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Abstrak :
Latar Belakang: Infeksi daerah operasi (IDO) merupakan salah satu komplikasi pascaoperasi tersering yang meningkatkan morbiditas, mortalitas, dan beban biaya kesehatan. Penerapan strategi pencegahan hanya menurunkan sedikit angka infeksi nosokomial pada pembedahan. Vitamin D diketahui memiliki pengaruh pada regulasi imun dan penyembuhan luka. Namun, hanya sedikit studi yang menilai efek potensialnya dalam mengurangi kejadian IDO dengan hasil yang didapatkan belum konsisten. Penelitian ini bertujuan untuk menilai hubungan status vitamin D serum praoperasi dengan kejadian IDO pascalaparotomi elektif. Metode: Studi kohort prospektif ini dilakukan pada subjek berusia 18–65 tahun di RS pendidikan tersier, RSUPN Dr. Cipto Mangungkusumo, yang dirawat untuk laparotomi elektif pada bulan Maret hingga Juni 2023. Pengukuran 25-hidroksi vitamin D serum praoperasi menggunakan metode chemiluminescent microparticle immunoassay (CMIA) dengan cutoff defisiensi pada kadar <30 ng/mL. Penegakkan diagnosis IDO berdasarkan kriteria Centers for Disease Control and Prevention dilakukan melalui pemantauan harian selama 30 hari pascaoperasi. Analisis bivariat dan multivariat digunakan untuk menilai hubungan antara variabel bebas dan terikat, serta mengidentifikasi faktor perancu lain yang berhubungan dengan IDO.  Hasil: Dari total 117 subjek penelitian, sebanyak 90,4% subjek defisiensi vitamin D dan 20,5% subjek mengalami IDO. Defisiensi vitamin D praoperasi signifikan meningkatkan risiko kejadian IDO dibandingkan tidak defisiensi (RR 1,16, 95% CI 1,07–1,26). Analisis lanjutan dengan regresi logistik untuk faktor perancu lain memeroleh bahwa status albumin serum praoperasi menjadi faktor yang paling signifikan meningkatkan risiko kejadian IDO. Kesimpulan: Terdapat hubungan yang bermakna secara statistik antara defisiensi vitamin D serum praoperasi dengan kejadian IDO pascalaparotomi elektif. ......Background: Surgical site infection (SSI) is one of the most common postoperative complications that increases morbidity, mortality, and healthcare costs. The implementation of preventive strategies has only resulted in a slight reduction in nosocomial infection rates in surgical procedures. Vitamin D is known to have an influence on immune regulation and wound healing. However, there have been few studies assessing its potential effect in reducing the incidence of SSI, and the results obtained so far have been inconsistent. This study aims to assess the relationship between preoperative serum vitamin D status and the occurrence of SSI after elective laparotomy. Methods: This prospective cohort study was conducted on subjects aged 18–65 years at a single tertiary teaching hospital, RSUPN Dr. Cipto Mangunkusumo, who underwent elective laparotomy from March to June 2023. Measurement of preoperative serum 25-hydroxy vitamin D was done using the chemiluminescent microparticle immunoassay (CMIA) method with a deficiency cutoff at levels <30 ng/mL. The diagnosis of SSI was based on the Centers for Disease Control and Prevention criteria through daily monitoring for 30 days postoperatively. Bivariate and multivariate analyses were used to assess the relationship between independent and dependent variables and identify other confounding factors associated with SSI.  Results: Out of a total of 117 study subjects, 90.4% were vitamin D deficient, and 20.5% developed SSI. Preoperative vitamin D deficiency significantly increased the risk of SSI compared to non-deficiency (RR 1.16, 95% CI 1.07–1.26). Further analysis using logistic regression for other confounding factors revealed that preoperative serum albumin status was the most significant factor in increasing the risk of SSI. Conclusion: There is a significant statistical association between preoperative serum vitamin D deficiency and the occurrence of SSI after elective laparotomy.

Abstrak :
Latar Belakang: Komplikasi pascaoperasi rentan terjadi pada populasi berisiko tinggi salah satunya adalah populasi yang menjalani operasi mayor. Infeksi daerah operasi (IDO) adalah salah satu komplikasi pascaoperasi yang sering ditemukan pada prosedur laparotomi. Pasien yang menjalani operasi akan mengalami respons stres pascaoperasi berupa peningkatan proses inflamasi yang berdampak pada peningkatan proteolisis protein otot. Sangat penting memerhatikan asupan protein praoperasi untuk meningkatkan cadangan protein otot, mendukung penyembuhan luka pascaoperasi dan imunitas. Penelitian terdahulu menjelaskan bahwa peningkatan asupan protein praoperasi sebesar 10% (> 1,2 g/kg BB/hari) dari kebutuhan dapat mengurangi risiko komplikasi (infeksi, non-infeksi dan dekubitus) sebesar 10%. Metode: Studi kohort prospektif dilakukan pada 93 pasien dengan kelompok cukup protein sebanyak 48 subjek dan kelompok tidak cukup protein sebanyak 45 subjek yang akan menjalani laparotomi elektif di RSUPN Dr. Cipto Mangunkusumo, Jakarta. Analisis kecukupan protein dilakukan dengan metode wawancara selama 7 hari praoperasi. Pemantauan pasien dilakukan selama 30 hari pascaoperasi untuk menilai adanya komplikasi berupa IDO. Analisis hubungan keduanya dilakuan menggunakan uji Chi-Square dan dilakukan analisis multivariat untuk menilai faktor-faktor yang paling berhubungan dengan kejadian IDO pascalaparotomi elektif. Hasil: Terdapat hubungan antara kecukupan protein praoperasi dengan kejadian infeksi daerah operasi pascalaparotomi elektif (RR 3,413; IK 95%, 1,363-8,549; p = 0,004). Hasil analisis multivariat menunjukan kecukupan protein praoperasi dan kadar albumin praoperasi berhubungan kuat untuk memprediksi terjadinya infeksi daerah operasi pascalaparotomi elektif. Kesimpulan: Kecukupan protein dan kadar albumin praoperasi dapat memprediksi kejadian infeksi daerah operasi pascalaparotomi elektif. ......Background: Postoperative complications are prone to occur in high-risk populations, one of which is the population undergoing major surgery. Surgical site infection (SSI) is one of the most common postoperative complications in laparotomy procedures. Patients who undergo surgery will experience a postoperative stress response in the form of an increase in the inflammatory process which results in an increase in muscle protein proteolysis. It is very important to focus on preoperative protein intake to increase muscle protein reserves, support postoperative wound healing and immunity. Previous research explained that the increment of preoperative protein by 10% (> 1.2 g/kg BW/day) can reduce the risk of complications (infectious, non-infectious and decubitus) by 10%. Methods: A prospective cohort study was conducted on 93 patients with sufficient protein group of 48 subjects and protein insufficient group of 45 subjects undergoing elective laparotomy at Dr. Cipto Mangunkusumo Hospital, Jakarta. Analysis of protein adequacy was carried out by interview method for 7 days preoperatively. Patient monitoring was carried out for 30 days postoperatively to assess complications in the form of SSI. Analysis of association between protein adequacy and SSI was carried out by using the Chi-Square test and multivariate analysis was performed to assess the most associated factors with post elective laparotomy SSI. Results: There is a association between preoperative protein adequacy and the incidence of post elective laparotomy SSI (RR 3,413; 95% CI, 1,363-8,549; p = 0,004). The multivariate analysis showed that preoperative protein adequacy and preoperative albumin levels were strongly related to predict the occurrence of post elective laparotomy SSI. Conclusion: Preoperative protein adequacy and albumin levels were strongly related to predict post elective laparotomy SSI.