ABSTRAKTujuan
Penelitian mengenai penggunaan analisis faktor risiko dan mortalitas pada operasi
jantung masih menjadi perdebatan dan merupakan area yang sedang berkembang.
Analisis faktor risiko dalam penilaian suatu hasil pembedahan jantung merupakan hal
yang tidak dapat dihindari. Ahli bedah dan rumah sakit memerlukan suatu hasil
penilaian faktor risiko terhadap risiko kejadian mortalitas perioperasi agar dapat
menentukan keputusan klinis. Tujuan penelitian ini adalah untuk membandingkan
Parsonnet dan European System for Cardiac Operative Risk Evaluation (EuroSCORE)
pada pasien yang menjalani perbaikan katup mitral dan memperkirakan faktor-faktor
risiko apa saja yang dapat mempengaruhi mortalitas perioperatif.
Pasien dan Metode
Dari bulan Januari 2010 sampai dengan bulan Desember 2012, 96 pasien terpilih yang
telah menjalani operasi perbaikan katup mitral menggunakan mesin jantung paru dan
telah dilakukan analisis faktor risiko berdasarkan Parsonnet score and EuroSCORE .
seluruh faktor risiko dianalisis dengan analisis deskriptif, tabulasi silang, Pearson Chi
Square, dan uji Anova, keduanya juga dianalisis dengan kurva ROC
Hasil
Angka mortalitas riil sebesar 5,2 %. Berdasarkan Parsonnet score, nilai prediksi
mortalitas sebesar 18,26 % sementara pada EuroSCORE nilai prediksi mortalitas
sebesar 3,68 %. Hasil keduanya signifikan secara statistik. Nilai prediksi EuroSCORE
lebih mendekati angka kematian riil bila dibandingkan Parsonnet score .
Kesimpulan
EuroSCORE lebih unggul dibandingkan dengan Parsonnet score .Nilai prediksi
EuroSCORE lebih mendekati angka kematian riil . EuroSCORE merupakan alat ukur
yang baik dalam analisis faktor risiko dan mortalitas pada operasi perbaikan katup
mitral
ABSTRACTObjective
The use of risk stratified mortality studies for analyzing surgical outcome in cardiac
surgery is obviously a developing area. Unfortunately, outcomes research in valve
repair surgery has been relatively limited. The risk stratification in the assessment of
cardiac surgical results is inevitable. Surgeons and hospitals need availability of risk
assessment result which may influence decision-making. Without risk stratification,
surgeons and hospitals treating high-risk patients will appear to have worse results
than others. Our purpose was to compare the performance of risk stratification models,
Parsonnet and European System for Cardiac Operative Risk Evaluation (EuroSCORE)
in our patients undergoing mitral valve repair (MVr) and predict the risk factors that
influence inhospital mortality .
Patient and methods
From January 2010 to December 2012, 96 consecutive patients have undergone MVr
using cardiopulmonary bypass and scored according to Parsonnet score and
EuroSCORE algorithm. All risk factors were analyzed by descriptive analytic, cross
tabulation, Pearson Chi Square, and Anova test, both scores analyzed by ROC curve.
Results
Overall hospital mortality was 5,2 %. In Parsonnet model, predicted mortality was
18,26 % while in the EuroSCORE model, predicted mortality was 3,68 %. and it was
statistically significant for the Parsonnet score and EURO score . Parsonnet Score has
a higher sensitivity compared to the EuroSCORE. From the ROC curve, AUC for
Parsonnet score (0,905) higher than AUC for EuroSCORE (0,892). Problems with the
Parsonnet score of subjectivity, inclusion of many items not associated with mortality,
and the overprediction of mortality have been highlighted. Pre operative NYHA class,
age, ejection fraction , complication, etiology, EuroSCORE, and Parsonnet score
during mitral valve repair were statistically significant for affecting inhospital
mortality risk.
Conclusions
The EuroSCORE is more reasonable overall predictor of hospital mortality in our
patients undergoing MVr compared to Parsonnet score.