Tesis

Validasi Skor Spivack sebagai Prediktor Penggunaan Ventilator Berkepanjangan Pasien Pascabedah Pintas Koroner di RSUPN Dr.Cipto Mangunkusumo = Validation of Spivack Score as Predictor of Prolonged Mechanical Ventilation (PMV) Following Coronary Artery Bypass Graft (CABG) Surgery in Cipto Mangunkusumo Hospital .

Latar Belakang : Penggunaan ventilator berkepanjangan pasien pascabedah pintas koroner dapat meningkatkan risiko morbiditas, mortalitas dan biaya perawatan pascabedah. Skor Spivack yang meliputi riwayat diabetes, unstable angina, gagal jantung kronik, merokok dan fraksi ejeksi merupakan skor sederhana untuk memprediksi penggunaan ventilator berkepanjangan pasien pascabedah pintas koroner. Tujuan : Menilai performa kalibrasi dan diskriminasi skor Spivack dalam memprediksi penggunaan ventilator berkepanjangan pasien pascabedah jantung di RSCM. Metode : Sebanyak 317 subjek diikuti secara retrospektif untuk dinilai skor Spivack dan diikuti selama 2 hari untuk dilihat penggunaan ventilator berkepanjangan. Performa kalibrasi dan diskriminasi dinilai dengan uji Hosmer-Lemeshow dan area under the curve (AUC) dengan Spesifitas, sensitifitas, NPV dan PPV. Hasil Penelitian : Penggunaan ventilator berkepanjangan terdapat sebanyak 51 subjek (16,1%). Performa kalibrasi skor Spivack dengan uji Hosmer-Lemeshow menunjukkan p=0,695 dan plot kalibrasi menunjukkan koefisien korelasi r= 0,792. Performa diskriminasi skor Spivack ditunjukkan dengan nilai AUC sebesar 0,646 (IK95% 0,564; 0,728) dengan spesifitas 42%, sensitifitas 74%, NPV 0,90 dan PPV 0,20. Simpulan : Skor Spivack memiliki kalibrasi yang baik dan diskriminasi yang lemah dalam memprediksi penggunaan ventilator berkepanjangan pasien bedah jantung pintas koroner.
Kata Kunci : ventilator berkepanjangan, bedah jantung, skor Spivack, validasi


Background : PMV after CABG surgery increases the risk of morbidity, mortality and hospital cost. Spivack score that includes history of diabetes, unstable angina, smoking, congestive heart failure and ejection fraction is a simple score to predict PMV following CABG surgery. Objective : To assess the performance of calibration and discrimination of Spivack score in predicting PMV following CABG surgery in Cipto Mangunkusumo Hospital. Methods : A total of 317 patients undergoing CABG surgery were reviewd retrospectively and evaluated for Spivack score. The subjects were followed up for up to 2 days postoperatively to predict PMV. Calibration properties were assessed by Hosmer-Lemeshow test and Discrimination properties were assessed by the area under the curve (AUC) with sensitivity, specifity, positive predictive value (PPV), and negative predictive value (NPV). Results : PMV following CABG surgery was observed in 51 subjects (16,1%). Hosmer Lemeshow test of Spivack score showed p=0.695 and calibration plot showed r=0.792. Discrimination of Spivack score was shown by the AUC value of 0.646 (95%CI 0.564; 0.728). The sensitivity, specifity, positive predictive value (PPV), and negative predictive value (NPV) are 74%, 42%, 0.20, and 0.90 respectively. Conclusion : Spivack score has been shown to have a good callibration but weak discrimination in predicting PMV following CABG surgery. Keywords : prolonged mechanical ventilation, coronary artery bypass grafting surgery, Spivack scoring system, validation