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Sukma Devi
Cost effectiveness analysis penata laksanaan cholecystolithiasis antara metode open cholecystectomy dengan metode laparascopic cholecystectomy di RSUPN dr. Cipto Mangunkusumo Jakarta Tahun 2007 = Cost effectiveness analysis of cholecystolithiasis management between open cholecystectomy method and laparoscopic cholecystectomy method at dr. Cipto Mangukusumo Hospital Jakarta In 2007
"Biaya pelayanan kesehatan khususnya rumah sakit sekitar 70% sampai 75 % terdiri dari biaya obat, pesonil dan biaya investasi alat kedokteran canggih. Penggunaan alat kedokteran canggih dalam pelayanan kesebatan akan membawa konsekuensi pada peningkatan biaya pelayanan kesehatan sehingga akan meningkatkan tarif pelayanan kesehatan.
Cholecystolithiasis adalah penyakit batu kandung empedu yang banyak menyerang orang yang berumur di ataS 40 tahun. Di RSUPN dr. Cipto Mangunkusumo ada dua metode yang dilakukan pada penata laksanaan Cholecystolithiasis yaitu dengan open cholecystectomy (konvensional) dan dengan laparasacopic cholecystectomy (minimal invasif) menggunakan alat kedokteran canggih, dimana tarif tindakan open cholecystectomy lebih murah di bandingkan dengan tindakan loparascopic cholecystectomy.
Penelitian ini merupakan evaluasi ekonomi yang bertujuan untuk memperoleh informasi tentang metode mana yang paling cost effective dan efisien dalam penata laksanaan cholecystolithiasis antara metode open cholecystectomy (open chole) dengan metode loparascopic cholecystectomy (lap chole) dengan menggunakan biaya per DRG's.
Jenis penelitian ini adalah descriptive-comparative menggunakan metode studi kasus dengan pendekatan kombinasi kuantitatif dan kualitatif yang dilaksanakan di RSUPN dr. Cipto Mangunkusumo (RSCM) dan dari bulan April sampai JUni 2008, menggunakan data sekunder dan Unit Rekam medik pasien rawat inap dengan diagnosa utama cholecystolithiasis dari bulan Januari-Desembec 2007, keuangan, asset untuk mendapatkan data biaya, serta data primer dari wawancara dengan dokter, paramedis dan petugas yang terlibat da1am penata laksanaan cholecystolithiasis. Unit cost dihitung berdasarkan direct cost dengan activity Based Costing (ABC) dan indirect cost dengan simple distribution.
Pengelompokan penata laksanaan cholecystolithiasis dengan open chole di RSCM, yaitu 1) Open choIe murni, 2) Open chole dengan penyulit, 3) Open chole dengan penyerta dan penyulit. Pengelompokan penata laksanaan cholecystolilhiasis dengan lap coole di RSCM, yaitu: 1) Lap coole murni, 2) Lap coole dengan penyerta, 3) Lap chole dengan penyulit, 4) Lap chole dengan penyerta dan penyulit.
Clinical pathwary penata laksanaan chOlecystolithiasis dengan open chole dan lap chole yang di dapatkan terdiri ataS tujuh (7) tahap, yaitu: pendaftaran, penetapan diagnosa, admission rawat inap (P3RN), pra operasi, operas, post operasi, dan pulang.
Cost of treatment penata laksana Cholecystolithiasis dengan open chole di RSCM tahun 2007, yaitu : Open chole murni dengan rata-rata lama hari rawat 8 hari, biaya Rp.6.454.003, open chole dengan penyulit rata-rata lama hari rawat 11 hari, biaya Rp.8.863.527, open chole dengan penyerta dan penyulit rata-rata lama hari rawat 23 hari, biaya Rp.17.060.543.
Cost of treatment penata laksanaan cholecystolithiasis dengan lap chole di RSCM tahun 2007, yaitu; lap chole murni dengan lama hari rawat 6 bali, biaya Rp.7.278.891, lap chole dengan penyerta rata-rata lama hari rawat 13 bali, biaya Rp. 13.004.740, lap chole dengan penyulit rata-rata lama hari rawat 10 hari, biaya Rp.9.246.148, lap chole dengan penyerta dan penyulit rata-rata lama hari rawat 19 hari, biaya Rp.l5.9S0.l93.
Effektifitas output cakupan untUk open chole murni 1 orang, open choIe dengan penyulit 2 orang, open chole dengan penyerta dan penyulit 1 orang. Untuk lap chole murni 28 orang, lap ckole dengan penyerta 13 orang, lap chole dengan penyulit 6 orang dan lap choIe dengan penyerta dan penyulit 4 orang. Rata-rata waktu operasi dan rata-rata hari kesembuhan untuk open chole murni 100 menit dan 3 hari, open chole dengan penyulit 110 menit dan 6 hari, open chole dengan penyerta dan penyulit 135 menit dan 7 hari. Rata-rata waktu operasi dan rata-rata hari kesembuhan untuk lap chole murni 92,86 menit dan 2 hari, lap chole dengan penyulit 105 menit dan 5 hari, lap chole dengan penyerta dan penyulit 118,75 menit dan 5 hari.
Cost effectiveness analysis dan kedua metode secara keseluruhan didapatkan biaya per pasien dalam setiap episode perawatan lebih mahal pada metode lap chole dibandingkan dengan open chole, dari effektivitas/output didapatkan rata-rata waktu operasi dan rata-rata hari kesembuhan lebih cepat pada metode lap chole dibandingkan dengan metode open chole, sehingga dapat disimpulkan bahwa metode lap chole lebih cost effective dibandingkan dengan metode open chle pada penata laksanaan Cholecystolithiasis.
Perlu dibuat clinical pathway dan perhitungan biaya perawatan pasien di rumah sakit secara nasional berdasarkan DRG"s untuk setiap penyakit, dan perlu dilakukan penelitian evaluasi ekonomi leblh lanjut terhadap alat kedokteran canggih lainnya.
Health care cost, specially in hospital is about 70 to 75 percent consisted of medicines. staff and modern medical equipment investation costs. Utilization of modern medical equipment in health care will take a consequence to increased health care cost, thus will result in increased health care charge. Cholecystholithiasis is a disease of gallstones formation, commonly occure over 40 ages. There are two types of Cholcystolithiasis management at dr. Cipto Mangunkusumo Hospital, open cholecystectomy (conventional) and laparoscopic cholecystectomy (minimal invasive) using modern medical equipment, and open cholecystectomy cost is lower compared to laparoscopic cholecystectomy.
This research was economic evaluation aimed to examine the most cost effective and efficient in cholcystolithiasis management between open cholecystectomy method (open chole) and laparoscopic cholecystectomy method (lap chole) using per DRG's cost.
The research design was descriptive-comparative using case study method with quantitative and qualitative combination approach, conducted at dr. Cipto Mangukusumo Hospital from April to June 2008. Data used were secondary data obtained from Inpatient Medical Record Unit from January to December 2007 with primary diagnosis of Cholecystolithiasis, financial, asset to obtain cost data, and primary data from interview with medical, paramedic and staff related to Cholcystolithiasis management. Unit cost was calculated by direct cost with Activity Base Costing (ABC) and indirect cost by simple distribution.
Grouping of cholcystolithiasis management with open chole at dr. Cipto Mangukusumo Hospital are 1) Pure open chole, 2) Open chole with complication, 3) Open chole with commorbidity and complication. Grouping of cholcystolithiasis management with lap chole are 1) Pure lap chole, 2) Lap cho1e with commorbidity, 3) Lap chofe with complication, 4) Lap chofe with commorbidity and complication.
Clinical Pathway of Cholcystolithiasis management with open chole and lap chole consisted of 7 steps, registration, diagnosis, admission (P3RN), pre operative, operative, post operative and discharge.
Cost of treatment of chofcystolithiasis management with open chofe at dr. Cipto Mangukusumo Hospital in 2007 were pure open chole with length of stay 8 day, the cost was Rp. 6.454.003, open chole with complication with length of stay 11 days, the cost was Rp. 8.863.527, Open chole with commorbidity and complication with length of stay 23 days, the cost was Rp. 17.060.543.
Cost of treatment of cholcystolithiasis management with lap chole at dr. Cipto Mangukusumo Hospital in 2001 were for pure lap chole with length of stay 6 days, the cost was Rp. 7.278.891, lap chole with commorbidity with length of stay 13 days, the cost was Rp. 13.004.740, lap chole with complication with length of stay 10 days, the cost was Rp. 9.245.148, lap chale with commorbidity and complication with length of stay 19 days, the cost was Rp. 15.950.193.
Coverage effectiveness or output for pure open chole was 1 patient, open chole with complication 2 patients, open chole with commorbidity and complication 1 patient. For pure lap chole was 28 patients, lap chole with cemmorbidity 13 patients, lap chole with complication 6 patients and lap chole with commotbidity and compacation 4 patients. Operation prosedure time mean and recovery day mean for pure open chole were 100 minutes and 3 days respectively. Open chole with complication were 110 minutes 6 days respectively, open chole with commorbidity and complication were 135 minutes and 7 days respectively. Opetation procedure time mean and recovery day mean for pure lap chole were 92,86 minutes and 2 day respectively, lap chole with complication were 1O5 minutes 5 days respectively, lap chole with commorbidity and complication were 118,7 minutes and 5 days respectively.
Total cost effectiveness analysis from both methods showed that cost per patient in evety management episode for lap chole was higher compared to open chole, and from effectiveness or output, it is showed that operation prosedur time and recovery day mean of lap chole was shorter compared to open chole. It is concluded that lap chole was more cost effective than open chole method in cholcystolithiasis management. It is suggested to built national clinical pathway and patient charge calculation in hospital based on DRG's for every disease, and it is neaded to conduct future economic evaluation study in other modern medical equipments."
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2008
T21201
UI - Tesis Open  Universitas Indonesia Library
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Julian
Cost of treatment cholelithiasis dengan laparoscopic cholecystectomy berdasarkan drg's di Rumah Sakit Gading Pluit 2007
"Batu empedu /cholelithiawls' adalah suatu penyakit yang cukup banyak terjadi, di Indonesia dilaporkan ada 268 kasus dalam empat tahun (1991-l994). Dimana kasus ini mcmerlukan operasi. Dengan majunya téknologi alat kedokteran dan ilmu kedokteran serta pengetahuan kesehatan rnasyarakat yang terus berkembang, mcnambah keinginan doktcr untuk mernbcrikan pelayanan pembedahan minimal invasy seiring tuntutan pasien akan tindakan pembedahan yang lebih nyaman.
Tindakan bedah dengan tehnik Laparoscopic memberikan pilihan altematif bagi penderita karena tindakan pembedahan dengan can ini hanya diperlukan Iuka opcrasi yang minimal/ kwa. 'rmaakan ms memcrlukan biaya yang besar dan sangat bervariasi, tergautungjenis tindakan yang dilakukan.
Pada umumnya nnnah sakit di Indonesia mempunyai masalah mengenai informasi biaya yang disebabkan oleh sistem pembayaran langsung pexjasa pelayanan (pee jbr ser-vice).Biaya pelayanan kesehatan yang bervariasi dan scmakin meningkat dikarenakan belum adanya harga standar berdasarkan unit cost untuk berhagai pelayanan kesehatan yang dibedkan. Pengendalian biaya dari bentukfzejbr service ke Prospective Payment System (PPS) perlu dilakukan. Salah satu bentuk PPS adalah Diagnosis Related Grolgps (DRG’S).DRG’s adalah sistem pembayamn perkelompok pcnyakit tanpa melihat tindakan yang cljberikan atau lamanya perawatan di rumah sakit. Tujuan penelitian ini adalah untuk melihat bagaimana pengelompokan, Clinical Pathway dan cost of treatment Cholelirhiasis dengan Laparoscopic Cholecysreclomy berdasarkan DRG’s di Rumah Sakit Gading Pluit tahun 2007.
Penelitian ini merupakan penelitian kuantitatif deskriptif dengan rancangan crossecrional retrospekryf Penelitian dilaksanaknn sejak awal Februari 2008 sampai dengan April 2000 dengan' mcnggunakan data sekunder dari kamar opcrasi dan rekam meaik pasien mwar inap dmgan aiggnosa chozezffhfasfr Salam tahun 2001. Unit cost dihitimg dengan manggunakan Activity Based Costing. Analisa data dilakukan secara univariat untuk melihat distribusi Bekuensi, nilai mean, median, modus, nilai minimum dan nilai maksimurn.
Pengelompokan Cfialelilhiasis dengan Lqpmoscopic Cholecyszecrorrrv berdasarkan DRG’s di Rumah Sakit Gading Pluit adalah : Laparoscopic Cholecysteclomy mumi, Laparoscopab Chnlecystectomy dengan Penyerta, Laparoscopxb Cholecystectomy dengan Penyulit dan Laparoscopic Cholecysteciomy dengan Penyerta dan Penyulit Berdasarkan basil penclitian diketahui clinical pathway Cholelfrhiasis dengan Laparoscopic Cholecysteciorny terdiri dari 9 tahapan yaitu : pendaiiaran poliklinik, penegakan diaguosa, Admision , penerimaan pasien, pm-oprasi, Operasi, post operasi, pulang dan Billing. Cost of treatment Cholelithiaais dengan Iaparoscopic ChoIecy.s-rectomy di Rumah Sakit Gading Pluit tahun 2007 adalah sebagai berikut : (1) Biaya Laparoscopic Cholecystectomy Rp.8.222.412.- (2) Biaya Laparoscopic Cholecysrectomy dengan Penyerta Rp.9.309.I64,- (3) Biaya Laparoscopic Cfrolecystectomy dengan Penyulit np.13.4a3_3o3,- (4) Biaya Laparoscopic Qliolecystecrorny aengan Pmyuliz can Penyertzi Rp.17.596.6o5,- Ijengan cost recovery rate rumah sdkit rata-rata nilainya 230%.
Dari hasil penelitian terlihat manfaatnya melakukan perhitungan biaya rawat ihap berdasarkan Diagnosis Related Groups sebagai dasar penetapan tarif rawat inap.
Gall-stone/ cholelithiasis is a commonly occurred disease. In Indonesia, there had been 2687 cases of this disease occurred for the last four years (1991 - 1994) that needed surgeries. The advancement of health instruments, medical knowledge, and continuously growing of health awareness in the society, motivate medical practitioner to give a minimally invasive surgery service, inlining with the patients needs ofa more convenient surgery.
The Laparoscopic surgery technique gives adds alternative choice to the patient, as this technique only needs a minimum surgical wound. This technique, however, require a large amount of costs; and it will vary according to the medical measure needed.
Generaly, Indonesian Hospitals will have a problem in providing infomration about the service fee, due to the direct fee for service payment system.The absence of standard unit costs for many medical services caused the costs of medical services varied and increasing.
Therefore, a change of cost control fiom fee per service to Prospective Payment System (PPS) is needed. One type of PPS is Diagnosis Related Groups (DRG’s) .DRG’s is a payment system per type of disease, without looking at the type of measurement given, or treatment dur°ation in the hospital. The objective of this research is to obtain the classification of Clinical Pathway and treatment cost of Cholelithiasis with Laparoscopic Cholecystectomy using DRG's at Gading Pluit Hospital in 2007.
This research is uses quantitative descriptive research with a cross-sectional retrospective method. The research was held from Febnrary - April 2008, by using a secondary data 'fiom one surgery room and inpatients medical records diagnosed with Cholclithiasis in 2007. The unit costs were measured by Activity Based Costing.
Univariate data analyses were used to see the iiequent distribution, means, median, modus, minimum and maximum value. The groupings of Cholelithiasis with Laparoscopic Cholecystectomy according to DRG's in Gading Pluit Hospital are: pure laparoscopic Cholecystectomy, Laparoscopic Cholccystectomy with complicating disease, Laparoscopic Cholecystectomy with associated condition and Laparoscopic Cholecystectomy with both complicating disease and associated condition.
According to the research, it is concluded that there are 9 steps in Cholelithiasis clinical pathway with laparoscopic Cholecystectomy: polyclinic registration, diagnosis, admission, patient acceptance, pre-surgery, surgery, post surgery, discharge and billing.
The Costs of Cholelithiasis treatment with Laparoscopic Cholecystectomy at Gading Pluit Hospital in 2007 are as foIlows:(l) Pune Laparoscopic Cholecystcctomy: Rp.8.222.4l2,-(2) Laparoscopic Cholecystectomy with complicating disease: Rp.9,309,l64,- (3)Laparoscopic Cholecystectomy with associated condition Rp.13.483.303,- (4)Laparoscopic Cholecystectomy with both complicating disease and associated condition :Rp. l'7.596.605,-.cost recovery rate for the hospital is approximately 230%. From the research, we can see the benefit of cost calculation using Diagnosis Related Groups as a way to dctcnnine the hospitalization costs."
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2008
T34434
UI - Tesis Open  Universitas Indonesia Library
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Natasya Dwi Amalia
Analisis Asuhan Keperawatan pada Pasien Kolelitiasis Pre Laparoskopi Kolesistektomi dengan Penerapan Intervensi Keperawatan Relaksasi Napas Dalam di Ruang Rawat Lantai 4 Zona B Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo Jakarta = Analysis of Nursing Care in Cholelithiasis Patient Pre-Laparoscopic Cholecystectomy with Deep Breathing Relaxation Nursing Intervention in Surgical Ward of RSUPN Dr. Cipto Mangunkusumo Jakarta
"Kolelitiasis menjadi salah satu masalah kesehatan sistem gastrointestinal utama di tingkat global. Hal ini disebabkan karena adanya perubahan gaya hidup masyarakat meliputi penurunan aktivitas fisik dan pola diet yang kurang tepat. Salah satu penatalaksanaan pembedahan yang dilakukan pada pasien kolelitiasis ialah laparoskopi kolesistektomi. Karya Ilmiah Akhir Ners ini bertujuan untuk menyajikan hasil analisis asuhan keperawatan pada pasien kolelitiasis pre laparoskopi kolesistektomi dengan menerapkan intervensi keperawatan teknik relaksasi napas dalam guna mengatasi ansietas preoperasi. Adapun intervensi lain yang direkomendasikan berdasar pada kajian praktik berbasis bukti meliputi penerapan intervensi penggunaan terapi musik guna menurunkan kecemasan pada pasien pra pembedahan laparoskopi kolesistektomi. Penggabungan penerapan relaksasi napas dalam dan terapi musikdiharapkan dapat diaplikasikan oleh perawat di ruangan khususnya pada pasien yang akan menjalankan operasi laparoskopi kolesistektomi untuk mengatasi masalah ansietas preoperasi.

Cholelithiasis is one of the major health problems of gastrointestinal system at the global level. This is due to changes in peoples lifestyles including decreased physical activity and inappropriate dietary patterns. One of the surgical treatments performed on cholelithiasis patients is laparoscopic cholecystectomy. The aims of this study is to analyse the nursing care of pre-laparoscopic cholecystectomy patients by applying deep breathing relaxation intervention to overcome the preoperative anxiety problem. Besides that, another intervention that is recommended based on evidence-based practice studies is the use of intervention of music therapy to reduce anxiety in pre-laparoscopic cholecystectomy patients. Combining the application of deep breathing relaxation and music therapy is expected to be applied by nurses, especially for patients who will undergo laparoscopic cholecystectomy to overcome the problem of preoperative anxiety."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2020
PR-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Sherlly Surijadi
Analisis efektifitas biaya kolesistektomi di rumah sakit Immanuel Bandung tahun 2001 = Cost effectiveness analysis on cholecystectomy at Immanuel Hospital Bandung year 2001
"Perkembangan teknologi dalam peralatan kedokteran menyebabkan adanya alternatif baru dalam pelayanan kesehatan. Laparoskopik sejak tahun 1995 telah dipergunakan di Rumah Sakit Immanuel Bandung dalam tindakan bedah pengangkatan kantong empedu (kolesistektomi). Tindakan ini disebut dengan metoda kolesistektomi laparoskopik. Efektifitas biaya dari kolesistektomi laparoskopik perlu diteliti untuk dibandingkan dengan metoda konvensional yang selama ini dipergunakan dalam pembedahan kolesistektomi.
Tujuan dari penelitian ini adalah untuk mengetahui kolesistektomi yang efektif biaya diantara metoda konvensional dan laparoskopik.
Penelitian yang dilakukan adalah studi kasus analitik menggunakan data sekunder yang diambil secara cross sectional tahun 2001 di Rumah Sakit Immanuel Bandung. Analisa biaya investasi menggunakan biaya investasi disetahunkan (annual investment cost), metoda analisis penghitungan biaya menggunakan metoda ABC (Activity Based Costing) dengan dasar alokasi biaya menggunakan proporsi luas lantai proporsi waktu operasi sebagai pemacu biaya. Biaya satuan aktual diperoleh dengan menghitung total biaya dan dibagi dengan besarnya output pada kegiatan tersebut, sedangkan biaya normatif diperoleh dari penjumlahan hasil bagi biaya tetap dengan kapasitas dan biaya tidak tetap dengan output.
Pada penelitian ini analisis efektifitas biaya dilakukan dengan cara : pertama, yaitu membandingkan biaya satuan antara kedua metoda; dan kedua, dengan melakukan tes analisis sensitivitas menggunakan simulasi penambahan biaya sewa dan simulasi penghitungan biaya total untuk menentukan besarnya output.
Pada cara pertama didapatkan bahwa pada penggunaan perbandingan biaya satuan aktual maka kolesistektomi konvensional paling efektif biaya pada kelas II B dan kolesistektomi laparoskopik paling efektif biaya pada kelas VIP LCA/Petra. Sedangkan pada biaya normatif didapatkan kolesistektomi laparoskopik paling efektif biaya secara umum tanpa membedakan kelas perawatan.
Pada hasil kedua yaitu simulasi perbandingan biaya satuan aktual dengan menambahkan biaya sewa didapatkan kolesistektomi konvensional paling efektif biaya pada kelas II B sedangkan laparoskopik pada kelas VIP LCA/Petra. Sedangkan simulasi penghitungan biaya total untuk menentukan besarnya output bahwa yang paling efektif biaya adalah kolesistektomi konvensional pada kelas II B dan laparoskopik pada kelas I.
Cost Effectiveness Analysis on Cholecystectomy at Immanuel Hospital Bandung Year 2001
The development of technology in medical equipment, resulting in a new alternative in health care services. Laparoscope is used since 1995 at Immanuel Hospital Bandung for cholecystectomy and this kind of surgery namely laparoscopic cholecystectomy method. Cost effectiveness of laparoscopic cholecystectomy need to be research to be compared with conventional cholecystectomy which commonly applied in the cholecystectomy surgery.
The purpose of this research is to find out which one is the most cost effective method between laparoscopic cholecystectomy and conventional cholecystectomy.
The research made was analytic case study using secondary data taken in cross sectional method during year 2001 at Immanuel Hospital in Bandung. The data analysis on investment cost using an annualized investment cost, cost analysis using activity based costing method with cost allocation using floor area proportion and operating time distribution as driver. Actual unit cost was obtained through a calculating from total cost divided by output while normative unit cost was obtained was calculating the sum of the result from fixed cost divided by capacity and the result of variable cost divided by output.
Cost effectiveness analysis was made through : first, comparing unit cost between two methods; and second, by doing sensitivity analysis test using simulation on adding rent cost and simulation on calculating total cost to find the output.
First step result is by using actual unit cost comparison, conventional cholecystectomy most effective on II B ward and laparoscopic on VIP LCA/Petra ward. By using normative unit cost comparison, laparoscopic is the most effective compare to conventional method without difference at ward class.
Second step result are by using simulation on comparing actual unit cost after added by rent cost that conventional cholecystectomy most effective on II B ward while laparoscopic on VIP LCA/Petra ward. And simulation on calculating total cost to find output result is that conventional cholecystectomy is most effective on II B ward and laparoscopic on I ward."
Depok: Universitas Indonesia, 2002
T7851
UI - Tesis Membership  Universitas Indonesia Library
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Rony
Validasi penilaian kantung empedu intraoperatif 10 poin (G10) pada kolesistektomi laparaskopik di RSUPN dr. Cipto Mangunkusumo = The validation of 10 points intraoperative gallbladder scoring system (G10) in laparoscopic cholecystectomy at RSUPN dr. Cipto Mangunkusumo
"Latar Belakang : Penatalaksanaan kolesistektomi laparoskopik telah menjadi baku emas untuk penanganan kolesistolitiasis simptomatik di RS Dr. Cipto Mangunkusumo (RSCM), sedangkan sampai saat ini belum ada sistem penilaian kantung empedu intraoperatif yang diterapkan saat operasi. Penilaian kantong empedu intraoperatif yang sesuai dapat menggambarkan tingkat kesulitan kolesistektomi laparaskopik secara objektif dan akan berpengaruh terhadap pemilihan teknik kolesistektomi laparaskopik yang tepat untuk mencegah terjadinya trauma bilier. Penelitian ini bertujuan mengevaluasi nilai G10 dan mencari hubungan dengan teknik operasi pada pasien yang sudah dilakukan kolesistektomi laparaskopik di RSCM.
Metode : Dilakukan penelitian retrospektif pada subjek yang telah dilakukan kolesistektomi laparaskopik pada Januari 2019 sampai Desember 2019 di institusi kami. Kami mengumpulkan karakteristik subjek berdasarkan catatan medis rumah sakit. Kami menentukan nilai G10 dan teknik operasi berdasarkan dokumentasi gambar intraoperatif dan laporan bedah. Data nilai G10 dan klasifikasi teknik operasi dilakukan uji non parametrik Mann-Whitney untuk melihat perbedaannya. Dilakukan uji statistik Kendalls Tau untuk menilai hubungan antara nilai G10 dengan prosedur bailout. Dilakukan uji ROC untuk melihat sensitifitas dan spesifisitas nilai G10 terhadap prosedur bailout, kemudian ditentukan nilai cut-off nya.
Hasil : 99 subjek Indonesia, usia rata-rata 49,80+13,421 tahun, menjalani kolesistektomi laparaskopik di Rumah Sakit Umum Dr.Cipto Mangunkusumo selama satu tahun. Sebagian besar diagnosis adalah kolesistolitiasis tanpa kolesistitis (68 subjek, 68,8%) dan kolesistitis kronis (23 subjek, 23,2%). Pembedahan elektif dilakuan pada 91 subjek (91,9%). Median nilai G10 adalah 2 (rentang 1-8). CVS dilakukan pada 81 subjek (81,8%), sedangkan 18 subjek dikelola dengan prosedur bailout (18,2%), terdiri dari 14 subjek dilakukan FF (14,2%), 2 subjek SC (2,0%) dan 2 subjek konversi operasi terbuka (2,0%). Nilai median G10 berbeda pada subjek yang menjalani CVS (1, rentang 1-6), FF (3, rentang 2-6), SC (5, rentang 5-5) dan konversi terbuka (6,5, rentang 5-8). Ada perbedaan median nilai G10 (<0,001) antara kelompok yang dilakukan CVS (1, rentang 1-6) dengan kelompok yang dilakukan prosedur bailout (4, rentang 2-8). Terdapat hubungan antara nilai G10 dengan prosedur bailout (<0,001, +0,478). Akurasi nilai G10 untuk memprediksi prosedur bailout dinilai dengan menggunakan kurva receiver operating characteristic (ROC) (<0,001, AUC 0,865) dan didapatkan cut-off point yang optimal untuk melakukan prosedur bailout adalah 2,5 (x2, p=0,000019).
Kesimpulan : Studi ini menunjukkan bahwa G10 adalah sistem penilaian kandung empedu intraoperatif yang objektif dan dapat diterapkan saat melakukan kolesistektomi laparaskopik. Nilai G10 berhubungan dengan prosedur bailout. Nilai 2,5 adalah cut-off point yang optimal untuk melakukan prosedur bailout saat kolesistektomi laparaskopik.
Introduction. Laparoscopic cholecystectomy has become a gold standard for symptomatic cholecystolithiasis management at Dr. Cipto Mangunkusumo Hospital (RSCM), while there is no intraoperative gallbladder assessment system applied during laparoscopic cholecystectomy. An appropriate intraoperative gallbladder assessment system can describe objectively the degree of difficulty in laparascopic cholecystectomy and fascilitate appropriate surgical decision-making to prevent biliary injury. This study aims to validate the intraoperative G10 scoring system and look for relationships with laparoscopic cholecystectomy techniques already performed at RSCM.
Method. A cross sectional study was established to the subjects had performed laparascopic cholecystectomy between Januari 2019 and December 2019. We collected characteristic of subjects based on medical records. We assessed the G10 scoring system and operation technique based on the documentation of intraoperatif images and surgical reports.
Results. Ninety-nine indonesian subjects, mean age 49.80+13.421 yrs, underwent laparascopic cholecystectomy at RSCM for a year. Most diagnosis were symptomatic cholecystolithiasis (67.7%) and chronic cholecystitis (23.2 %). Most of surgery was elective (91.9%). The median G10 score was 2 (range 1-8). CVS was feasible in 81.8%, whereas 18.2% cases were managed by bailout procedure. Of those, 14.2 % cases underwent FF, 2% SC and 2% open surgery conversion. The median G10 score differs among subjects undergoing CVS (median 1, range 1-6), FF (median 3, range 2-6), SC (median 5, range 5-5) and open conversion (median 6.5, range 5-8). There was a difference in the G10 score (<0.001) between the groups that performed CVS (median 1, range 1-6) and the groups that performed bailout procedures (median 4, ranges 2-8). There is a relationship between the G10 score and the bailout procedure (<0.001,+0.487). The accuracy of the G10 score to predict the bailout was assessed using a ROC curve (<0.001, AUC 0.865) and the optimal cut-off point to perform a bailout procedure was 2.5 (x2, p=0.000019).
Conclusion. The G10 is an objective and applicable intraoperative gallbladder assessment system when performing laparoscopic cholecystectomy. The G10 score has a relationship with the bailout procedure during laparascopic cholecystectomy. G10 score 2.5 is the optimal cut-off point for a bailout procedure when performing laparoscopic cholecystectomy."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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Raya Henri Batubara
Kolesistektomi laparoskopi di Rumah Sakit Cipto Mangunkusumo 2014 : Studi retrospektif observasional = Laparoscopic cholecystectomy experience at Cipto Mangunkusumo Hospital 2014 : A retrospective study
"ABSTRAK
Latar belakang: Kolesistektomi merupakan tindakan abdomen tersering dan saat ini
kolesistektomi laparoskopi (KL) merupakan baku emas dan telah dilakukan pada 90% kasus
kolesistitis simtomatik. Tujuan penelitian ini adalah untuk mengetahui hasil KL di RSCM,
Jakarta.
Metode: Penelitian retrospektif observasional ini menggunakan data dari departemen bedah
divisi digestif RSCM dari bulan Januari hingga Desember 2014. Partisipan penelitian ini
adalah pria atau wanita yang berusia 23-66 tahun yang menjalani KL. Tindakan bedah
dilakukan baik berupa perawatan 1 hari (one day care (ODC)) maupun elektif. Data yang
dikaji adalah temuan preoperatif dan intraoperatif, durasi operasi, lama rawat inap, dan angka
konversi ke tindakan kolesistektomi terbuka (open). Kemudian kami menganalisis faktor
yang mempengaruhi angka konversi.
Hasil: Jumlah pasien yang masuk inklusi adalah 90 orang. Usia rata-rata 43,9 tahun (SE=1,26
tahun) dengan jumlah pasien wanita 61 orang (67,8%). Median durasi operasi adalah 90±36,9
menit dimana pasien yang konversi membutuhkan operasi lebih dari 2 jam lebih banyak
(12% vs 1,5%), namun tidak bermakna secara statistik (p= 0,63). Median lama rawat inap
adalah 9±27.2 hari dan meningkat bermakna pada kasus yag konversi (24±9 hari, p = 0.011).
Median lama pre-operasi = 7±26,8 hari, dan pasca-operasi = 2±3.8 hari, dengan 13,3% pasien
dilakukan endoscopic retrograde cholangio-pancreatography (ERCP) sebelum KL. Cedera
duktus biliaris komunis (CBDK) ditemukan pada 3 kasus (3,33%). Konversi menjadi
laparotomi dibutuhkan pada 4,44% kasus. Faktor yang mempengaruhi angka konversi hanya
pada kasus adhesi (RR (95%IK) = 25,7 (2,4-273,5); p=0,007.
Kesimpulan temuan: kolesistektomi laparoskopi menawarkan lama rawat inap yang lebih
singkat. Durasi operasi pendek dan prosedur ini standard, aman, dan efektif di institusi kami. ABSTRACT
Background: Cholecystectomy is the most frequently performed abdominal operation and
currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in
90% cases of symptomatic gallstones. The aim of the study was to determine results obtained
with LC at our hospital, RSCM, Jakarta.
Methods: This retrospective observational study was conducted in digestive divison in
surgery department of RSCM using data from January to December 2014. The study
participants were patients of both gender aged 23?66 years undergoing LC. Surgery was
performed either in one day care (ODC) or elective schedule. Demographic variables,
preoperative and intraoperative findings, mean operation time, hospital stay, and conversion
rate were evaluated. Factors influencing rate of conversion were also studied.
Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) with
a female 61 (67.8%). Median operative time was 90±36.9 minutes which converted cases
patient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant
(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in converted
cases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation
= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography
(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).
Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate of
conversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007.
Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time is
short and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation and
currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in
90% cases of symptomatic gallstones. The aim of the study was to determine results obtained
with LC at our hospital, RSCM, Jakarta.
Methods: This retrospective observational study was conducted in digestive divison in
surgery department of RSCM using data from January to December 2014. The study
participants were patients of both gender aged 23?66 years undergoing LC. Surgery was
performed either in one day care (ODC) or elective schedule. Demographic variables,
preoperative and intraoperative findings, mean operation time, hospital stay, and conversion
rate were evaluated. Factors influencing rate of conversion were also studied.
Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) with
a female 61 (67.8%). Median operative time was 90±36.9 minutes which converted cases
patient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant
(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in converted
cases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation
= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography
(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).
Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate of
conversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007.
Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time is
short and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation and
currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in
90% cases of symptomatic gallstones. The aim of the study was to determine results obtained
with LC at our hospital, RSCM, Jakarta.
Methods: This retrospective observational study was conducted in digestive divison in
surgery department of RSCM using data from January to December 2014. The study
participants were patients of both gender aged 23?66 years undergoing LC. Surgery was
performed either in one day care (ODC) or elective schedule. Demographic variables,
preoperative and intraoperative findings, mean operation time, hospital stay, and conversion
rate were evaluated. Factors influencing rate of conversion were also studied.
Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) with
a female 61 (67.8%). Median operative time was 90±36.9 minutes which converted cases
patient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant
(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in converted
cases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation
= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography
(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).
Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate of
conversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007.
Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time is
short and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation and
currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in
90% cases of symptomatic gallstones. The aim of the study was to determine results obtained
with LC at our hospital, RSCM, Jakarta.
Methods: This retrospective observational study was conducted in digestive divison in
surgery department of RSCM using data from January to December 2014. The study
participants were patients of both gender aged 23?66 years undergoing LC. Surgery was
performed either in one day care (ODC) or elective schedule. Demographic variables,
preoperative and intraoperative findings, mean operation time, hospital stay, and conversion
rate were evaluated. Factors influencing rate of conversion were also studied.
Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) with
a female 61 (67.8%). Median operative time was 90±36.9 minutes which converted cases
patient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant
(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in converted
cases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation
= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography
(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).
Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate of
conversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007.
Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time is
short and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation and
currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in
90% cases of symptomatic gallstones. The aim of the study was to determine results obtained
with LC at our hospital, RSCM, Jakarta.
Methods: This retrospective observational study was conducted in digestive divison in
surgery department of RSCM using data from January to December 2014. The study
participants were patients of both gender aged 23?66 years undergoing LC. Surgery was
performed either in one day care (ODC) or elective schedule. Demographic variables,
preoperative and intraoperative findings, mean operation time, hospital stay, and conversion
rate were evaluated. Factors influencing rate of conversion were also studied.
Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) with
a female 61 (67.8%). Median operative time was 90±36.9 minutes which converted cases
patient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant
(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in converted
cases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation
= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography
(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).
Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate of
conversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007.
Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time is
short and procedure is standard, safe and effective in our institution."
Fakultas Kedokteran Universitas Indonesia, 2015
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R. Amanda Sumantri
Perbandingan efektivitas terapi topikal antara larutan Kalium Hidroksida (KOH) 10% dengan larutan Kantaridin 0,7% pada pasien Moluskum Kontagiosum anak di Rumah Sakit Dr. Cipto Mangunkusumo Jakarta : analisis efektivitas-biaya = Comparison of the effectiveness between Topical 10% Potassium Hydroxide solution and 0,7% Cantharidin solution for children with Molluscum Contagiosum in Dr. Cipto Mangunkusumo Hospital Jakarta : cost-effectiveness analysis / R. Amanda Sumantri
"ABSTRAK
Penelitian ini membandingkan efektivitas terapi topikal larutan KOH 10% dengan larutan kantaridin 0,7% terhadap moluskum kontagiosum pada anak, dilihat dari aspek medis dan efektivitas-biaya. Penelitian analitik dengan rancangan uji klinis acak terbuka dilakukan di Divisi Dermatologi Anak poliklinik Ilmu Kesehatan Kulit dan Kelamin Rumah Sakit dr. Cipto Mangunkusumo Jakarta tahun 2012. Pembuatan larutan KOH 10% dilakukan di Departemen Farmasi Fakultas Kedokteran Universitas Indonesia. Hasil penelitian menunjukkan bahwa secara klinis efektivitas larutan KOH 10% lebih baik daripada larutan kantaridin 0,7% dan biaya keseluruhan yang diperlukan lebih rendah. Meskipun demikian, tidak ditemukan perbedaan bermakna secara statistik.
ABSTRACT
This study compares the effectiveness between topical 10% potassium hydroxide solution and 0,7% cantharidin solution against molluscum contagiosum in children, viewed from the medical and cost-effectiveness aspects. The analytical open randomized clinical trial was conducted in Pediatric Dermatology Division, Dermatovenereology Clinic of dr. Cipto Mangunkusumo Hospital in 2012. The making of 10% potassium hydroxide solution was performed at the Department of Pharmacy Faculty of Medicine, University of Indonesia. Result shows that clinically, 10% potassium hydroxide solution is more effective than 0,7% cantharidin solution with less total cost. There were no statistically significant difference."
Fakultas Kedokteran Universitas Indonesia, 2012
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Tulus Kurnia Indah
Analisis Efektivitas Perencanaan dan Pengadaan Obat di RSUP Nasional Dr. Cipto Mangunkusumo Tahun 2023 Dengan Metode Lean Six Sigma = Analysis of Effectiveness of Drug Planning And Procurement At RSUP Nasional Dr. Cipto Mangunkusumo On 2023 Using Lean Six Sigma Method
"Latar Belakang: Proses perawatan di rumah sakit didukung oleh berbagai aktivitas operasional diantaranya pengelolaan logistik dan distribusi perbekalan farmasi. Biaya perbekalan kesehatan merupakan pengeluaran terbesar kedua di rumah sakit setelah belanja pegawai, oleh sebab itu pimpinan rumah sakit perlu mengidentifikasi peluang untuk meningkatkan proses logistik untuk menurunkan biaya dan meningkatkan kualitas pelayanan kesehatan. Untuk meningkatan proses logistik diperlukan pemahaman terkait kinerja rantai pasokan yang saat ini berjalan, sehingga melakukan analisa kinerja rantai pasokan merupakan hal mendasar untuk mengatasi kekurangan dalam aktivitas logistik.
Tujuan: Studi ini bertujuan melakukan analisa terkait waste yang ada pada proses perencanaan dan pengadaan obat di RSUPN Dr. Cipto Mangunkusumo, kemudian mencari penyebab dan akar masalah timbulnya pemborosan.
Metode: Penelitian ini menggunakan metode kualitatif dengan pendekatan studi kasus. Lokasi penelitian di RSUPN Dr. Cipto Mangunkumo bulan April-Mei 2024. Data primer diperoleh melalui wawancara dengan key specialist informan yang terkait dengan kegiatan perencanaan dan pengadaan dan observasi lapangan. Data sekunder diperoleh dari telaah data realisasi pemakaian obat tahun 2022, data usulan perencanaan dari unit kerja dan hasil rekapitulasi instalasi farmasi tahun 2023, data daftar barang dalam kontrak tahun 2023, datapenerimaan dan data pemakaian obat tahun 2023. Tahapan penelitian disusun berdasarkan lean six sigma dari mulai define, measure, analyze dan improve.
Hasil: Jenis waste yang terjadi diantaranya penyedia tidak mengirimkan obat terhadap item perencanaan yang telah memiliki kontrak, obat yang dipesan dan  dikirim tetapi tidak memiliki realisasi penggunaan, penyedia bersedia mengirimkan obat tetapi tidak mau berkontrak dengan rumah sakit, penyedia tidak bersedia mengirimkan obat dan  tidak mau berkontrak dengan rumah sakit dan adanya pengadaan lain di luar jalur kontrak utama. Dari seluruh waste yang ada terjadinya pengadaan di luar jalur kontrak utama merupakan jumlah waste yang paling sering terjadi sehingga menjadi area improvement pada penelitian ini. Penyebab dari pemborosan yang masih dapat dikontrol oleh internal rumah sakit adalah keterlambatan penerbitan kontrak. Akar masalahnya karena tiap unit kerja yang terkait dengan kegiatan perencanaan dan pengadaan menyelesaikan proses kerja tanpa mempertimbangkan waktu penyelesaian proses sesudahnya, sehingga tujuan dari perencanaan dan pengadaan yang berupa penerbitan kontrak sebelum tahun anggaran menjadi tidak terlaksana.
Kesimpulan: Dalam proses yang berjalan secara berkelanjutan diperlukan proses kerja yang terintegrasi berdasarkan komitmen setiap anggota rantai agar tujuan proses tersebut dapat tercapai.
Introduction: The hospital care process is supported by various operational activities including logistics management and distribution of pharmaceutical supplies. The cost of health supplies is the second largest expenditure in hospitals after personnel expenditure, therefore hospital leaders need to identify opportunities to improve logistics processes to reduce costs and improve the quality of health services. To improve logistics processes, an understanding of current supply chain performance is required, so analyzing supply chain performance is fundamental to overcoming deficiencies in logistics activities.
Objective: This study aims to analyze waste in the drug planning and procurement at RSUPN Dr. Cipto Mangunkusumo, then looked for the causes and root causes of waste.
Method: This research uses qualitative methods with a case study approach. The research location is at RSUPN Dr. Cipto Mangunkumo on April-May 2024. Primary data was obtained through interviews with key specialist informants related to planning and procurement activities and field observations. Secondary data was obtained from a review of drug use in 2022, drug planning proposals from units and results of drug planning recapitulation by pharmaceutical installations in 2023, list of drugs in contracts 2023, drug receive order and drug use in 2023. The research stages were arranged based on lean six sigma method from define, measure, analyze and improve.
Results: Types of waste that occur include supplier not sending drugs from planning items that already have a contract, drugs ordered and sent but not having actual use, suppliers willing to send drugs but refusev to contract with the hospital, suppliers refuse to send drugss and refuse to contracts with hospitals and procurements that come from another its main contracts. The procurements that come from another its main contract occurs most frequently, so it is an area of ​​improvement in this research. The cause of waste that can still be internally controlled by the hospital is delays in issuing contracts. The root of the problem is because each unit related to planning and procurement activities completes the process without considering the completion time of the process afterwards, so that the aim of planning and procurement to complete all the procurement contract before end of the year do not achieved.
Conclusion: In a process that runs continuously, an integrated work process is needed based on the commitment of each member of the chain so that the process objectives can be achieved."
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2024
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Dewi Saputra
Analisis efektivitas biaya laparoskopik herniotomy dan open herniotomy pada pasien hernia inguinalis unilateral di Rumah Sakit Gading Pluit Jakarta Utara tahun 2014 = cost effectiveness analysis of laparoscopic herniotomy and open herniotomy in patients with unilateral inguinalis Hernia at Gading Pluit Hospital North Jakarta year of 2014
"Tesis ini merupakan suatu evaluasi ekonomi dengan metode kuantitatif dan desain penelitian cross sectional, bersifat observational dengan melakukan studi perbandingan (comparative study) antara 2 teknik pembedahan herniotomy. Tesis ini bertujuan untuk menganalisis efektivitas biaya antara pasien yang menjalani teknik Laparoskopik Herniotomy dengan pasien yang menjalani teknik Open Herniotomy pada pasien hernia inguinalis.
Penelitian ini menggunakan perhitungan Activity Based Costing dengan simple distribution untuk mendapatkan total cost lalu dibandingkan dengan output, sehingga didapatkan Cost Effectiveness Ratio (CER). Nilai CER kemudian dibandingkan dan mana yang lebih kecil adalah yang lebih efektif.
Hasil penelitian menunjukkan bahwa teknik Open Herniotomy menghasilkan nilai CER yang lebih kecil dibandingkan dengan teknik Laparoskopik Herniotomy. Maka dapat disimpulkan bahwa teknik Open Herniotomy lebih efektif dibandingkan dengan teknik Laparoskopik Herniotomy.
This thesis is an economic evaluation with a cross sectional quantitative method design, observational and using comparative studies between two herniotomy techniques. The aim of this thesis is to analyze the cost effectiveness between patients with Laparoscopic Herniotomy and patients with Open Herniotomy of the inguinal hernia.
This research is using Activity Based Costing with simple distribution to achieve total cost and then compared with the output, therefore cost effectiveness ratio (CER) is achieved. The CER is then compared to understand which is the lesser cost therefore is more effective.
The research result shows that Open Herniotomy gives a smaller CER than the Laparoscopic Herniotomy. Therefore it is found that Open Herniotomy is more effective compared with Laparoscopic Herniotomy."
Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2015
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Halauwet, Marisha Friska
Timing kolesistektomi laparoskopik pasien dengan kolesistolitiasis dan koledokolitiasis pasca endoscopic retrograde cholangiopancreatography-sphincterectomy dan faktor-faktor yang memengaruhinya = Timing of laparoscopic cholecystectomy in patients with cholecystolithiasis and choledocholithiasis post endoscopic retrograde cholangiopancreatography-sphincterectomy and the factors that affect it
"Latar Belakang: Penanganan batu empedu dapat dilakukan melalui intervensi bedah atau non-bedah. Untuk penanganan bedah, kolesistektomi dapat dilakukan dengan teknik terbuka maupun laparoskopik. Tindakan ERCP yang diikuti oleh kolesistektomi dianggap sebagai modalitas terapi terbaik saat ini. Teknik ini bisa dilakukan sebelum tindakan kolesistektomi laparoskopik atau dilakukan secara bersamaan. Saat ini masih belum disepakati alur strategi yang terbaik, mengenai interval waktu untuk melakukan tindakan kolesistektomi laparoskopik pascaERCP.
Metode: Deskriptif analitik dengan desain studi potong-lintang (cross-sectional study) dengan mengambil data rekam medis subjek pada 2 rumah sakit di Jakarta. Tatalaksana interval waktu tindakan kolesistektomi laparoskopik pascaERCP diketahui melalui telusur rekam medis.
Hasil: Pada penelitian ini didapatkan lebih banyak subjek yang dilakukan tindakan operasi lebih dari 72 jam dibandingkan dengan kurang dari sama dengan 72 jam pascaERCP (27 subjek (56,2%) dibandingkan 21 subjek (43,8%). Total sampel pada penelitian ini adalah 48 subjek, melebihi jumlah sampel minimal yaitu 20 subjek. Pankreatitis terjadi pada 7 subjek (33%) pada kelompok kurang dari sama dengan 72 jam dan pada 7 subjek (26%) pada kelompok lebih dari 72 jam. Berdasarkan uji Chi-square, tidak ditemukan hubungan yang bermakna antara komplikasi pankreatitis dengan durasi kolesistektomi laparoskopik pascaERCP (p = 0,75).
Kesimpulan: Tidak didapatkan perbedaan yang bermakna antara kelompok interval laparoskopik kolesistektomi awal (kurang dari sama dengan 72 jam) dan lambat (lebih dari 72 jam) pascaERCP dengan terjadinya komplikasi pascaERCP berupa pankreatitis. Tidak didapatkan perbedaan bermakna antara kelompok interval laparoskopik kolesistektomi awal (kurang dari sama dengan 72 jam) dan lambat (lebih dari 72 jam) pascaERCP dengan lama rawat pasien.
Background: Gallstones can be managed through surgical or non-surgical intervention. Cholecystectomy can be performed with open or laparoscopic techniques. Endoscopic retrograde cholangiopancreatography followed by cholecystectomy is considered the best treatment modality at this time. This technique can be performed before laparoscopic cholecystectomy or done simultaneously. At present the best strategy path has not been agreed upon, regarding the time interval to perform post ERCP laparoscopic cholecystectomy.
Methods: Analytical descriptive with cross-sectional study design by taking the medical record from two hospitals in Jakarta. The timing of Post- laparoscopic cholecystectomy post ERCP time interval is obtained through medical record search.
Result: More subjects were treated with surgery after 72 hours compared to before72 hours post-ERCP (27 subjects (56.2%) compared to 21 subjects (43.8%). The total sample in this study was 48 subject, exceeding the minimum sample size of 20 subjects. Pancreatitis occurred in 7 subjects (33%) in the group before 72 hours and in 7 subjects (26%) in the group after 72 hours post ERCP. Based on the Chi-square test, there is no significant association between pancreatitis complications and the duration of post-CP laparoscopic cholecystectomy (p = 0.75).
Conclusion: There is no significant difference between the early laparoscopic cholecystectomy group (before 72 hours) and the late laparoscopic cholecystectomy group (less 72 hours) post-ERCP with the occurrence of complications post-ERCP determined as pancreatitis. There is no significant differences in the length of stay of the patient between the early laparoscopic cholecystectomy group (before 72 hours) and the late laparoscopic cholecystectomy group (less 72 hours) post-ERCP."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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UI - Tugas Akhir  Universitas Indonesia Library
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