 to June 2025. The dependent variable was patient survival.
Independent variables included sex, gestational age, birth weight, age at
surgery, neonatal sepsis, associated congenital anomalies, type and location of
obstruction, cause of obstruction, surgical procedure, and operative duration.
Data were analyzed using ROC curve analysis, Kaplan–Meier survival analysis,
and Cox regression.
Results: The
optimal cut-off point for age at surgery was 3.5 days (AUC 0.589). Survival was
better in neonates who underwent surgery at >3.5 days (p=0.030), although
this was not statistically significant in Cox regression analysis (HR 2.197;
p=0.062). The optimal cut-off for operative duration was 197.5 minutes (AUC
0.695) and was significantly associated with survival. Operative duration
?197.5 minutes increased the risk of mortality by 2.6 times (HR 2.648;
p=0.026). Other preoperative and surgical factors were not significantly
associated with survival. Low birth weight and associated congenital anomalies
showed a tendency to increase the risk of mortality.
Conclusion:
Operative duration significantly affects survival in neonates with congenital
duodenal obstruction. The timing of surgery should consider the patient’s
clinical stability, while operative duration should be minimized through
optimal surgical planning.
Kata Kunci : Obstruksi duodenum kongenital, Usia operasi, Durasi operasi, Kesintasan neonatus
