Dampak infeksi luka operasi Appendektomi terhadap lama hari rawat dan biaya perawatan di Rumah Sakit Mardi Waluyo Metro Lampung

SUWARDIMAN, dr. Jarir A. Thobari, Ph.D

2007 | Tesis | S2 Ilmu Kesehatan Masyarakat (Manaj. Rumah Sakit)-

Latar belakang: Infeksi nosokomial masih sering terjadi dan prevalensi relatif tinggi pada rumah sakit di Indonesia. Infeksi nosokomial paling umum terjadi adalah infeksi luka operasi (ILO). Hasil penelitian terdahulu menunjukkan bahwa angka kejadian ILO pada rumah sakit di Indonesia bervariasi antara 2-18 % dari keseluruhan prosedur pembedahan atau 2% dari prosedur appendektomi. Beberapa penelitian menunjukkan dampak dari ILO terhadap mortalitas dan morbiditas. Tetapi, sampai saat ini belum ada data pasti dampak ILO terhadap lama hari rawat (LOS) dan biaya perawatan pasien di rumah sakit, khususnya pasien-pasien yang menjalani pembedahan appendektomi pada rumah sakit di Indonesia. Tujuan: Untuk mengetahui faktor-faktor resiko ILO dan dampaknya terhadap lama hari rawat dan biaya perawatan pasien yang menjalani pembedahan appendektomi. Metode: Penelitian ini dirancang dengan cross sectional study. Populasi penelian adalah semua pasien appendektomi dari Januari 2005 - Mei 2007 di Rumah Sakit Mardi Waluyo, Metro, Lampung. Variabel dependen yaitu lama hari rawat, biaya perawatan, biaya rawat jalan dan jumlah kunjungan rawat jalan, variabel independen adalah ILO pasca appendektomi. Data dianalisa menggunakan uji-t dan uji khi-kuadrat. Hasil penelitian: Penelitian ini mencakup 252 pasien yang menjalani appendektomi sepanjang periode dari Jan 2005 - Mei 2007. ILO terjadi di 82 pasien (32.5%). Faktor risiko kejadian ILO appendektomi yang ditemukan adalah waktu pemberian antibiotika profilaksi >60 menit (OR=2,59; 95%CI 1,49–4,51), perawatan di kelas 3 (OR=2,75; 95% CI 1,47–5,15) dan lama pembedahan >60 menit (OR=6,70; 95%CI:3,54–12,69). Rata-rata lama hari rawat pasien yang mengalami infeksi 5,8 hari dan 3,1 hari untuk pasien yang tidak terkena infeksi (p<0001), jadi ILO pasca appendektomi meningkatkan lama hari rawat rata-rata 2,7 hari. Penambahan biaya langsung rawat inap klas 2 sebesar Rp 1,3 juta dan untuk kelas 3 sebesar Rp 548.000. Jumlah kunjungan rawat jalan pasien dengan ILO lebih tinggi 1,5 kali dibandingkan pasien tanpa ILO. Total selisih biaya rawat jalan sebesar Rp 203.000 untuk pasien yang mengalami infeksi. Kesimpulan: Faktor risiko kejadian ILO pasca appendektomi adalah waktu pemberian antibiotika profilaksi, perawatan di kelas 3 dan lama pembedahan. Infeksi luka operasi appendektomi meningkatkan lama hari rawat, menambah beban biaya langsung perawatan, menaikkan jumlah kunjungan rawat jalan dan menambah beban biaya langsung rawat jalan.

Background: Nosocomial infection is commonly occurred and the prevalence is relatively high in Indonesian’s hospital. The most common nosocomial infection is surgical site infection (SSI). Previous studies have shown that incidence of post-operative SSI in Indonesian’s hospital was varied between 2-18 % from overall surgical procedures or 2% from appendectomy procedure. Some studies showed the impact of SSI on morbidity and mortality. But, no data currently exist about the impact of the SSI in length of stay (LOS) and medical cost of patients, in particularly among patients undergoing appendectomy in Indonesian’s hospital. Objective: To know the risk factors for SSI and the impact of SSI on length of stay and medical costs among patient undergoing appendectomy. Method: This study was designed as cross sectional design. Population of the study was all patients of appendectomy from January 2005 – May 2007 at Mardi Waluyo Hospital, Metro, Lampung. Dependent variables consisted of length of stay, medical costs of care, post-discharge costs whereas independent variable was SSI. Data were analyzed using chi-square test and t-test. Result: This study included 252 patients undergoing appendectomy during the period of Jan 2005 – May 2007. SSI was occurred in 82 patients (32.5%). The risk factors of SSI in patient appendectomy which found was time of antibiotic prophylaxis > 60 minute ( OR=2,59; 95%CI 1,49-4,51), treatment in 3rd class wards ( OR=2,75; 95% CI 1,47-5,15) and prolonged duration of surgery > 60 minute ( OR=6,70; 95%CI:,54-12,69). Average length of stay was 5.8 days for patients having SSI and 3.1 days for those without SSI (p<0.001). Therefore appendectomy SSI increased length of stay at average of 2.7 days. The estimate of incremental costs for patients with SSI who stayed in class 2 was IDR 1.3 million and for class 3 was IDR 548,000. The number of outpatient visits for those with SSI was also higher in patient with SSI, at average 1.5 times higher than those without SSI. The total incremental costs of outpatients having SSI was IDR 203,000. Conclusion: The risk factors for having SSI in patient appendectomy were time of antibiotic prophylaxis , treatment in 3rd class and prolonged duration of surgery. The impact of SSI was increased length of stay, inpatient medical direct costs, number of outpatient visits and outpatient direct costs.

Kata Kunci : Infeksi Luka Operasi,Lama Hari Rawat dan Biaya Perawatan, surgical site infection, length of stay, cost