FAKTOR PROGNOSTIK MORTALITAS PADA OPERASI EMERGENSI AKUT ABDOMEN PADA PASIEN USIA LANJUT DI RSUP DR. SARDJITO

AHMAD DAENURI, dr. Agus Barmawi, SpB.KBD

2015 | Tesis | SP ILMU BEDAH

Latar Belakang. Semakin meningkatnya angka harapan hidup, meningkat pula jumlah pasien akut abdomen usia lanjut yang membutuhkan operasi emergensi. Operasi emergensi berhubungan dengan tingginya mortalitas, terlebih pada pasien usia lanjut Tujuan. Penelitian ini bertujuan untuk mengetahui hubungan faktor prognostik skor POSSUM terhadap tingginya mortalitas pasca operasi pasien akut abdomen usia lanjut. Metode. Penelitian kasus kontrol terhadap 235 pasien akut abdomen usia lanjut yang dilakukan operasi emergensi, memiliki kasus 85 pasien dan kontrol 150 pasien. Perforasi sistem gastrointestinal merupakan kasus terbanyak yang dilakukan tindakan operasi emergensi yaitu 73 pasien (31,06 %), diikuti oleh ileus obstruksi 72 pasien (30,64%), hernia inkarserata 54 pasien (22,98%), apendisitis 21 pasien (8,94 %) dan kasus lain–lain 15 pasien (6,38%). Faktor prognostik skor POSSUM dianalisis dengan analisis bivariat menggunakan uji Chi-square, sedangkan untuk variabel didalam skor POSSUM dianalisis dengan Chi-square dan uji regresi logistik ganda Hasil. Frekuensi tertinggi mortalitas didapatkan pada kasus perforasi gastrointestinal yaitu sebanyak 47 kasus (55,30%) diikuti oleh ileus obstruksi sebanyak 25 kasus (29,41%). Sementara prosedur operasi enterostomi merupakan prosedur tertinggi yang mengalami mortalitas yaitu sebanyak 27 kasus (31,76%) dan diikuti oleh prosedur penjahitan gastrointestinal sebanyak 25 kasus (29,41%). Dengan uji Chi-square didapatkan variabel penyusun skor POSSUM yang berpengaruh terhadap mortalitas adalah GCS, status respirasi, status kardiologis, EKG, ureum, frekuensi nadi, beratnya operasi, kontaminasi peritoneum, jumlah operasi, kehilangan darah, jenis operasi. Dengan uji regresi logistik ganda didapatkan faktor yang paling berpengaruh signifikan adalah jenis operasi (p=0,000). Mortalitas menurut POSSUM berkisar antara 3 % - 96,2 % dengan rerata 50,49 %. Adapun proporsi O:E menurut POSSUM sebesar 0,7164 atau 1,4 kali lebih tinggi dibanding mortalitas sesungguhnya. Skor POSSUM juga berpengaruh signifikan terhadap mortalitas dengan p=0,000 Kesimpulan. Faktor prognostik berupa skor POSSUM berpengaruh signifikan terhadap mortalitas. Skor POSSUM merupakan sistem skoring yang mempunyai tingkat akurasi yang sangat baik dalam prediksi hasil akhir berupa kematian pasien akut abdomen usia lanjut

Background : Along with the improvement of life expectancy, the number of elderly patients with acute abdomen who require emergency surgery is also increasing. However, emergency surgery has been always associated with high mortality rate, especially in elderly patients. Purpose : This study is aimed to knowing the relationship between prognostic factor, Possum Score, with postoperative mortality rate acute abdomen in elderly. Method : This is a case-controlled study on 235 elderly patients with acute abdomen who underwent emergency surgery, with 85 cases and 135 control. Perforation of digestive tract is the largest case, as many as 73 patients (31.06%) underwent emergency surgery, while other cases are obstructive ileus, incarcerated hernia, appendicitis and other causes (72 patients, 30.04%; 54 patients, 22.98%; 21 patients, 8.94%; and 15 patients, 6.38%, respectively). One prognostic factor,Possum Score, was analyzed by bivariate analysis using Chi-square test, whereas for the variables in Possum Score were analyzed by Chi-square test and multiple logistic regression. Results. The highest frequency of mortality was found in gastrointestinal perforation cases, as many as 47 cases (55.30 %), followed by obstructive ileus (25 cases, 29.41%). Enterostomy is the commonest procedure followed by mortality (27 cases, 31.76%), followed by gastrointestinal suturing procedures (25 cases, 29.41%). Chi-square test revealed that the variables in Possum Score correlated with mortality are GCS , respiratory status , cardiologic status , ECG , ureum level, pulse rate, severity level of surgery, peritoneal contamination, number of surgery being performed, blood loss, type of surgery. Multiple logistic regression analysis found that the most significant influential factor is the type of surgery (p = 0.000). Mortality according to Possum ranged from 3% - 96.2% with a mean of 50.49%. The proportion of O:E by Possum is 0.7164 or 1.4 times higher than the actual mortality. Possum Scores also have a significant effect on mortality with p = 0.000. Conclusion. Possum Score as a prognostic factor has significant effect on mortality. Possum Score is a scoring system that has a very good accuracy in predicting mortality as outcome in elderly patients with acute abdomen.

Kata Kunci : faktor prognostik – POSSUM – akut abdomen – usia lanjut – mortalitas pasca operasi