Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar Belakang: Pembedahan saluran cerna memiliki risiko komplikasi tinggi yang meningkatkan morbiditas, mortalitas, dan biaya kesehatan. Penurunan albumin pascaoperasi terkait inflamasi sistemik menjadi indikator penting komplikasi. Comprehensive Complication Index (CCI) digunakan untuk menilai komplikasi lebih komprehensif dibanding Clavien-Dindo Classification.Metode:Studi kohort prospektif ini dilakukan di RSUPN Cipto Mangunkusumo pada Juli-November 2024. Subjek penelitian adalah pasien dewasa yang menjalani pembedahan saluran cerna. Dari 80 subjek awal, 78 memenuhi kriteria dengan 39 pada kelompok albumin dibawah rata-rata atau median dan 39 albumin diatas rata-rata atau median. Komplikasi pascaoperasi diukur menggunakan Comprehensive Complication Index (CCI), yang mencerminkan seluruh komplikasi pada skala kontinu 0-100, di mana skor lebih tinggi menunjukkan beban komplikasi yang lebih berat. Analisis bivariat dilakukan dengan uji Mann-Whitney untuk membandingkan skor CCI antara kedua kelompok albumin.Hasil: Dari total 78 subjek penelitian, didapatkan nilai tengah albumin 2,85 g/dL. Kelompok dengan albumin <2,85 g/dL memiliki skor CCI lebih tinggi dibandingkan kelompok dengan albumin ≥2,85 g/dL. Analisis menunjukkan hubungan bermakna secara signifikan antara status albumin dan komplikasi pascaoperasi (p<0,05).Kesimpulan: Status pascaoperasi berhubungan signifikan dengan komplikasi pasca pembedahan saluran cerna. Penilaian albumin dapat digunakan untuk mengidentifikasi pasien berisiko tinggi komplikasi dan merencanakan intervensi nutrisi guna mengurangi komplikasi.

---

Background: Gastrointestinal surgery carries a high risk of complications, increasing morbidity, mortality, and healthcare costs. Postoperative albumin decline associated with systemic inflammation serves as an important indicator of complications. The Comprehensive Complication Index (CCI) is used to assess complications more comprehensively than the Clavien-Dindo Classification.

Methods: This prospective cohort study was conducted at RSUPN Cipto Mangunkusumo from July to November 2024. The study subjects were adult patients undergoing gastrointestinal surgery. Out of 80 initial subjects, 78 met the inclusion criteria, with 39 in the <2.85 g/dL albumin group and 39 in the >2.85 g/dL albumin group. Postoperative complications were measured using the Comprehensive Complication Index (CCI), which reflects all complications on a continuous scale from 0 to 100, with higher scores indicating greater complication burden. Bivariate analysis was performed using the Mann-Whitney test to compare CCI scores between the two albumin groups.

Results: Among the 78 subjects, the median albumin level was 2.85 g/dL. CCI score in the <2.85 g/dL albumin group significantly higher than the >2.85 g/dL albumin group. These findings indicate a significant association between albumin levels and postoperative complication (p<0.05)..

Conclusion: Postoperative albumin status is significantly associated with gastrointestinal surgery complications. Albumin assessment can be used to identify high-risk patients and plan nutritional interventions to reduce complications."

"Latar Belakang: Pembedahan saluran cerna memiliki risiko komplikasi tinggi yang meningkatkan morbiditas, mortalitas, dan biaya kesehatan. Penurunan albumin pascaoperasi terkait inflamasi sistemik menjadi indikator penting komplikasi. Comprehensive Complication Index (CCI) digunakan untuk menilai komplikasi lebih komprehensif dibanding Clavien-Dindo Classification.Metode:Studi kohort prospektif ini dilakukan di RSUPN Cipto Mangunkusumo pada Juli-November 2024. Subjek penelitian adalah pasien dewasa yang menjalani pembedahan saluran cerna. Dari 80 subjek awal, 78 memenuhi kriteria dengan 39 pada kelompok albumin dibawah rata-rata atau median dan 39 albumin diatas rata-rata atau median. Komplikasi pascaoperasi diukur menggunakan Comprehensive Complication Index (CCI), yang mencerminkan seluruh komplikasi pada skala kontinu 0-100, di mana skor lebih tinggi menunjukkan beban komplikasi yang lebih berat. Analisis bivariat dilakukan dengan uji Mann-Whitney untuk membandingkan skor CCI antara kedua kelompok albumin.Hasil: Dari total 78 subjek penelitian, didapatkan nilai tengah albumin 2,85 g/dL. Kelompok dengan albumin <2,85 g/dL memiliki skor CCI lebih tinggi dibandingkan kelompok dengan albumin ≥2,85 g/dL. Analisis menunjukkan hubungan bermakna secara signifikan antara status albumin dan komplikasi pascaoperasi (p<0,05).Kesimpulan: Status pascaoperasi berhubungan signifikan dengan komplikasi pasca pembedahan saluran cerna. Penilaian albumin dapat digunakan untuk mengidentifikasi pasien berisiko tinggi komplikasi dan merencanakan intervensi nutrisi guna mengurangi komplikasi.

---

Background: Gastrointestinal surgery carries a high risk of complications, increasing morbidity, mortality, and healthcare costs. Postoperative albumin decline associated with systemic inflammation serves as an important indicator of complications. The Comprehensive Complication Index (CCI) is used to assess complications more comprehensively than the Clavien-Dindo Classification.

Methods: This prospective cohort study was conducted at RSUPN Cipto Mangunkusumo from July to November 2024. The study subjects were adult patients undergoing gastrointestinal surgery. Out of 80 initial subjects, 78 met the inclusion criteria, with 39 in the <2.85 g/dL albumin group and 39 in the >2.85 g/dL albumin group. Postoperative complications were measured using the Comprehensive Complication Index (CCI), which reflects all complications on a continuous scale from 0 to 100, with higher scores indicating greater complication burden. Bivariate analysis was performed using the Mann-Whitney test to compare CCI scores between the two albumin groups.

Results: Among the 78 subjects, the median albumin level was 2.85 g/dL. CCI score in the <2.85 g/dL albumin group significantly higher than the >2.85 g/dL albumin group. These findings indicate a significant association between albumin levels and postoperative complication (p<0.05)..

Conclusion: Postoperative albumin status is significantly associated with gastrointestinal surgery complications. Albumin assessment can be used to identify high-risk patients and plan nutritional interventions to reduce complications."

"The increasing prevalence of obesity in many countries means that it should now be considered a pandemic. It is widely recognized that obesity increases the risk of a variety of life-threatening conditions, including heart disease, diabetes, and hypertension. Bariatric surgery is often the most effective way to treat such morbid obesity. Nevertheless, while various bariatric procedures have been proposed, to date standards have been lacking. In this book, leading experts from around the world discuss all aspects of bariatric surgery and present their own favored versions of surgical procedures with the aid of informative illustrations. Technical nuances are carefully described, and detailed attention is devoted to potential complications and how to avoid them. "

"ABSTRAKInfeksi daerah operasi IDO adalah infeksi yang terjadi hingga 30 hari setelah operasi pada pasien non implan atau satu tahun pada pasien menggunakan implan. IDO memberikan dampak morbiditas maupun mortalitas. Antibiotik profilaksis merupakan antibiotik yang digunakan 30-60 menit sebelum insisi bertujuan untuk mengurangi risiko IDO. Tujuan penelitian ini mengevaluasi penggunaan antibiotik profilaksis pada pasien IDO dan menghitung angka IDO di RSUP Fatmawati periode Januari-April 2017. Penelitian dilakukan secara observational dengan metode deskriptif. Data diperoleh secara prospektif dan retrospektif. Pengambilan data dilakukan dengan teknik total sampling. Evaluasi penggunaan antibiotik profilaksis berupa evaluasi kesesuaian penggunaan antibiotik profilaksis dengan pedoman penggunaan antibiotik PPAB RSUP Fatmawati dan formularium RSUP Fatmawati, kesesuaian waktu pemberian serta kesesuaian berdasarkan kelas operasi. Pasien IDO yang memenuhi kriteria sebagai subjek penelitian terdapat 38 pasien dan hanya 31 pasien IDO yang menggunakan antibiotik profilaksis. Data menunjukkan, antibiotik yang banyak digunakan oleh pasien IDO adalah sefazolin 45,16 . Hasil evaluasi didapatkan sebesar 38,89 antibiotik profilaksis yang digunakan pasien IDO dinyatakan sesuai dengan PPAB dan 83,87 dinyatakan sesuai dengan formularium. Evaluasi terhadap waktu pemberian didapatkan 7 pasien IDO 20,33 dinyatakan sesuai penggunaannya dan 70,49 sesuai terhadap kelas operasi bersih kontaminasi. Analisis bivariat terlihat adanya hubungan antara IDO dengan penggunaan antibiotik profilaksis p-value 0,004 dan tidak adanya hubungan antara IDO dengan kesesuaian penggunaan antibiotik berdasarkan pedoman p-value 0,542.

---

ABSTRACTSurgical site infection (SSI) is an infection that occurs up to 30 days after non implant surgery or one year in patients that using implants. This infection will have an impact on morbidity and mortality. Prophylactic antibiotics are antibiotics that used 30 60 minutes before the incision that aimed to reduce the risk of infection on the surgical area. The purpose of this study to evaluate the use of prophylactic antibiotic in SSI patients and calculate the incidence surgical site infection in RSUP Fatmawati from January to April 2017. This research was observational with descriptive method based on the perspective and retrospective data that collected by total sampling technique. The evaluation of antibiotic with guidance of antibiotic usage of Fatmawati General Hospital 2014 and formulary of Fatmawati General Hospital 2014, conformity of timing and conformity with operation class. SSI patients who met the criteria for the study subjects were 38 patients with only 31 SSI patients on prophylactic antibiotics. The data shown the antibiotics that used by SSI patients was cefazoline 45.16 . The results of the evaluation obtained that 38.89 of prophylactic antibiotic used by SSI patients in accordance with guidance of antibiotic usage of Fatmawati General Hospital, 83.87 use of prophylactic antibiotics according to formulary, Only 7 IDO patients were declared using prophylactic antibiotics timely and 70.49 are suitable with the use of antibiotics in accordance with the class of clean contamination operations. Bivariate analysis showed that there was a correlation between SSI incidence with prophylactic antibiotic usage with p value 0.004 and aren rsquo t correlation between SSI incidence and suitability of antibiotic use based on guidance with p value 0.524."

"This handbook is aimed at first-line health care providers involved in the perioperative care of adult and pediatric neurosurgical patients. It is unique in its systematic focus on how to deal with common and important clinical challenges encountered in day-to-day practice in the OR, the PACU, and the ICU and is designed as a problem-solving tool for all members of the perioperative medicine team: trainees and faculty in anesthesiology, neurosurgery, and critical care; nurses; nurse anesthetists; and physician’s assistants. • Encompasses clinical continuum from neurosurgical pre-op to critical care – plus anesthesia in neuroradiology• Adult and pediatric care• Structured algorithmic approach supports clinical decision-making• Succinct presentation of clinically relevant basic science• End-of-chapter summaries, with suggestions for further reading• Collaborative approach and multidisciplinary nature of perioperative medicine emphasized• Extensive summary tables• Portable and formatted for quick retrieval of information• Ideal for use in the OR, the PACU, and the ICU"

"Latar Belakang: Gagal ginjal akut (GGA) yang terjadi pasca operasi adalah komplikasi yang sering terjadi pada pasien yang menjalani operasi mayor risiko tinggi. Data dari ICU Rumah Sakit Umum Pusat Fatmawati, pada tahun 2018, angka GGA pasca operasi mencapai 73,56% dari seluruh pasien GGA yang dirawat di ICU. Mortalitasnya mencapai 52% dan sebanyak 42% membutuhkan terapi pengganti ginjal mulai dari terapi pengganti ginjal kontinu sampai hemodialisa konvensional. GGA selanjutnya dihubungkan dengan komplikasi, morbiditas dan mortalitas yang tinggi, lama rawat ICU yang memanjang, meningkatnya risiko infeksi nosokomial dan beban pembiayaan rumah sakit yang lebih tinggi.Terapi pengganti ginjal menjadi pilihan terapi utama untuk kasus GGA berat. Untuk pasien kritis dalam perawatan di ICU, salah satu mode terapi pengganti ginjal yang umum digunakan pada pasien GGA-PO di ICU adalah terapi pengganti ginjal kontinu (continuous renal replacement therapy/CRRT). CRRT dapat menurunkan kadar sitokin inflamasi dan menekan reaksi inflamasi yang berlebihan sehingga mengurangi cedera ginjal dan mendorong pemulihan ginjal. Saat ini belum ada konsensus tentang waktu optimal inisiasi RRT. Waktu inisiasi RRT sebaiknya ditegakkan tidak hanya mempertimbangkan indikasi renal, tetapi juga mempertimbangkan terapi purifikasi darah ekstrakorporeal.Penelitian ini bertujuan untuk membandingkan waktu inisiasi CRRT dini yaitu <8 jam sejak diagnosis GGA ditegakkan dengan waktu inisiasi lambat yaitu >8 jam sejak diagnosis GGA pasca operasi ditegakkan dalam mempengaruhi perubahan kadar sitokin inflamasi pada pasien GGA pasca operasi risiko tinggi di UPI.Metodologi: Penelitian ini menggunakan desain kohort prospektif. Penelitian dilakukan di Unit Perawatan Intensif Rumah Sakit Umum Pusat Fatmawati. Populasi target penelitian adalah seluruh pasien dewasa dengan diagnosis gangguan ginjal akut pasca operasi mayor risiko tinggi yang menjalani CRRT. Kadar sitokin IL-6 dan IL-10 diperiksa sebelum CRRT dimulai dan 12 jam pasca terapi.Hasil: Terdapat perbedaan bermakna kadar IL-6 pada 12 jam setelah terapi pada kelompok inisiasi dini (p= 0,047 vs. p=0,676). Tidak didapatkan perbedaan kadar IL-10 antara CRRT dini dan lambat pada jam awal CRRT maupun 12 jam setelah terapi (p=0,989 vs p=0,616). Ditemukan perbedaan kadar IL-6 pada jam ke-12 setelah terapi dengan perbedaan yang bermakna (p=0.002) dengan nilai lebih rendah pada kelompok hidup. Selain itu ditemukan perbedaan bermakna pada kadar mediator inflamasi IL-10 (p=0,016) dengan nilai lebih rendah saat jam ke-12 setelah terapi pada kelompok hidup (OR=2,29, CI 1,19 – 4,38).Kesimpulan: CRRT inisiasi dini dengan onset <8jam sejak pasien terdiagnosis AKI dapat dipertimbangkan untuk pasien pascaoperasi risiko tinggi yang mengalami GGA di UPI dengan mempertimbangkan faktor risiko dan tingkat keparahan penyakit pasien. Perlu dikembangkan kriteria klasifikasi yang dipersonalisasi sesuai kondisi tingkat keparahan penyakit pasien pasca operasi untuk melakukan inisiasi CRRT di UPI.

---

Background: Acute renal failure (ARF) that occurs after surgery is a common complication in patients undergoing major high-risk surgery. Data from the ICU of Fatmawati General Hospital, in 2018, the number of post-operative ARF reached 73.56% of all ARF patients treated in the ICU. Mortality reached 52% and as many as 42% required renal replacement therapy ranging from continuous renal replacement therapy to conventional hemodialysis. ARF is further associated with complications, high morbidity and mortality, prolonged ICU stay, increased risk of nosocomial infection and higher hospital cost burden.

Renal replacement therapy is the main therapy of choice for severe ARF cases. For critical patients in the ICU, one of the common modes of renal replacement therapy used in ARF-PO patients in the ICU is continuous renal replacement therapy (CRRT). CRRT can reduce inflammatory cytokine levels and suppress excessive inflammatory reactions, thereby reducing kidney injury and promoting kidney recovery. Currently, there is no consensus on the optimal timing of RRT initiation. The timing of RRT initiation should be established not only considering renal indications, but also considering extracorporeal blood purification therapy.

This study aims to compare the early initiation time of CRRT, which is <8 hours since the diagnosis of ARF was established with the late initiation time, which is >8 hours since the diagnosis of ARF postoperatively was established in influencing changes in inflammatory cytokine levels in high-risk postoperative ARF patients at UPI.

Methodology: This study used a prospective cohort design. The study was conducted in the Intensive Care Unit of Fatmawati General Hospital. The target population of the study was all adult patients with a diagnosis of high-risk post-major surgical acute kidney injury undergoing CRRT. IL-6 and IL-10 cytokine levels were examined before CRRT was started and 12 hours after therapy.

Results: There was a significant difference in IL-6 levels at 12 hours after therapy in the early initiation group (p= 0.047 vs. p=0.676). There was no difference in IL-10 levels between early and late CRRT in the early hours of CRRT or 12 hours after therapy (p=0.989 vs. p=0.616). A significant difference was found in IL-6 levels at 12 hours after therapy (p=0.002) with lower values ​​in the living group. In addition, a significant difference was found in the levels of the inflammatory mediator IL-10 (p=0.016) with lower values ​​at 12 hours after therapy in the living group (OR=2,29, CI 1,19 – 4,38).

Conclusion: Early initiation CRRT with onset <8 hours since the patient was diagnosed with AKI can be considered for high-risk postoperative patients with AKI in UPI by considering the patient's risk factors and disease severity. It is necessary to develop personalized classification criteria according to the severity of postoperative patient disease to initiate CRRT in UPI."

"The demand for cosmetic procedures is increasing worldwide. This book presents all the potential side-effects and complications of the most frequently used procedures in aesthetic dermatology and provides sound practical advice on their management. It will be helpful not only to beginners but also to experienced dermatologists who want to start performing new procedures. The text is fully illustrated and very simple to consult. For each procedure, the book discusses both common and uncommon side-effects and complications, provides tips on how to avoid them, and explains clearly how they are best treated."