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"ABSTRAKLatar Belakang : Komplikasi paru pasca operasi memiliki kontribusi penting dalam peningkatan angka morbiditas, mortalitas, dan lamanya perawatan. Terdapat beberapa faktor risiko diantaranya: status kesehatan pasien, jenis operasi, dan jenis anestesi yang digunakan. Model skor indeks risiko yang dikembangkan Arozullah dapat digunakan untuk memprediksi komplikasi gagal napas dan pneumonia pasca operasi. Oleh karena terdapat perbedaan karakteristik populasi pasien, maka perlu dilakukan validasi untuk mengetahui performa model skor tersebut. Tujuan : Menilai performa kalibrasi dan diskriminasi model skor indeks risiko komplikasi paru Arozullah dalam memprediksi komplikasi gagal napas dan pneumonia pasca operasi pada pasien yang menjalani operasi non kardiak di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSCM). Metode :Penelitian ini merupakan studi kohort retrospektif pada populasi pasien yang menjalani operasi nonkardiak di RSCM dari bulan Januari sampai Desember 2015. Variabel yang dinilai adalah jenis operasi, usia, operasi darurat, riwayat Penyakit Paru Obstruksi Kronis (PPOK), albumin darah, ureum darah, status fungsional, penurunan berat badan, perokok, penggunaan alkohol, transfusi darah pre operasi, anestesi umum, riwayat cerebrovascular disease, gangguan sensorium akut, penggunaan steroid kronis. Luaran yang dinilai adalah komplikasi gagal napas dan pneumonia 30 hari pasca operasi. Performa kalibrasi dinilai dengan uji Hosmer-Lemeshow. Performa diskriminasi dinilai dengan area under the curve (AUC). Hasil : Didapatkan 403 subyek memenuhi kriteria penerimaan dengan 74 subyek mengalami kejadian komplikasi paru (18,4%). Terdapat 52 subyek mengalami gagal napas dan 34 subyek komplikasi pneumonia, serta terdapat 12 subyek mengalami komplikasi keduanya. Uji Hosmer-Lemeshow pada komplikasi gagal napas menunjukkan p=0,333, sedangkan nilai AUC 0,911. Pada komplikasi pneumonia didapatkan hasil kalibrasi dengan nilai p=0,617 dan nilai diskriminasi AUC 0,789. Simpulan : Model skor perioperatif paru Arozullah mempunyai performa yang baik dalam memprediksi komplikasi gagal napas dan pneumonia 30 hari pasca operasi pasien di RSCM Kata Kunci : Gagal napas, pneumonia, operasi non kardiak, validasi, indeks risiko Arozullah.

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ABSTRACTRisk Index Score Perioperative Arozullah of Surgical Patients in Cipto Mangunkusumo General Hospital 2015 Background: Post operative pulmonary complication had important effect in increasing morbidity, mortality as well as length of stay. Several factor contributing those such as patient?s health status, type of operation and type anaesthesia used. There were risk score develop by Arozullah that can be used to predict the possibility of respiratory failure and post operative pneumonia. Due to the differences of the characteristic population, the study needed internal validation to discover the performance of the Arozullah score. Objectives: To assess the performance of calibration and discrimination of Arozullah?s model risk score in predicting complications of respiratory failure and pneumonia postoperative in patients under going non-cardiac surgery in Cipto Mangunkusumo General Hospital (RSCM) Methods: A cohort retrospective study in patients undergoing non-cardiac surgery in RSCM from January to December 2015.Considered variable were type of surgery, age, emergency surgery, history of Chronic Obstructive Pulmonary Disease (COPD), serum albumin, ureum, functionalstatus, weight loss, history of smoking, alcohol use, blood transfusions pre surgery, general anaesthesia , history of cerebrovascular disease, acute impaired sensorium, chronic steroid use. Outcomes assessed were complications of respiratory failure and pneumonia 30 days post-operative. Performance calibration were assess with Hosmer-Lemeshow test and performance discrimination were assess with area under the curve ( AUC ) . Result: 403 subjects were meet the inclusion criteria with 74 of subjects had pulmonary complications (18.4 %), 52 subjects had respiratory failure, 34 subjects had pneumonia post operative, and 12 subjects had both complication. Hosmer-Lemeshow test on the complications of respiratory failure showed p = 0.333 and the AUC value is 0.911. While pneumonia complications showed p = 0.617 and AUC value is 0.789. Conclusion: Arozullah score perioperative had good performance in predicting respiratory failure and pneumonia 30-days post operative in RSCM. Key Word: respiratory failure, pneumonia, non cardiac surgery, validation, risk index score perioperative Arozullah;"

"Latar Belakang : Major Adverse Cardiac Events (MACE) adalah penyebab penting morbiditas dan mortalitas perioperatif pasien usia lanjut yang menjalani operasi non kardiak. Geriatric Sensitive Cardiac Risk Index diketahui memiliki akurasi yang baik dalam memprediksi kejadian henti jantung dan infark miokardium pada usia lanjut yang menjalani operasi non kardiak. Namun, belum pernah dilakukan uji performa index tersebut di Indonesia dengan perbedaan karakteristik usia dan komorbiditas yang berbeda.Tujuan: Mengetahui performa index GSCRI dalam memprediksi kejadian MACE (Major Adverse Cardiac Event) pada pasien usia lanjut yang menjalani operasi non kardiak dengan karakteristik usia lanjut pada populasi geriatri Indonesia.Metode : Studi retrospektif berbasis uji prognostik dengan data rekam medis pasien usia > 60 tahun yang menjalani operasi non kardiak di poliklinik perioperatif dan rawat Inap Gedung A yang menjalani operasi pada tahun 2021-2022 di RSCM dengan memasukkan data-data determinan sesuai kalkulator GSCRI dengan luaran berupa persentase kejadian dan dilihat luaran berupa henti jantung dan infark miokardium pasca operasi. Studi ini dianalisa dengan uji diskriminasi dengan Area Under the Curve (AUC).Hasil : Analisa dilakukan pada 225 subjek dengan median usia 65 tahun dengan proporsi MACE sebesar 3.1% (7 subjek) yang mengalami kejadian MACE pasca pembedahan non kardiak. Performa diskriminasi yang baik (AUC 0.888, IK95% 0.831-0.944).Kesimpulan : Index GSCRI memiliki performa diskriminasi baik dalam memprediksi kejadian MACE pasien usia lanjut yang menjalani pembedahan non kardiak.

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Background : Major Adverse Cardiac Events (MACEs) is an important cause of perioperative morbidity and mortality in elderly patients undergoing non-cardiac surgery. The Geriatric Sensitive Cardiac Risk Index is known to have good accuracy in predicting cardiac arrest and myocardial infarction in the elderly undergoing non-cardiac surgery. However, this performance index has never been tested in Indonesia with different age characteristics and different comorbidities.

Objective: We aimed to determine the performance of the GSCRI index predicting the incidence of MACE (Major Adverse Cardiac Event) in elderly patients undergoing non-cardiac surgery with elderly characteristics in the Indonesian geriatric population.

Methods : Retrospective study based on prognostic test with medical record data of patients aged > 60 years who underwent non-cardiac surgery at the perioperative outpatient and inpatient who underwent surgery in 2021-2022 at RSCM by entering determinant data according to the GSCRI calculator with outcomes form of cardiac arrest and myocardial infarction postoperative. This study was analyzed by discrimination test with Area Under the Curve (AUC).

Results : The analysis was carried out on 225 subjects with an median age of 65 years with a proportion of MACE of 3.1% (7 subjects) who experienced MACE events after non-cardiac surgery. GSCRI had good discrimination performance (AUC 0.888, CI95% 0.831-0.944).

Conclusion: GSCRI index has good discriminatory performance in predicting the incidence of MACE in elderly patients undergoing non-cardiac surgery."

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Latar Belakang. POCD merupakan penurunan fungsi kognitif pasca pembedahan yang banyak ditemukan pada usia tua. Respon stres dari prosedur pembedahan dan agen anestesi yang lama dianggap memengaruhi homeostasis dan status kognitif yang bermanifestasi dengan munculnya POCD. Namun, etiologi dan patofisiologi mekanisme POCD hingga saat ini masih kontroversial. Oleh karena itu, peneliti ingin mengetahui faktor risiko terjadinya POCD pada pasien usia lanjut yang menjalani operasi non kardiak dan non neurologic di RSCM.

Metode. Penelitian merupakan penelitian kohort prospektif, menilai pengaruh usia, lama anestesia, pembedahan berulang, dan jenis pembedahan terhadap penurunan fungsi kognitif pada 108 pasien geriatri (≥60 tahun) yang menjalani anestesia umum untuk bedah nonkardiak non-neurologik. Penelitian menggunakan uji fungsi kognitif berupa RAVLT, TMT, dan Digit span test. Dikatakan terdapat POCD jika terdapat penurunan fungsi kognitif pascaoperasi sebanyak 20% pada minimal 2 tes fungsi kognitif.

Hasil. Terdapat 57,4% kejadian POCD pasien geriatri yang menjalani operasi non kardiak dan non neurologik. Angka POCD pada usia tua (60-69 tahun) 55,7%, dan yang sangat tua (>70 tahun) hanya 65%; operasi minor 57,8%; serta riwayat pembedahan berulang 58,8%.  Sebagian besar prosedur operasi berdurasi singkat (<240 menit) dengan POCD sebanyak 58,1%.  Tidak terdapat perbedaan bermakna untuk setiap variabel terhadap angka kejadian POCD.

Simpulan. Terjadi perubahan berupa penurunan fungsi kognitif pascabedah  (POCD) pada pasien geriatri yang menjalani anestesi umum untuk operasi nonkardiak dan non-neurologik di RSCM sebesar 57,4%. Akan tetapi tidak dipengaruhi oleh  tingkat usia, lama pembedahan >4 jam, riwayat pembedahan berulang, dan jenis pembedahan.

Kata Kunci. POCD, geriatri, faktor risiko, non-kardiak, lama operasi, operasi mayor, minor, berulang

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Background. POCD is deterioration in cognitive function after surgery that is many found in elderly. Stress response from surgical procedures and anesthetic agents is thought to affect homeostasis and cognitive status that manifests with the appearance of POCD. However, the etiology and pathophysiology of the POCD is still controversial. Therefore, researchers want to know the risk factors for POCD in elderly patients who undergo non-cardiac and non-neurologic surgery at RSCM.

Method. The study was a prospective cohort study, assessing the effect of age, duration of anesthesia, repeated surgery, and type of surgery on cognitive impairment in 108 geriatric patients (≥60 years) who underwent general anesthesia for non-neurologic noncardiac surgery. The study used cognitive tests such as RAVLT, TMT, and Digit span tests. POCD definition is reduction in postoperative cognitive function by as much as 20% at a minimum of 2 cognitive tests.

Results. There was 57.4% POCD of geriatric patients who underwent non-cardiac and non-neurological surgery. POCD numbers at old age (60-69 years) 55.7%, and very old (> 70 years) only 65%; minor surgery 57.8%; and repeated surgery 58.8%. Most operating procedures are short duration (<240 minutes) with POCD as much as 58.1%. There were no significant differences for each variable on the incidence of POCD.

Conclusion. The rate of Post operative cognitive dysfunction (POCD) in geriatric patients undergoing general anesthesia for noncardiac and non-neurological surgery at RSCM were 57.4%. However, it is not affected by age level, length of surgery, repeated surgery, and type of surgery.

Keywords. POCD, geriatrics, risk factors, non-cardiac, length of operation, major, minor, secondary surgery.

 

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