Hasil Pencarian  ::  Simpan CSV :: Kembali

Hasil Pencarian

Ditemukan 35 dokumen yang sesuai dengan query
cover
Rizky Amaliah, supervisor
Karakteristik pasien ulkus peptikum perforasi dan kaitannya dengan morbiditas dan mortalitas di Rumah Sakit Cipto Mangunkusumo periode Januari 2006 - Maret 2012 = Characteristic of perforated peptic ulcer patient and correlation in morbidity and mortality in Cipto Mangunkusumo Hospital 2006 January - 2012 March
"[ABSTRAK
Ulkus peptikum perforasi merupakan salah satu kasus bedah gawat darurat yang cukup sering di RSCM. Perkembangan medikamentosa dalam tatalaksana ulkus peptikum telah berkembang pesat sehingga menurunkan angka tindakan bedah secara elektif. Studi ini bertujuan untuk melihat karakteristik dan faktor risiko pasien dengan morbiditas dan mortalitas ulkus peptikum perforasi. Seluruh pasien ulkus peptikum perforasi yang dilakukan tindakan pembedahan emergensi di Instalasi Gawat Darurat Rumah Sakit Cipto Mangunkusumo periode Januari 2006 sampai dengan Maret 2012 dievaluasi secara retrospektif. Empat puluh delapan pasien ulkus peptikum perforasi telah dilakukan tindakan pembedahan di IGD RSCM yang terdiri dari 36 pasien laki-laki dan 12 pasien perempuan dengan usia berkisar antara 17 ? 97 tahun. Faktor risiko terbanyak adalah pemakaian obat-obatan ulserogenik (NSAID dan jamu) sebanyak 70.83%. Sebanyak 52.08% pasien dengan ulkus peptikum perforasi datang dengan keluhan yang dirasakan >24 jam dengan rerata durasi 42 jam. Lokasi perforasi tersering adalah prepilorus sebanyak 66.7% dengan median diameter perforasi 10 mm. Tindakan tersering yang dilakukan adalah penjahitan primer dengan omental patch sebanyak 93.75%. Komplikasi tersering adalah acute kidney injury, sepsis dan infeksi luka operasi sebanyak 45.83%, 31.25% dan 14.58%. Angka morbiditas dan mortalitas pasien ulkus peptikum perforasi adalah 68.75% dan 33.3%. Pada studi ini tidak ditemukan hubungan yang bermakna antara karakteristik pasien dengan morbiditas dan mortalitas. Angka morbiditas dan mortalitas pasien ulkus peptikum perforasi masih tinggi. Faktor risiko yang ada dapat digunakan untuk meningkatkan pilihan tindakan dan menurunkan morbiditas dan mortalitas pasien ulkus peptikum perforasi. ABSTRACT Perforated peptic ulcer is one of the most common emergency case in RSCM. Development medicine treatment in peptic ulcer treatment had developed hence had decreased number of elective surgical treatment. This study was aimed to identify patients? characteristic and risk factor in perforated peptic ulcer in morbidity and mortality. All of the patient of perforated peptic ulcer that was done emergency laparotomy in emergency operating room of Cipto Mangunkusumo Hospital since 2006 January until 2012 March was evaluated retrospectively. Fourty eight percent of perforated peptic ulcer patients had been done surgery in Emergency Operating Room of Cipto Mangunkusumo Hospital that consist of 36 male and 12 female with age range 17 ? 97 years old. The most common risk factor is ulcerogenic drug using (70.83%). Patients came to hospital >24 hours (52.08%) after felt complaint with mean duration 42 hours. The most common location of perforation was prepiloric with median of diameter was 10 mm. The most common surgical treatment was primary suturing with omental patch (93.75%). The common complication were acute kidney injury, sepsis and surgical wound infection around 45.83%, 31.25% and 14.58%/. Morbidity rate was 68.75%. Mortality rate was 33.3%. There were no relation between patients? characteristic with morbidity and mortality. Morbidity and mortality rate in perforated peptic ulcer were still high. Risk factor that still be used to increase more choice for surgical treatment and decrease morbidity and mortality rate in perforated peptic ulcer., Perforated peptic ulcer is one of the most common emergency case in RSCM. Development medicine treatment in peptic ulcer treatment had developed hence had decreased number of elective surgical treatment. This study was aimed to identify patients’ characteristic and risk factor in perforated peptic ulcer in morbidity and mortality. All of the patient of perforated peptic ulcer that was done emergency laparotomy in emergency operating room of Cipto Mangunkusumo Hospital since 2006 January until 2012 March was evaluated retrospectively. Fourty eight percent of perforated peptic ulcer patients had been done surgery in Emergency Operating Room of Cipto Mangunkusumo Hospital that consist of 36 male and 12 female with age range 17 – 97 years old. The most common risk factor is ulcerogenic drug using (70.83%). Patients came to hospital >24 hours (52.08%) after felt complaint with mean duration 42 hours. The most common location of perforation was prepiloric with median of diameter was 10 mm. The most common surgical treatment was primary suturing with omental patch (93.75%). The common complication were acute kidney injury, sepsis and surgical wound infection around 45.83%, 31.25% and 14.58%/. Morbidity rate was 68.75%. Mortality rate was 33.3%. There were no relation between patients’ characteristic with morbidity and mortality. Morbidity and mortality rate in perforated peptic ulcer were still high. Risk factor that still be used to increase more choice for surgical treatment and decrease morbidity and mortality rate in perforated peptic ulcer.]"
Fakultas Kedokteran Universitas Indonesia, 2013
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
cover
Yusak Kristianto
Perbandingan antara klasifikasi Jepang dan sistem TNM dalam menentukan stadium keganasan sigmoid dan rektum di RSCM-RSF (laporan pendahuluan) = Comparison of Japanese classification with the tnm system in determining stage classification of sigmoid and rectal cancer patients at Cipto Mangunkusumo Hospital Fatmawati Hospital (preliminary study)
"[ABSTRAK
Pendahuluan Metastasis KGB pada keganasan kolorektal merupakan penentu independen faktor prognosis dan tatalaksana lanjutan Saat ini sistem baku penentuan stadium keganasan kolorektal adalah menurut sistem TNM dengan melihat jumlah KGB yang positif anak sebar Klasifikasi Jepang KJ menentukan stadium keganasan kolorektal dengan melihat distribusi metastasis KGB parakolika pararektal intermediate dan pangkal arteri mesenterika tanpa melihat jumlah KGB nya Metode Studi pendahuluan ini melakukan analisis terhadap 15 pasien keganasan sigmoid dan rektum yang menjalani pembedahan di RSCM dan RSUP Fatmawati periode September Oktober 2015 Dilakukan penilaian histopatologi terhadap spesimen tumor aspek yang dinilai adalah jumlah KGB yang positif anak sebar dan distribusi metastasis KGB Berdasarkan hasil tersebut dilakukan penentuan stadium menurut sistem TNM dan Klasifikasi Jepang serta dilakukan analisis kesesuaian Hasil dan pembahasan Didapatkan ge 12 KGB dari semua sampel Menurut sistem TNM terdapat 7 pasien stadium II 3 pasien stadium IIIb dan 5 pasien stadium IIIc sedangkan pada Klasifikasi Jepang terdapat 7 pasien stadium II 1 pasien stadium IIIa dan 7 pasien stadium IIIb Kecocokan antara kedua sistem klasifikasi dalam mendapatkan stadium II adalah 46 67 Penentuan stadium IIIa KJ dan stadium IIIa b TNM dengan kecocokan sebesar 6 7 Kecocokan sebesar 13 3 dalam menentukan stadium IIIb KJ dan stadium IIIc TNM Analisis kesesuaian terhadap kedua sistem klasifikasi didapatkan nilai Kappa sebesar 49 3 Kategori Sedang dengan P value 0 04 Kesimpulan Pada studi pendahuluan ini didapatlkan tingkat kesesuaian antara kedua sistem klasifikasi dalam menentukan stadium keganasan sigmoid dan rektum dengan kategori sedang Klasifikasi Jepang dapat dijadikan salah satu pertimbangan Diperlukan sampel yang lebih besar untuk meningkatkan akurasi tingkat kesesuaian Kata kunci metastasis KGB kolorektal sistem TNM Klasifikasi jepangPendahuluan Metastasis KGB pada keganasan kolorektal merupakan penentu independen faktor prognosis dan tatalaksana lanjutan Saat ini sistem baku penentuan stadium keganasan kolorektal adalah menurut sistem TNM dengan melihat jumlah KGB yang positif anak sebar Klasifikasi Jepang KJ menentukan stadium keganasan kolorektal dengan melihat distribusi metastasis KGB parakolika pararektal intermediate dan pangkal arteri mesenterika tanpa melihat jumlah KGB nya Metode Studi pendahuluan ini melakukan analisis terhadap 15 pasien keganasan sigmoid dan rektum yang menjalani pembedahan di RSCM dan RSUP Fatmawati periode September Oktober 2015 Dilakukan penilaian histopatologi terhadap spesimen tumor aspek yang dinilai adalah jumlah KGB yang positif anak sebar dan distribusi metastasis KGB Berdasarkan hasil tersebut dilakukan penentuan stadium menurut sistem TNM dan Klasifikasi Jepang serta dilakukan analisis kesesuaian Hasil dan pembahasan Didapatkan ge 12 KGB dari semua sampel Menurut sistem TNM terdapat 7 pasien stadium II 3 pasien stadium IIIb dan 5 pasien stadium IIIc sedangkan pada Klasifikasi Jepang terdapat 7 pasien stadium II 1 pasien stadium IIIa dan 7 pasien stadium IIIb Kecocokan antara kedua sistem klasifikasi dalam mendapatkan stadium II adalah 46 67 Penentuan stadium IIIa KJ dan stadium IIIa b TNM dengan kecocokan sebesar 6 7 Kecocokan sebesar 13 3 dalam menentukan stadium IIIb KJ dan stadium IIIc TNM Analisis kesesuaian terhadap kedua sistem klasifikasi didapatkan nilai Kappa sebesar 49 3 Kategori Sedang dengan P value 0 04 Kesimpulan Pada studi pendahuluan ini didapatlkan tingkat kesesuaian antara kedua sistem klasifikasi dalam menentukan stadium keganasan sigmoid dan rektum dengan kategori sedang Klasifikasi Jepang dapat dijadikan salah satu pertimbangan Diperlukan sampel yang lebih besar untuk meningkatkan akurasi tingkat kesesuaian Kata kunci metastasis KGB kolorektal sistem TNM Klasifikasi jepang;ABSTRACT Introduction Lymph node metastasis of colorectal cancer is an independent prognostic factor and guidance for adjuvant therapy TNM staging system has been used widely and became the gold standart for colorectal cancer staging nowadays TNM staging system classified cancer staging based on numbers of positive lymph node metastasis whether Japanese Classification based on distribution of lymph node metastasis paracolic rectal intermediate root of mesenteric artery Method This preliminary study analyzed 15 patients of sigmoid and rectal cancer underwent surgery at Cipto Mangunkusumo Hospital and Fatmawati Hospital between September and October 2015 We sent the specimen for histopathological evaluation about numbers of positive lymph nodes and lymph node metastasis distribution Based on the findings stage classifications was done by TNM staging system and Japanese Classification then we did agreement analysis Result We found ge twelve lymph nodes from every sample Based on TNM staging system there are 7 patients on stage II 3 patients on stage IIIb and 5 patients on stage IIIc meanwhile based on Japanese Classification there is 7 patients on stage II one patient at stage IIIa and 7 patients at stage IIIb Analysis of agreement between both classification resulted Kappa coeffisient 49 3 Moderate category with P value 0 04Conclusion This preliminary study shows that agreement between both classification in determining sigmoid and rectal staging is moderate category Japanese classification is feasible to be used Agreement accuracy may be obtained by collecting bigger samples Keywords Colorectal lymphnode metastasis TNM system Japanese Classification;Introduction Lymph node metastasis of colorectal cancer is an independent prognostic factor and guidance for adjuvant therapy TNM staging system has been used widely and became the gold standart for colorectal cancer staging nowadays TNM staging system classified cancer staging based on numbers of positive lymph node metastasis whether Japanese Classification based on distribution of lymph node metastasis paracolic rectal intermediate root of mesenteric artery Method This preliminary study analyzed 15 patients of sigmoid and rectal cancer underwent surgery at Cipto Mangunkusumo Hospital and Fatmawati Hospital between September and October 2015 We sent the specimen for histopathological evaluation about numbers of positive lymph nodes and lymph node metastasis distribution Based on the findings stage classifications was done by TNM staging system and Japanese Classification then we did agreement analysis Result We found ge twelve lymph nodes from every sample Based on TNM staging system there are 7 patients on stage II 3 patients on stage IIIb and 5 patients on stage IIIc meanwhile based on Japanese Classification there is 7 patients on stage II one patient at stage IIIa and 7 patients at stage IIIb Analysis of agreement between both classification resulted Kappa coeffisient 49 3 Moderate category with P value 0 04Conclusion This preliminary study shows that agreement between both classification in determining sigmoid and rectal staging is moderate category Japanese classification is feasible to be used Agreement accuracy may be obtained by collecting bigger samples Keywords Colorectal lymphnode metastasis TNM system Japanese Classification;Introduction Lymph node metastasis of colorectal cancer is an independent prognostic factor and guidance for adjuvant therapy TNM staging system has been used widely and became the gold standart for colorectal cancer staging nowadays TNM staging system classified cancer staging based on numbers of positive lymph node metastasis whether Japanese Classification based on distribution of lymph node metastasis paracolic rectal intermediate root of mesenteric artery Method This preliminary study analyzed 15 patients of sigmoid and rectal cancer underwent surgery at Cipto Mangunkusumo Hospital and Fatmawati Hospital between September and October 2015 We sent the specimen for histopathological evaluation about numbers of positive lymph nodes and lymph node metastasis distribution Based on the findings stage classifications was done by TNM staging system and Japanese Classification then we did agreement analysis Result We found ge twelve lymph nodes from every sample Based on TNM staging system there are 7 patients on stage II 3 patients on stage IIIb and 5 patients on stage IIIc meanwhile based on Japanese Classification there is 7 patients on stage II one patient at stage IIIa and 7 patients at stage IIIb Analysis of agreement between both classification resulted Kappa coeffisient 49 3 Moderate category with P value 0 04Conclusion This preliminary study shows that agreement between both classification in determining sigmoid and rectal staging is moderate category Japanese classification is feasible to be used Agreement accuracy may be obtained by collecting bigger samples Keywords Colorectal lymphnode metastasis TNM system Japanese Classification;Introduction Lymph node metastasis of colorectal cancer is an independent prognostic factor and guidance for adjuvant therapy TNM staging system has been used widely and became the gold standart for colorectal cancer staging nowadays TNM staging system classified cancer staging based on numbers of positive lymph node metastasis whether Japanese Classification based on distribution of lymph node metastasis paracolic rectal intermediate root of mesenteric artery Method This preliminary study analyzed 15 patients of sigmoid and rectal cancer underwent surgery at Cipto Mangunkusumo Hospital and Fatmawati Hospital between September and October 2015 We sent the specimen for histopathological evaluation about numbers of positive lymph nodes and lymph node metastasis distribution Based on the findings stage classifications was done by TNM staging system and Japanese Classification then we did agreement analysis Result We found ge twelve lymph nodes from every sample Based on TNM staging system there are 7 patients on stage II 3 patients on stage IIIb and 5 patients on stage IIIc meanwhile based on Japanese Classification there is 7 patients on stage II one patient at stage IIIa and 7 patients at stage IIIb Analysis of agreement between both classification resulted Kappa coeffisient 49 3 Moderate category with P value 0 04Conclusion This preliminary study shows that agreement between both classification in determining sigmoid and rectal staging is moderate category Japanese classification is feasible to be used Agreement accuracy may be obtained by collecting bigger samples Keywords Colorectal lymphnode metastasis TNM system Japanese Classification, Introduction Lymph node metastasis of colorectal cancer is an independent prognostic factor and guidance for adjuvant therapy TNM staging system has been used widely and became the gold standart for colorectal cancer staging nowadays TNM staging system classified cancer staging based on numbers of positive lymph node metastasis whether Japanese Classification based on distribution of lymph node metastasis paracolic rectal intermediate root of mesenteric artery Method This preliminary study analyzed 15 patients of sigmoid and rectal cancer underwent surgery at Cipto Mangunkusumo Hospital and Fatmawati Hospital between September and October 2015 We sent the specimen for histopathological evaluation about numbers of positive lymph nodes and lymph node metastasis distribution Based on the findings stage classifications was done by TNM staging system and Japanese Classification then we did agreement analysis Result We found ge twelve lymph nodes from every sample Based on TNM staging system there are 7 patients on stage II 3 patients on stage IIIb and 5 patients on stage IIIc meanwhile based on Japanese Classification there is 7 patients on stage II one patient at stage IIIa and 7 patients at stage IIIb Analysis of agreement between both classification resulted Kappa coeffisient 49 3 Moderate category with P value 0 04Conclusion This preliminary study shows that agreement between both classification in determining sigmoid and rectal staging is moderate category Japanese classification is feasible to be used Agreement accuracy may be obtained by collecting bigger samples Keywords Colorectal lymphnode metastasis TNM system Japanese Classification]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
cover
Liberty Tua Panahatan
Efektivitas preoperatif incentive spirometry terhadap atelktasis pneumonia dan hipoksemia pasca operasi mayor abdomen = Efficacy of incentive spiromtry in reducing atelectasis pneumonia and hypoxemia after major abdominal surgery
"[ABSTRAK
Tujuan dari penelitian ini adalah untuk menilai dampak dari preopratif incentive spirometry terhadap komplikasi paru dan uji fungsi paru di antara pasien dengan operasi abdomen mayor Pasien yang menjalani operasi mayor abdomen tanpa riwayat penyakit paru secara acak dibagi menjadi dua kelompok: kelompok latihan dan kelompok kontrol. Kelompok Latihan diberi 15 menit latihan empat kali sehari selama 2 hari sebelum operasi. Kelompok kontrol tidak menerima latihan. Pengukuran fungsi paru baseline dan pasca operasi diambil pada kedua kelompok. Fungsi paru pasca operasi diukur dari hari pertama sampai hari ketujuh. Semua pasien dinilai untuk komplikasi paru pasca operasi oleh ahli pulmonologi.
Kami merekrut 23 pasien dalam setiap kelompok. Insiden komplikasi paru adalah 56,5% pada kelompok kontrol dan tidak ada komplikasi yang ditemukan di antara pasien pada kelompok latihan. Ada penurunan yang signifikan dari komplikasi paru pada kelompok exrcise (p <0,001). Ada penurunan signifikan dari atelektasis (p <0,01), pneumonia (p 0,025), Hipokemia (p 0,005). Incentive spirometry memiliki efek perlindungan dengan resiko relative (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) untuk komplikasi pada kelompok kontrol adalah 3,3 (OR 3,30 CI 95% 1,97-5,54) pada komplikasi paru. Dalam hal fungsi paru, kami menemukan peningkatan yang signifikan pada Vital Capacity (dari 2336,96 + 722,56 mL ke 2541,30 + 718,78 mL dengan p <0,01) dan Force Vital Capacity (dari 2287,39 + 706 , 11 untuk 2469,57 + 676,10 dengan p <0,01) setelah latihan. Sebagai kesimpulan, preoperatif incentive spirometry dapat menurunkan insiden komplikasi paru.ABSTRACT The aim of this study is to assess the impact of preoperative incentive spirometry on pulmonary complication and pulmonary fuction test among patients with major abdominal surgery. Petient underwent major abdominal surgery without any history pulmonary disease were randomized into two group: the exercise group and the control group. Exercise group were given 15 minute exercise four times daily for 2 days prior to surgery. The control group receive no exercise. Baselie and post-surgery pulmonary function measurement were taken in both groups. Post surgery pulmonary function measure in first until seventh day after surgery. All patients were assessed for post operative pulmonary complication by attending
pulmonologist.
We recruited 23 patients in each group. The incidence of pulmonary complication was 56,5% in the control group and no complication were found among patient in the exercise group. There was a significant decrease of pulmonary complication in exrcise group (p <0,001). There were signigicant decrease of atelectasis (p <0,01), pneumonia (p 0,025), Hipoxemia (p 0,005). Incentive spirometry has protective effect with relative risk (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) for complication in control group was 3,3 (OR 3,30 CI 95% 1,97-5,54) on pulmonary complication. In terms of pulmonary function, we found significant increase on Vital Capacity (from 2336,96 + 722,56 mL to 2541,30 + 718,78 mL with p<0,01) and Force Vital Capacity (from 2287,39 + 706,11 to 2469,57 + 676,10 with p<0,01) after exercise.
As conclusion, preoperative incentive spirometry may decrease incidence of pulmonary complication. , The aim of this study is to assess the impact of preoperative incentive spirometry on pulmonary complication and pulmonary fuction test among patients with major abdominal surgery. Petient underwent major abdominal surgery without any history pulmonary disease were randomized into two group: the exercise group and the control group. Exercise group were given 15 minute exercise four times daily for 2 days prior to surgery. The control group receive no exercise. Baselie and post-surgery pulmonary function measurement were taken in both groups. Post surgery pulmonary function measure in first until seventh day after surgery. All patients were assessed for post operative pulmonary complication by attending
pulmonologist.
We recruited 23 patients in each group. The incidence of pulmonary complication was 56,5% in the control group and no complication were found among patient in the exercise group. There was a significant decrease of pulmonary complication in exrcise group (p <0,001). There were signigicant decrease of atelectasis (p <0,01), pneumonia (p 0,025), Hipoxemia (p 0,005). Incentive spirometry has protective effect with relative risk (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) for complication in control group was 3,3 (OR 3,30 CI 95% 1,97-5,54) on pulmonary complication. In terms of pulmonary function, we found significant increase on Vital Capacity (from 2336,96 + 722,56 mL to 2541,30 + 718,78 mL with p<0,01) and Force Vital Capacity (from 2287,39 + 706,11 to 2469,57 + 676,10 with p<0,01) after exercise.
As conclusion, preoperative incentive spirometry may decrease incidence of pulmonary complication. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
cover
Purnama Satria Bakti
Gambaran klinis dan penunjang tuberkulosis abdomen = Clinical and laboratory pictures of abdominal tuberculosis / Purnama Satria Bakti
"ABSTRAK
Latar belakang: Tuberkulosis TB adalah penyakit yang masih merupakan masalah global dan dapat melibatkan seluruh organ, termasuk organ-organ gastrointestinal. Insidensi dan angka kesakitan dari TB abdomen terus meningkat pada dekade terakhir, namun penegakkan diagnosa TB abdominal seringkali menemui kendala.Metode: Penelitian ini merupakan suatu penelitian deskriptif potong lintang dengan menggunakkan rekam medis penderita dengan diagnosa TB abdomen yang dirawat inap di Rumah Sakit Umum Pusat Nasional RSUPN Cipto Mangunkusumo, Rumah Sakit Umum Pusat RSUP Fatmawati periode Januari 2011 hingga Desember 2013.Hasil: Ada 48 pasien, dengan kisaran umur 1-85 tahun, dengan pasien perempuan lebih banyak rasio laki-laki banding perempuan= 1:1,4 . Mayoritas pasien berkisar antar usia 25-44 tahun 47,9 , dengan keluhan utama tersering adalah nyeri abdomen. Hanya 15 penderita 31,25 yang memiliki gambaran rontgen TB paru. Sedangkan hasil pemeriksaan laboratorium menunjukkan hasil yang cukup beragam. Kesimpulan: Mendiagnosis TB abdominal masih sering terkendala karena tidak adanya keluhan dan gejala yang khas serta tidak ada pemeriksaan penunjang yang memiliki nilai diagnostik yang tinggi. Sehingga, kombinasi dari anamnesis, pemeriksaan fisis, serta pemeriksaan penunjang diperlukan untuk dapat menegakkan diagnosa TB abdomen.Kata kunci: TB abdomen, gambaran klinis
ABSTRACT
Introduction Abdominal Tuberculosis TB is a global burden and can infect many organs, including gastrointestinal organs. There has been an increase in the incidence and morbidity rate of abdominal TB. However, there are still some hurdles in diagnosis abdominal TB.Methods This study is a descriptive cross sectional study using medical records of patients diagnosed with abdominal TB that are hospitalized in RSUPN Cipto Mangunkusumo and RSUP Fatmawati from January 2011 to December 2013.Results There was a total of 48 patients included in this study whose age ranges from 1 85 years old, and predominantly were female male to female ratio 1 1,4 . Majority of the patients were in 25 44 years old 47,9 with the most common chief complaint was abdominal pain. Only 15 patients 31,25 had radiographical findings suggestive of pulmonary TB. Laboratory tests results were varied.Conclusion Diagnosing abdominal TB is often difficult due to the wide array of signs and symptoms, and also the unavailability of auxillary examinations with high diagnostic value. Therefore, a combination of anamnesis, physical examination, and supporting examinations are needed to diagnose abdominal TB.Keywords Abdominal TB, clinical presentation"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Yusak Kristianto
Akurasi Immunoscore dan Rasio Netrofil Limfosit Dalam Prediksi Kekambuhan 5 Tahun Pada Pasien Kanker Kolorektal Stadium I-III = The accuracy of Immunescore and Neutrophil Lymphocyte Ratio in Predicting 5 Years Recurrence of Stage I-III Colorectal Cancer
"Latar belakang: Pascapembedahan dan tatalaksana adjuvan kanker kolorektal (KKR), sekitar 30-50% pasien mengalami kekambuhan. Pemeriksaan berbasis imun, seperti Immunoscore (IS) dan Neutrophil-Lymphocyte Ratio (NLR) bersifat independen dalam prediksi kekambuhan dan kesintasan pasien. NLR memiliki keunggulan seperti murah, sederhana, dan mampu laksana bila dibandingkan pemeriksaan IS. Hingga saat ini belum ada penelitian yang mengukur akurasi keduanya dalam prediksi kekambuhan kasus KKR.
Metode: Penelitian ini menggunakan desain potong lintang (cross sectional) dan dilakukan di Rumah Sakit Siloam Kebon Jeruk dan MRCCC (Mochtar Riady Comprehensive Cancer Centre) pada rentang waktu Juli-Desember 2023 menggunakan data sekunder rekam medis pasien kanker kolorektal stadium I-III, hasil NLR dan IS, dan luaran pasien. Analisis statistik berupa analisis deskriptif, akurasi tes, dan uji hipotesis (bivariat) memakai perangkat lunak Statistical Package for the Social Sciences (SPSS) versi 25. Penentuan cut-off nilai NLR menggunakan kurva ROC. Perbandingan nilai tes NLR dan IS dalam memprediksi kekambuhan menggunakan perbandingan ROC area (AUC). Pengukuran kesepakatan/kesesuaian 2 alat tes (NLR, IS) dalam membedakan kambuh dan tidak kambuh menggunakan statistik Kappa.
Hasil: Dari 80 pasien kanker kolorektal, terdapat 26 pasien yang mengalami kekambuhan (32,5%) dengan waktu kekambuhan paling banyak yaitu 2 tahun pertama (53%) dan terdapat 54 pasien yang tidak mengalami kekambuhan (67,5%). NLR (cut-off 6,6) memiliki sensitivitas (46,2%), spesifisitas (81,5%), dan nilai akurasi diagnostik NLR 70%. Hasil Chi square menunjukkan terdapat hubungan yang bermakna antara NLR dengan kejadian kekambuhan (p-value = 0,020). IS memiliki sensitivitas (7,7%), spesifisitas (96,3%), dan nilai akurasi diagnostik IS 67,5%. Hasil Fisher Exactmenunjukkan tidak terdapat hubungan yang bermakna antara IS dengan kejadian kekambuhan (p-value = 0,592). Nilai AUC IS dan NLR dengan p-value sebesar 0,064 artinya kemampuan/akurasi antara tes NLR dan IS untuk mendeteksi kekambuhan pada pasien KKR tidak berbeda/sama. Hasil statistik Kappa didapatkan nilai 1.000 (p-value = <,001), artinya terdapat kesesuaian/kesepakatan sangat tinggi antara tes IS tinggi dan NLR rendah dalam membedakan kambuh dan tidak kambuh pada pasien kanker kolorektal.
Kesimpulan: NLR dan IS sama sama memiliki akurasi lemah dalam memprediksi kekambuhan kanker kolorektal stadium I-III, tetapi NLR memiliki korelasi signifikan dengan kekambuhan dibandingkan IS. Kedua tes unggul dalam prediksi kasus kanker kolorektal yang tidak kambuh sehingga dapat diaplikasikan dalam praktek sehari hari.
Background: It is estimated about 30-50% of colorectal cancer (CRC) patients experience recurrence even after definitive therapy. Immune-based tests, such as immune score (IS) and Neutrophil-Lymphocyte Ratio (NLR) are independent predictors of CRC recurrence and survival. NLR examination is more affordable, simple, and feasible compared to oncological panel examination IS. To this date, there have been no studies measuring the accuracy of both in predicting recurrence rates in CRC.
Methods: This cross-sectional study was conducted at Siloam Kebon Jeruk Hospital and MRCCC (Mochtar Riady Comprehensive Cancer Centre) within the period of July to December 2023, utilizing secondary data from medical records of stage I-III CRC patients, focusing on NLR and IS results, and outcomes. Statistical analysis comprised of descriptive analysis, accuracy test, and hypothesis testing (bivariate) using the Statistical Package for the Social Sciences (SPSS) version 25. NLR cut-off value was computed using ROC curve. The comparison of NLR and IS test values was assessed through comparison of ROC area (AUC). Measure of agreement between the two test (NLR and IS) was done using Kappa statistics.
Results: Out of 80 CRC patients, 26 patients experienced recurrence (32.5%), mostly in the first two years (53%), while 54 patients did not recur (67.5%). NLR (cut-off 6.6) showed sensitivity (46.2%), specificity (81.5%), and diagnostic accuracy value 70%. Chi-Square analysis indicated a significant relationship between NLR and recurrence (p-value=0.020). IS showed sensitivity (7,7%), specificity (96,3%), and diagnostic accuracy value 67,5%. Fisher Exact analysis showed no significant relationship between IS and recurrence (p-value=0.592). The AUC value of both tests indicated that the accuracy to predict recurrence in CRC patients are not different/ same (p-value = 0.064). The Kappa statistic indicating a very high agreement between high IS and low NLR tests in predicting non recurrence cases (p-value=<0.001).
Conclusions: NLR and IS has the same weak accuracy in predicting stage I-III CRC recurrences, but NLR has a statistically significant correlation compare to IS. Both tests superior in predicting non recurrence cases and can be applied in daily practice (surveillance)."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Ridho Ardhi Syaiful
Faktor-faktor prognostik dan sintasan penyakit selama 1 tahun pada pasien kanker periampular stadium lanjut di Rumah Sakit Cipto Mangunkusumo pada Januari 2015-Desember 2017 = One year survival analysis of post double bypass surgery of advanced stage Periampullar Cancer patient in Cipto Mangunkusumo Hospital January 2015-December 2017
"ABSTRAK
Objektif: Pembedahan merupakan tatalaksana paliatif utama dari kanker periampular stadium lanjut, namun hal tersebut memiliki angka komplikasi postoperatif, rekurensi penyakit, dan mortalitas yang tinggi. Objektif dari penelitian ini yaitu untuk mengetahui faktor prognostik dan sintasan penyakit selama 1 tahun dari kanker periampular stadium lanjut pada Rumah Sakit Cipto Mangunkusumo. Metode: Penelitian ini merupakan uji analisis sintas dengan desain kohort retrospektif. Data dikumpulkan dari pendaftaran per bulan dari Divisi Bedah Digestif dan rekam medis dari Rumah Sakit Cipto Mangunkusumo dari Januari 2015 hingga Desember 2017. Sintasan penyakit satu tahun dianalisis dengan metode Kaplan-Meier. Dilakukan analisis bivariat dan multivariat dari masing-masing variabel pada sintasan satu tahun pasien. Hasil: Sintasan penyakit selama 1 tahun dari pasien post-double bypass yaitu 19% dengan median (minimal-maksimal) sintasan yaitu 159 (2-365) hari. Berdasarkan perbandingan antarkelompok sintasan pasien, hemoglobin (p=0,013) dan klasifikasi ASA (p=0,001) memiliki estimasi sintasan yang bermakna secara statistik. Pada analisis multivariat, jenis kelamin (p=0,250, HR=3,910) dan nilai laboratorium preoperatif (albumin (p=0,350, HR=0,400), aspartat aminotransferase (AST) (p=0,13, HR=5,110) dan alanin aminotransferase (ALT) (p=0,280, HR=0,05)) berhubungan dengan sintasan. Kesimpulan: Sintasan selama 1 tahun pada pasien post-double bypass pada Rumah Sakit Cipto Mangunkusumo rendah. Laju mortalitas satu bulan yang rendah mengindikasikan bahwa double bypass merupakan prosedur yang aman. Faktor prognostik yang berhubungan dengan sintasan yang rendah yaitu jenis kelamin perempuan dan nilai laboratorium preoperatif (albumin, AST, ALT).
ABSTRACT
Objective: Surgery is the main palliative treatment of advanced periampullary cancer, however it has high number of post-operative complication, disease recurrence and mortality. The objective of the current study was to examine prognostic factors and one year survival rate of advanced stage periampullary cancer in Cipto Mangunkusumo Hospital. Methods: This is a survival analysis test study with retrospective cohort design. Data were collected from monthly registration of Digestive Surgery Division and medical records from Cipto Mangunkusumo Hospital from January 2015 until December 2017. One year survival rate were analyzed with Kaplan-Meier method. Bivariate and multivariate analysis of each variable on one year survival of the patient were done. Result: One year survival rate of the post-double bypass patients is 19% with median (min-max) survival 159 (2-365) days. From the comparison of survival rate based patients grouping, hemoglobin (p=0.013) and ASA classification (p=0.001) have significant survival estimation statistically. In multivariate analysis, gender (p=0.250, HR=3.910) and preoperative laboratory values (albumin (p=0.350, HR=0.400), aspartate aminotransferase (AST) (p=0.13, HR=5.110) and alanine aminotransferase (ALT) (p=0.280, HR=0.05)) are associated with survival rate. Conclusion: One year survival rate of post double bypass patients in Cipto Mangunkusumo hospital is low. Low one month mortality rate indicates double bypass is a safe procedure. Prognostic factors that associated with lower survival are woman gender and preoperative laboratory value (albumin, AST, ALT)."
2018
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Supit, Caroline
Durasi dan frekuensi pemasangan kateter pada stenosis vena sentral: studi kasus kontrol = Duration and Frequency of Catheterization in Central Vein Stenosis: a case control study
"Pendahuluan: Kateterisasi vena sentral (KVS) adalah sebuah faktor risiko utama untuk terjadinya stenosis vena sentral (SVS). Kontak berulang dari kateter ke dinding pembuluh darah menyebabkan inflamasi, mikrotrombi, hiperplasia intima, fibrosis dan akhirnya stenosis. Artikel ini melaporkan korelasi antara durasi dan frekuensi KVS dengan terjadinya SVS.
Metode: Studi kasus kontrol dilakukan di Rumah Sakit CiptoMangunkusumo. Data diambil dari rekam medis tahun 2013 sampai 2015.
Hasil: Lima puluh empat dari 717 pasien yang menjalani KVS untuk hemodialisa menderita SVS. 32 pasien dengan SVS menjadi kasus dan 128 tanpa SVS sebagai kontrol. Durasi KVS >6 minggu tidak meningkatkan resiko SVS (p=0,207), rasio odds SVS ditemukan 30 kali pada pasien yang menjalani KVS >2 kali dibandingkan <2 kali (p<0,001).
Konklusi: Frekuensi KVS > 2 kali meningkatkan risiko SVS. Durasi >6 minggu tidak meningkatkan risiko SVS.
Introduction: Central vein catheterization (CVC) is a major risk factor for central vein stenosis (CVS). Repetitive contacts of the CVC to the blood vessel wall results in inflammation, microthrombi, hyperplasia of the intima, fibrosis and thus development of CVS. This article reports the correlation of duration and frequency of CVC in patients with CVS.
Methods: A matched case control study was conducted in CiptoMangunkusumo Hospital. Samples were gathered from the medical record from 2013 to 2015.
Results: Fifty four out of 717 patients underwent CVC for HD had CVS. 32 patients with CVS included in the study with 128 non-CVS patients included as control. Duration of CVC >6 weeks does not increase the risk of CVS (p= 0.207), whilst the odds ratio of CVS on the frequency of CVC >2 times is 30 times compared to those underwent <2 times (p= <0.001).
Conclusion: The frequency of CVC >2 times increased the risk of CVS. Longer duration of CVC for HD did not increase CVS rate."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
T58603
UI - Tesis Membership  Universitas Indonesia Library
cover
Rhea Putri Ulima
Pemberian Antibiotik Pada Operasi Bedah Elektif Di RSUPN dr. Cipto Mangunkusumo: Evaluasi Penatagunaan Antibiotik Berdasarkan Alur Gyssens = Antibiotic Administration For Elective Surgeries At The Dr. Cipto Mangunkusumo Hospital: Evaluation Of Antibiotics Usage Based On Gyssens Method
"Pendahuluan. Saat ini, infeksi daerah operasi (IDO) tetap menjadi komplikasi paling umum dari prosedur bedah. Dalam pencegahannya, antibiotik profilaksis menjadi pilihan pertama dan menyebabkan penggunaan antibiotik yang tinggi. Namun, pemberian antibiotik harus didasarkan pada strategi, yaitu stewardship. Oleh karena itu, penelitian ini bertujuan untuk menilai penggunaan antibotik menggunakan metode Gyssens. Metode Studi kohort retrospektif menganalisis pemberian antibiotik pada sebagian besar operasi elektif besar, termasuk tiroidektomi, mastektomi, dan kolesistektomi yang dilakukan di Rumah Sakit Umum Dr. Cipto Mangunkusumo, Jakarta, Indonesia dari Januari hingga Juli 2023. Indikasi, jenis, dosis, waktu, interval, durasi, dan rute pemberian adalah variabel yang diteliti. Hasil Dari 191 subjek yang menjalani prosedur bedah elektif paling umum, 30 menggunakan antibiotik kombinasi. Kategori Gyssens 0 terdiri dari 165 subjek (86,5%), dan 11 subjek (5,8%) diklasifikasikan sebagai kategori IIA, yang menunjukkan dosis yang tidak sesuai (tidak memadai, tidak mencukupi). Ketidakakuratan penggunaan antibiotik teridentifikasi sebagai pemberian pada waktu yang salah (5,8%), pemilihan antibiotik yang kurang tepat (3,1%), dosis yang salah (2,6%), dan waktu pemberian yang tidak tepat (2,1%). Hubungan antara kategori Gyssens dengan SSI menunjukkan nilai p > 0,05 dengan odds ratio 1, yang menunjukkan bahwa pemberian antibiotik yang sesuai maupun tidak sesuai dari kategori Gyssens tidak menunjukkan hubungan pada kejadian IDO atau non-IDO. Kesimpulan Tingkat kepatuhan penatagunaan antibiotik pada kasus bedah elektif terbanyak di Departemen Bedah RSUPN dr. Cipto Mangunkusumo yang dinilai menggunakan alur Gyssens mencapai 86,4% dan memerlukan perbaikan.
Introduction. Nowadays, surgical site infections (SSI) remain the most common complication of surgical procedures. In prevention, the prophylactic antibiotic is the first option and somehow leads to the high use of antibiotics. However, antibiotic administration should be based on the strategies, which is the stewardship. Thus, the study aimed to assess using Gyssens' method. Method. A retrospective cohort study analyzed the antibiotic administration of most major elective surgeries, including thyroidectomy, mastectomy, and cholecystectomy proceeded in Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia from January to July 2023. Indication, type, dosage, timing, interval, and duration and route of administration were the variables of interest. Results. Of 191 subjects who underwent the most common elective surgery procedures, 30 used combination antibiotics. Gyssens category 0 consists of 165 subjects (86.5%), and 11 subjects (5.8%) were classified as category IIA, indicating inappropriate dose (inadequate, insufficient). Inaccuracies were identified as mistimed administration (5.8%), less effective antibiotic selection (3.1%), incorrect dosage (2.6%), and inappropriate timing (2.1%). The association of Gyssens categories with SSIs showed a p–value of > 0.05 with an odds ratio of 1, indicating that both appropriate and inappropriate antibiotics of the Gyssens category showed no impact on SSIs or non–SSIs. Conclusion. The adherence to antimicrobial stewardship in the most common elective surgery in the Department of Surgery, dr. Cipto Mangunkusumo General Hospital was 86.4 and subjected to improvement."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
Simbolon, Prabowo Wirjodigdo
Faktor risiko lama rawat diabetic foot ulcer dengan negative pressure wound therapy di RS dr. Cipto Mangunkusumo = Risk Factors that influence Hospital length of stay in Diabetic Foot Ulcer with Negative Pressure Wound Therapy at RS. dr. Cipto Mangunkusumo
"Latar belakang: Diperkirakan sekitar 15% penderita diabetes akan mengalami diabetic foot ulcer (DFU) dalam masa hidupnya. Negative Pressure Wound Therapy (NPWT) terbukti lebih efektif dibandingkan dengan perawatan konvensional. NPWT menciptakan lingkungan luka yang lembab, peningkatan aliran darah lokal dan merangsang jaringan granulasi sehingga mempercepat penyembuhan luka. Penelitian ini dilakukan untuk mengetahui faktor risiko yang memengaruhi lama rawat DFU dengan NPWT.
Metode Penelitian: Penelitian ini merupakan studi retrospektif dengan desain cross sectional analitik pada 105 subjek yang dirawat pada Januari 2016 sampai Desember 2018 di RS dr. Cipto Mangunkusumo. Karakteristik dan demografi pasien dan faktor risiko diambil dari rekam medik. Durasi perawatan dari aplikasi pertama NPWT hingga luaran sebagai hasil, kemudian dianalisis terhadap faktor risiko yang memengaruhinya.
Hasil Penelitian: Lama rawat DFU dengan NPWT adalah 19,9 ± 19,3 hari. Faktor risiko yang mempengaruhi lama rawat adalah riwayat ulkus (r = 0,01; p = 0,034), kedalaman luka (r = 0,292; p = 0.003), Hb (r = 0,05; p = 0,039), HbA1c (r = 0,06; p = 0,033), albumin (r = 0,06; p = 0,017), PCT (r = 0,10; p = 0,035), dan lama menderita DM (r = 0,193; p = 0,009).
Kesimpulan: Penelitian ini menunjukkan bahwa lama rawat DFU dengan NPWT dipengaruhi oleh faktor sitemik (lama menderita DM, Hb, HbA1c, albumin, dan PCT) dan faktor lokal (riwayat ulkus sebelumnya dan kedalaman luka). Kedalaman luka merupakan faktor yang paling berhubungan positif terhadap lama perawatan DFU pasca NPWT (r = 0,292, p = 0,003). Intervensi pada faktor risiko yang dapat diperbaiki sebelum penggunaan NPWT patut dilakukan untuk memaksimalkan penggunaan NPWT dan mengurangi lama perawatan.
Background: It is estimated that around 15% of diabetic patients will experience diabetic foot ulcer (DFU) in their lifetime. Negative Pressure Wound Therapy (NPWT) is proven to be more effective than conventional treatments. NPWT creates a moist wound environment, increases local blood flow and stimulates tissue granulation thereby accelerating wound healing. This study was conducted to determine the risk factors that affect the length of stay of DFU with NPWT. Knowing this risk factors may be helpful for optimizing management strategy.
Methods: This research is a retrospective study with a cross-sectional analytic design in 105 subjects treated in January 2016 to December 2018 at RS. dr. Cipto Mangunkusumo. Patient characteristics, demographics and risk factors were taken from medical records. The length of stay of the patient from the first application of NPWT to its outcomes was the main result, then the correlation to the risk factors that influence it was analyzed.
Results: The length of stay of DFU with NPWT was 19.9 ± 19.3 days. Risk factors affecting the length of stay were history of ulcers (r = 0.01; p = 0.034), wound depth (r = 0.292; p = 0.003), Hb (r = 0.05; p = 0.039), HbA1c (r = 0.06; p = 0.033), albumin (r = 0.06; p = 0.017), PCT (r = 0.10; p = 0.035), and duration of DM (r = 0.193; p = 0.009).
Conclusions: This study showed that the length of stay of DFU with NPWT was influenced by systemic factors (duration of DM, Hb, HbA1c, albumin, and PCT) and local factors (history of previous ulcers and wound depth). The depth of the wound was the most positively related factor to the length of stay in DFU post NPWT (r = 0.292; p = 0.003). Interventions on the risk factors that can be corrected before the application of NPWT may amplify the result of NPWT and reduce the length of treatment."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
cover
Adelina
Hubungan antara Kejadian Ileus Pascaoperasi Laparotomi dengan Status Hidrasi Praoperasi Berdasarkan Bioelectrical Impedance Vector Analysis di RSUPN dr. Cipto Mangunkusumo = Association between Postoperative Ileus After Laparotomy and Preoperative Hydration Status Measured by Bioelectrical Impedance Vector Analysis at dr. Cipto Mangunkusumo Hospital
"Latar Belakang: Ileus pascaoperasi (IPO) terjadi pada 3 – 32% pascaoperasi abdomen mayor. Prevalensi IPO di RSUPN dr. Cipto Mangunkusumo (RSCM) sendiri belum diketahui. Imbang cairan perioperatif berkontribusi terhadap kejadian IPO. Berbagai studi menunjukkan imbang cairan intra- dan pascaoperasi yang positif berhubungan dengan peningkatan risiko IPO, namun peran status hidrasi praoperasi belum diketahui. Pemeriksaan bioelectrical impedance vector analysis (BIVA) mulai digunakan untuk evaluasi status hidrasi, namun metode ini belum umum digunakan untuk evaluasi cairan perioperasi. Penelitian ini dilakukan untuk mengetahui insidensi IPO di RSCM, serta mengetahui hubungan antara IPO dengan status hidrasi praoperasi berdasarkan BIVA. Metode: Penelitian ini adalah studi potong lintang pada pasien yang menjalani laparotomi elektif di RSCM, Jakarta. Diambil karakteristik praoperasi berupa data demografis, antropometri, dan status hidrasi yang meliputi BIVA, osmolalitas serum, imbang cairan, dan rasio blood urea nitrogen/creatinine (rasio BUN/Cr); karakteristik intraoperasi yaitu imbang cairan intraoperasi, lama operasi, dan jumlah perdarahan; serta status hidrasi pascaoperasi yang dinilai pada hari kedua pascaoperasi. Dilakukan analisis hubungan IPO dengan status hidrasi praoperasi berdasarkan BIVA, yang dilanjutkan dengan analisis multivariat untuk menyingkirkan faktor perancu.
Hasil: Sebanyak 90 subjek menjalani laparotomi elektif untuk kasus digestif (37,8%), ginekologi (57,8%), urologi (2,2%), serta join digestif-vaskular dan digestif- ginekologi (2,2%). Status hiperhidrasi praoperasi berdasarkan BIVA didapatkan sebanyak 38,9% dan meningkat menjadi 74,4% pascaoperasi. Osmolalitas serum pra- dan pascaoperasi berada dalam rentang normal dan tidak menunjukkan perubahan yang bermakna, sedangkan imbang cairan dan rasio BUN/Cr meningkat bermakna pascaoperasi. Status hiperhidrasi praoperasi berhubungan bermakna dengan IPO (OR 3.386, 95%CI 1.319 – 8.601; p=0.009). Namun berdasarkan analisis multivariat, hanya jumlah perdarahan intraoperasi (> 500 mL) yang berhubungan dengan IPO (OR 7.95, 95% CI 1.41 – 44.78; p=0.019). Stratifikasi lebih lanjut menunjukkan status hiperhidrasi praoperasi meningkatkan risiko IPO pada subjek dengan jumlah perdarahan intraoperasi kurang dari 500 mL (OR 6.8, 95% CI 1.436 – 32.197; p =0.016). Kesimpulan: Status hidrasi praoperasi menentukan keluaran klinis pascaoperasi. Status hiperhidrasi praoperasi berdasarkan BIVA ditemukan berhubungan dengan peningkatan risiko IPO laparotomi, namun status hiperhidrasi praoperasi dapat dimodifikasi oleh jumlah perdarahan intraoperasi. Dibutuhkan studi lebih lanjut hubungan antara IPO dengan status hiperhidrasi praoperasi, terutama pada kelompok subjek dengan jumlah perdarahan intraoperasi kurang dari 500 mL.
Background: Postoperative ileus (POI) is a complication commonly found after major abdominal surgery, with a prevalence of 3 – 32%. Prevalence of POI at dr. Cipto Mangunkusumo Hospital (RSCM) is yet to be reported. Perioperative hydration status contributes to the risk of developing POI. Studies have shown that positive intra- and postoperative fluid balance are associated with increased risk of POI, but the role of preoperative hydration status is not yet known. Bioelectrical impedance vector analysis (BIVA) has started to be used widely to evaluate hydration status, nonetheless it is still not commonly used in evaluation of perioperative hydration status. This study aims to determine POI incidence in RSCM, and to explore the association between IPO and preoperative hydration status evaluated with BIVA. Methods: This study was a cross-sectional study done at RSCM, Jakarta. We recruited patients who were scheduled to undergo elective laparotomy. Preoperative characteristics were collected such as demographical data, anthropometry, and hydration status including BIVA, serum osmolality, fluid balance, and blood urea nitrogen/creatinine (BUN/Cr) ratio; intraoperative characteristics such as fluid balance, length of surgery, and total bleeding volume; and postoperative hydration status which was analyzed in postoperative day two. Analysis to determine the associatiob between POI and preoperative hydration status by BIVA was done, and continued with logistic regression analysis to control confounding factors.
Results: Ninety subjects recruited in this study underwent elective laparotomy for digestive (37,8%), gynecology (57,8%), urology (2,2%), also joined digestive-vascular and digestive-gynecology (2,2%) surgery. Preoperative hyperhydration by BIVA was found in 38,9% subjects, and increased to 74,4% postoperatively. Pre- and postoperative serum osmolality were within normal range and did not show any significant increment, while fluid balance and BUN/Cr ratio increased postoperatively. Preoperative hyperhydration was associated with POI (OR 3.386, 95%CI 1.319 – 8.601; p=0.009). Only total bleeding volume (> 500 mL) was found to increase the risk of POI after logistic regression analysis (OR 7.95, 95% CI 1.41 – 44.78; p=0.019). Further stratification analysis showed that preoperative hyperhydration increased the risk of POI in subjects with total bleeding less than 500 mL (OR 6.8, 95% CI 1.436 – 32.197; p =0.016). Conclusion: Preoperative hydration status has an impact on postoperative clinical outcome. Preoperative hyperhydration was found to increase the risk of POI, but preoperative hyperhydration status could be modified by the degree of intraoperative bleeding. Further study needs to be done to determine the link between POI and preoperative hyperhydration, especially in subjects with total bleeding less than 500 mL."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
<<   1 2 3 4   >>