FAKTOR RISIKO INFEKSI LUKA OPERASI POST LAPAROTOMI OBSTETRI DAN GINEKOLOGI DI RSUD ARIFIN ACHMAD PEKANBARU

ELVI MURNIASIH, dr. Jarir At Thobari, Ph.D

2014 | Tesis | S2 Magister Keperawatan

Latar Belakang. Kejadian infeksi luka operasi di Indonesia sekitar 2-18%. Dampak dari infeksi luka operasi meningkatkan angka morbiditas, mortalitas, dan bertambahnya lama hari rawat di rumah sakit sehingga meningkatkan biaya perawatan. Tujuan penelitian ini untuk mengukur faktor risiko dan faktor paling berisiko terhadap kejadian infeksi luka operasi post laparotomi obstetri dan ginekologi di RSUD Arifin Achmad Pekanbaru. Metode. Rancangan penelitian case controlretrospektif dari rekam medis mulai Januari 2009 – Desember 2013. Sampel penelitian adalah wanita post operasi laparotomi obstetri dan ginekologi. Diagnosis infeksi luka operasi berdasarkan kriteria Centers for Disease Control and Prevention(CDC). Hasil tehnik random sederhana dari 4,301 pasien observasi, jumlah sampel 192 pasien kelompok kasus dan 576 pasien kelompok kontrol. Analisis data menggunakan independent t-Test, chi-square, analisis Kaplan Meierdan analisis multivariat regresi logistik. Hasil Penelitian. Infeksi luka operasi terjadi pada 192 pasien (4,46%). Hasil analisis regresi logistik faktor yang signifikan: tipe operasi emergency(47,4% vs 36,5%; OR=1,51; CI 1,03-2,21), antibiotik profilaksis (22,9% vs 13,9%; OR=2,01; CI 1,27-3,19), lama hari rawat >5 hari (32,3% vs 18,9%; OR=1,99; CI 1,19-3,33) dan kompleksitas (27,1% vs 18,8%; OR=1,62; CI 1,07-2,46) dengan nilai Cox& Snell R Square0,062. Hasil analisis survival Kaplan Meier 50% pasien yang diberikan antibiotik profilaksis mengalami infeksi luka operasi pada hari ke-26 post operasi, sedangkan yang tidak mendapatkan antibiotik profilaksis pada hari ke-21. Kesimpulan. Faktor risiko yang berhubungan dengan kejadian infeksi luka operasi yaitu lama hari rawat, kompleksitas dan tipe operasi, sedangkan faktor yang berisiko yaitu antibiotik profilaksis.

Background.The incidence of surgical site infection in Indonesia is in the range of 2-18%. The impact of surgical site infections increase morbidity, mortality, and increased duration of hospitalization thereby increasing health care costs. The purpose of this study was to measure the risk factors and the dominant factors related to surgical site infections after laparotomy the incidence of obstetrics and gynecology at the Arifin Achmad Hospital Pekanbaru. Methods.The design of study is a retrospective case-control of medical records from January 2009 – December 2013. The sample was post operative females undergoing obstetrics and gynecology laparotomy. The diagnosis of surgical site infection is based on the criteria of the Centers for Disease Control and Prevention (CDC). The results of the simple random technique of 4,301 observation patient yields 192 samples of cases group patients and 576 control group patients. The data were analyzed using independent t-Test, chi-square, Kaplan-Meier analysis and multivariate logistic regression analysis. Research results. Surgical site infections occurred in 192 patients (4,46%). The results of logistic regression analysis for significant factors are: the type of emergency surgery (47,4% vs 36,5%, OR = 1,51; CI 1,03 to 2,21), antibiotic prophylaxis (22,9% vs 13, 9%, OR = 2,01; CI 1,27 to3,19), with a length of stay >5 days (32,3% vs. 18,9%, OR = 1,99; CI 1,19 to 3, 33) and complexity (27,1% vs 18,8%, OR = 1,62; CI 1,07 to 2,46) with the value of Cox & Snell R Square 0,062. The results of Kaplan-Meier survival analysis yields 50% of patients given prophylaxis antibiotic experienced surgical site infections at day 26 post-surgery, while those with antibiotic prophylaxis did not getto experience it on day 21. Conclusions. The risk factors associated with the incidence of surgical site infection include length of stay, complexity and type of surgery, while the risk factor is antibiotic prophylaxis.

Kata Kunci : Infeksi luka operasi, laparotomi, obstetri dan ginekologi