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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
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UI - Tugas Akhir  Universitas Indonesia Library
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Ade Susanti
Kelebihan Cairan sebagai Prediktor Kebocoran Kapiler pada Pasien Pascabedah Abdomen Mayor: Kajian terhadap Keseimbangan Cairan Kumulatif, Tekanan Vena Sentral, Rasio Albumin-Kreatinin Urin dan Indeks Kebocoran Kapiler = Fluid Overload as A Predictor of Capillary Leakage in the Patient of Postoperative Abdomen Mayor Surgery : Study of Cumulative Fluid Balance, Central Venous Pressure, Urine Albumin-Creatinine Ratio and Capillary Leak Index
"Latar Belakang: Pasien pascabedah abdomen mayor seringkali berhubungan dengan terjadinya general increase permeability sindrom akibat kelebihan cairan selama selama durante operasi dan pada saat perawatan pascabedah. Tujuan dari penelitian ini adalah ingin membuktikan apakah keseimbangan cairan kumulatif, tekanan vena sentral dan rasio albumin-kreatinin urin dapat digunakan sebagai prediktor kebocoran kapiler.
Metode: Penelitian ini merupakan penelitian kohort prospektif dengan subjek penelitian adalah pasien dewasa yang menjalani tindakan bedah abdomen mayor. Dilakukan pemeriksaan keseimbangan cairan kumulatif, tekanan vena sentral, rasio albumin-kreatinin urin dan indeks kebocoran kapiler, pada saat sebelum induksi anestesi, 48 jam dan 72 jam pasca bedah.
Hasil: Pada penelitian ini didapatkan nilai titik potong dari indeks kebocoran kapiler 155 (AUC 0,013, sensitifitas 100% dan spesifisitas 74,50%. Analisis dengan Generalized Estimating Equations didapatkan tekanan vena sentral menujukan hubungan tidak bermakna dengan indeks kebocoran kapiler (OR 1,62 ; CI 95% = 0,92 – 2,83), sedangkan keseimbangan cairan kumulatif dan rasio albumin kreatinin urin menunjukkan hubungan yang bermakna dengan indeks kebocoran kapiler (OR = 2,561 ; CI 95% = 1,352-4,850 dan OR = 2,017 ; CI 95% = 1,086-3,749). Faktor skor SOFA terkategori sepsis juga mempunyai hubungan dengan indeks kebocoran kapiler (OR = 2,764 ; CI 95% = 1,244-6,140).
Kesimpulan: Kelebihan cairan kumulatif, rasio albumin kreatinin urin dan skor SOFA terbukti dapat digunakan untuk memprediksi kebocoran kapiler.
Background: Patients after major abdominal surgery are often associated with the occurrence of general increase in permeability syndrome due to excess fluid during surgery and during postoperative care. The purpose of this study was to prove whether cumulative fluid balance, central venous pressure and urine albumin-creatinine ratio of urine can be used as predictors of capillary leakage.
Method: This study is a prospective cohort study with research subjects as adult patients undergoing major abdominal surgery. Cumulative fluid balance, central venous pressure, urine albumin-creatinine ratio and capillary leak index were examined, before anesthesia induction, 48 hours and 72 hours postoperatively.
Result: In this study, a cut-off point from the capillary leak index ≥155 (AUC 0.013, sensitivity 100% and specificity 74.50%) was obtained. Generalized Estimating Equations analysis showed that the central venous pressure showed no significant relationship with the capillary leak index (OR 1.62; 95% CI = 0.92 - 2.83), while cumulative fluid balance and urine albumin : creatinin ratio showed a significant association with capillary leak index (OR = 2.561; 95% CI = 1.352-4.850 and OR = 2.017; 95% CI = 1,086-3,749) Sepsis categorized SOFA score factors also have a relationship with capillary leak index (OR = 2.764; 95% CI = 1,244-6,140).
Conclusion: Cumulative fluid overload, urine creatinine albumin ratio and SOFA score have been shown to predict capillary leakage."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Ridho Ardhi Syaiful
Infeksi daerah operasi pada pembedahan abdominal di Rumah Sakit Cipto Mangunkusumo Jakarta dari tahun 2012-2013 = Surgical site infection in abdominal surgery at Cipto Mangunkusumo Hospital from 2012-2013
"[ABSTRAK
Infeksi daerah operasi merupakan hal yang harus diperhatikan oleh para ahli bedah mengingat tingginya morbiditas dan mortalitas pada pasien yang menderita infeksi daerah operasi Penulis ingin melakukan analisa secara garis besar bagaimana infeksi daerah operasi terutama pada infeksi daerah operasi pada operasi dengan golongan operasi bersih dan bersih tercemar Dilakukan penelitian retrospektif terhadap semua pasien divisi bedah digestif FKUI RSCM dari september 2012 hingga Juli 2014 Pasien dinilai berdasarkan kondisi preoperatif intraoperatif dan pasca operatif Dari data yang terhimpun selama penelitian di dapatkan 57 pasien menderita infeksi daerah operasi Delapan persen dari seluruh total operasi bedah digestif Keganasan kolorektal adenocarcinoma kolorektal menempati urutan pertama 22 39 Didapatkan 2 kasus yang merupakan operasi dengan tipe operasi bersih Didapatkan 17 kasus yang merupakan operasi dengan tipe bersih terkontaminasi Kata kunci Infeksi Daerah Operasi Pembedahan abdominal ABSTRACTSurgical site infection SSI have been responsible for the increasing cost morbidity and mortality related to surgical operations and continue to be a major problem even in hospitals with most modern facilities This study aimed to determine the incidence of SSI in the abdominal surgeries Obsteric and Gynecology surgery was excluded It was conducted over a period of 12 months All Surgeries 791 cases where abdominal wall was opened were considered for the study Wound class was considered as clean clean contaminated contaminated and dirty The data collected includes details of timing of antimicrobial prophylaxis surgical wound infection types of surgeries emergency and elective nutrional status preoperative condition ASA preoperative bed stay intraoperative condition bleeding amount duration of operative and death rate The overall surgical wound infection rate was 8 Predominantly male had SSI than female Mostly case at productive age 25 65 years Colorectal was leading case of SSI 22 cases There was one case of clean surgery , Surgical site infection SSI have been responsible for the increasing cost morbidity and mortality related to surgical operations and continue to be a major problem even in hospitals with most modern facilities This study aimed to determine the incidence of SSI in the abdominal surgeries Obsteric and Gynecology surgery was excluded It was conducted over a period of 12 months All Surgeries 791 cases where abdominal wall was opened were considered for the study Wound class was considered as clean clean contaminated contaminated and dirty The data collected includes details of timing of antimicrobial prophylaxis surgical wound infection types of surgeries emergency and elective nutrional status preoperative condition ASA preoperative bed stay intraoperative condition bleeding amount duration of operative and death rate The overall surgical wound infection rate was 8 Predominantly male had SSI than female Mostly case at productive age 25 65 years Colorectal was leading case of SSI 22 cases There was one case of clean surgery ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Faktor-faktor yang mempengaruhi mobilisasi dini pada klien pasca operasi Laparatomi
"Laparatomi adalah tindakan pembedahan dengan cara insisi pada rongga abdomen, prosedur ini dilakukan mencakup saluran pencernaan dan organ-organ asesorisnya ( Harkness, 1996). Berdasarkan pengamatan di lapangan banyak sekali klien dengan pasca operasi laparatomi yang tidak melakukan mobilisasi dini, banyak faktor-faktor yang mempengaruhi mereka untuk melakukan mobilisasi aktif baik dilihat secara fisik maupun psikologis. Tujuan penelitian ini adlaah untuk mengidentifikasi faktor-faktor apa saja yang mempengaruhi mobilisasi dini pada klien pasca operasi laparatomi."
Fakultas Ilmu Keperawatan Universitas Indonesia, 2002
TA5236
UI - Tugas Akhir  Universitas Indonesia Library
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Radhita Fatma Kamil
Manfaat skor APACHE II, MPI, dan ARPI sebagai penentu On Demand Relaparotomy = Benefits of APACHE II, MPI, and ARPI as determinants of On Demand Relaparotomy
"[ABSTRAK
Pendahuluan: Keputusan relaparotomi yang terlambat menambah morbiditas dan mortalitas. Keputusan on demand relaparotomy bersifat subjektif dari klinis, sehingga diperlukan pemeriksaan diagnostik tambahan dan alat untuk menentukan keputusan secara tepat, yaitu sistem skor. Metode penelitian: kasus kontrol dengan menggunakan 32 kasus on demand relaparotomy dan 64 kasus laparotomi, secara retrospektif. Hasil penelitian: Analisis perbedaan dua kelompok menunjukkan bahwa skor APACHE II tidak mempunyai perbedaan bermakna (p=0,144) sedangkan skor MPI dan ARPI mempunyai perbedaan yang bermakna (p<0,0001). Dari kurva ROC didaptkan APACHE II mempunyai AUC 59,2% dengan cut off point 10, MPI mempunyai AUC 86,4% dengan cut off point 20 dan ARPI mempunyai AUC 77,6% dengan cut off point 10. Kesimpulan: MPI dan ARPI bermanfaat sebagai penentu on demand relaparotomy.ABSTRACT Background: Delayed decision to do relaparotomy add morbidity and mortality. The decision to do on demand relaparotomy is subjective based on the clinical nature, therefore, it is necessary to have an examination and additional diagnostic and tools to determine the correct decisions, that is the scoring system. Methods: this is a case-control using 32 cases of on demand relaparotomy and 64 cases of laparotomy, retrospectively. Results: The analysis of the two groups showed that APACHE II has no significant difference (P = 0.114) while the MPI and ARPI has significant difference (P <0.0001) and on ROC curve obtained APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10.
Conclusion: MPI and ARPI can be used as determinants on demand relaparotomy. ;Background: Delayed decision to do relaparotomy add morbidity and mortality. The decision to do on demand relaparotomy is subjective based on the clinical nature, therefore, it is necessary to have an examination and additional diagnostic and tools to determine the correct decisions, that is the scoring system. Methods: this is a case-control using 32 cases of on demand relaparotomy and 64 cases of laparotomy, retrospectively. Results: The analysis of the two groups showed that APACHE II has no significant difference (P = 0.114) while the MPI and ARPI has significant difference (P <0.0001) and on ROC curve obtained APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10.
Conclusion: MPI and ARPI can be used as determinants on demand relaparotomy. ;Background: Delayed decision to do relaparotomy add morbidity and mortality. The decision to do on demand relaparotomy is subjective based on the clinical nature, therefore, it is necessary to have an examination and additional diagnostic and tools to determine the correct decisions, that is the scoring system. Methods: this is a case-control using 32 cases of on demand relaparotomy and 64 cases of laparotomy, retrospectively. Results: The analysis of the two groups showed that APACHE II has no significant difference (P = 0.114) while the MPI and ARPI has significant difference (P <0.0001) and on ROC curve obtained APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10.
Conclusion: MPI and ARPI can be used as determinants on demand relaparotomy. ;Background: Delayed decision to do relaparotomy add morbidity and mortality. The decision to do on demand relaparotomy is subjective based on the clinical nature, therefore, it is necessary to have an examination and additional diagnostic and tools to determine the correct decisions, that is the scoring system. Methods: this is a case-control using 32 cases of on demand relaparotomy and 64 cases of laparotomy, retrospectively. Results: The analysis of the two groups showed that APACHE II has no significant difference (P = 0.114) while the MPI and ARPI has significant difference (P <0.0001) and on ROC curve obtained APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10.
Conclusion: MPI and ARPI can be used as determinants on demand relaparotomy. , Background: Delayed decision to do relaparotomy add morbidity and mortality. The decision to do on demand relaparotomy is subjective based on the clinical nature, therefore, it is necessary to have an examination and additional diagnostic and tools to determine the correct decisions, that is the scoring system. Methods: this is a case-control using 32 cases of on demand relaparotomy and 64 cases of laparotomy, retrospectively. Results: The analysis of the two groups showed that APACHE II has no significant difference (P = 0.114) while the MPI and ARPI has significant difference (P <0.0001) and on ROC curve obtained APACHE II had AUC of 59.2% with a cut-off point of 10, MPI had AUC of 86.4% with a cut-off point of 20 and ARPI had AUC of 77.6% with a cut-off point of 10.
Conclusion: MPI and ARPI can be used as determinants on demand relaparotomy. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Harsono
Faktor-faktor yang mempengaruhi intensitas nyeri pasca bedah abdomen dalam konteks asuhan keperawatan di Rumah Sakit Umum Daerah Ade Mohammad Djoen Sintang = The influencing factors of abdominal postoperative pain intensity in the context of the nursing care at ade Mohammad Djoen District Public Hospital in Sintang
"ABSTRAK
Nyeri pasca bedah abdomen adalah gabungan dari beberapa pengalaman sensori, emosional, dan mental yang tidak menyenangkan akibat trauma bedah. Walaupun nyeri telah dikelola dengan baik, kira-kira 86% pasien mengalami nyeri sedang ke hebat pasca bedah meskipun analgesik ditingkatkan. Penelitian ini bertujuan mendeskripsikan karakteristik responden (exploratory study) dan selanjutnya menjelaskan faktor-faktor yang mempengaruhi intensitas nyeri pasca bedah abdomen (explanatory study). Desain penelitian ini adalah deskriptif analitik dengan pendekatan cross sectional pada 67 orang responden pasca bedah abdomen. Pada penelitian ini digunakan instrumen State Anxiety Inventory (S-AI) Form Y untuk menilai keadaan cemas pasien pasca bedah abdomen, sikap dan keyakinan terhadap nyeri, dan skala nyeri untuk menilai intensitas nyeri pasca bedah menggunakan kombinasi Visual Analog Scale (VAS) dan Numeric Rating Scale (NRS). Hasil penelitian ini menunjukan bahwa faktor-faktor yang mempengaruhi secara signifikan terhadap intensitas nyeri pasca bedah abdomen adalah jenis kelamin (p value = 0,005), letak insisi (p value = 0,0005), dan tingkat kecemasan (p value = 0,0005). Faktor yang paling mempengaruhi intensitas nyeri pasca bedah abdomen adalah tingkat kecemasan (standardized coefficient β 0,501). Hasil penelitian ini bermanfaat bagi praktisi keperawatan sebagai acuan asuhan keperawatan dalam melakukan pengelolaan nyeri pasca bedah abdomen untuk mempertimbangkan faktor tingkat kecemasan, jenis kelamin, dan letak insisi. Rekomendasi hasil penelitian ini perlu adanya penelitian lebih lanjut dengan jumlah sampel yang lebih besar dan faktor-faktor lain yang dapat mempengaruhi nyeri.
ABSTRACT
Abdominal postoperative pain is a combined of several unpleasant sensory, emotional, and mental experience precipitated by the surgical trauma. Pain experience are influenced by many factors and it is difficult to understand and about 86% of patients experience moderate to severe pain following surgery in the hospital. The purpose of this study was to identify the characteristic of respondent (exploratory study) and to explain influencing factors of abdominal postoperative pain intensity (explanatory study). The design was an analytic description using a cross sectional for 67 respondents abdominal postoperative. In the study using State Anxiety Inventory (S-AI) Form Y instrument was used to measure the abdominal postoperative state anxiety, attitudes and beliefs about pain, and pain scale using a combined Visual Analog Scale (VAS) and Numeric Rating Scale (NRS) was used to measure postoperative pain intensity. The finding showed that gender (p value = 0,005), incision site (p value = 0,0005), and anxiety levels (p value = 0,0005) were significantly influencing factors of abdominal postoperative pain intensity. The most influencing factor of abdominal postoperative pain intensity was anxiety levels (standardized coefficient β 0,501). This study information for nursing practitioner as reference in nursing care planning should be considered anxiety levels, gender, and incision site to management of patients with postoperative pain relief. It is recommended to conduct further research using more samples and other factors that also may alter pain reaction."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2009
T-Pdf
UI - Tesis Open  Universitas Indonesia Library
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Brittenden, John, editor
Radiology of the post surgical abdomen
"Radiology of the post surgical abdomen provides a comprehensive overview of all abdominal operations involving the gastrointestinal tract, pancreas, hepatobiliary and genitourinary systems. Each chapter is fully illustrated with artists' drawings and radiological images of normal post operative anatomy. The complications associated with each procedure are described alongside imaging examples. Written by experts in the field, Radiology of the post surgical abdomen provides the reader with key teaching points emphasising differentiation between normal post-operative anatomy and complications."
London : Springer, 2012
e20426026
eBooks  Universitas Indonesia Library
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Freesia Novita Kusumawardani
Hubungan Defisiensi Vitamin D Serum Praoperasi dengan Kejadian Infeksi Daerah Operasi Pasca Laparotomi Elektif = Association between Preoperative Serum Vitamin D Deficiency and Surgical Site Infections after Elective Laparotomy
"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."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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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
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Analisis Asuhan Keperawatan pada Pasien dengan Carcinoma Recti dan Penerapan Latihan Mobilisasi Dini untuk Meningkatkan Peristaltik Usus = Nursing Care Analysis in Patients with Carcinoma Recti and Implementation of Early Mobilization Exercise to Improve The Intestinal Peristaltics
"Pembedahan laparatomi merupakan salah satu modalitas penatalaksanaan pada pasien dengan carcinoma recti. Penggunaan agen anestesi pada pasien yang menjalani prosedur bedah laparatomi dapat menyebabkan timbulnya gangguan aktivitas peristaltik usus. Penerapan terapi mobilisasi dini pada pasien post operasi laparatomi bertujuan untuk mempercepat timbulnya aktivitas peristaltik usus sehingga mencegah terjadinya komplikasi seperti infeksi nosokomial dan lambatnya proses penyembuhan luka bedah. Penerapan terapi mobilisasi dini yang dilakukan setiap 2 jam sekali selama 6 hari perawatan terbukti mampu mempercepat timbulnya aktivitas peristaltik usus yang ditunjukkan dengan timbulnya bising usus dengan frekuensi 6-8x/menit serta berkurangnya keluhan mual dan begah yang dialami pasien, hingga keluhan tersebut hilang pada hari ketiga sejak dilakukan mobilisasi dini. Hasil penerapan mobilisasi dini pada pasien post operasi laparatomi ini dapat dijadikan sumber informasi perawat dalam melakukan keperawatan mandiri dalam mengurangi mual dan begah seiring munculnya aktivitas peristaltik usus, serta mengurangi nyeri dan mempercepat proses penyembuhan.
Laparatomy surgery is one of the management modalities in patients with carcinoma recti. The use of anesthetic agents in patients undergoing laparotomy surgical procedures can cause disruption of intestinal peristaltic activity. The application of early mobilization therapy to post laparotomy patients aims to accelerate the emergence of intestinal peristaltic activity so as to prevent complications such as nosocomial infections and the slow healing process of surgical wounds. The application of early mobilization therapy that is carried out every 2 hours for 6 days of treatment is proven to be able to accelerate the occurrence of intestinal peristaltic activity as indicated by the emergence of bowel sounds with a frequency of 6-8x / minute and reduced complaints of nausea and pain experienced by patients, until the complaint disappears on the day third since early mobilization. The results of the application of early mobilization in postoperative laparotomy patients can be used as a source of information for nurses in carrying out independent nursing in reducing nausea and sickness as intestinal peristaltic activity arises, as well as reducing pain and accelerating the healing process."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2019
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