Tesis

Analisis perioperatif pasien post open repair elektif aneurisma aorta abdominal yang meninggal di RSUP Fatmawati periode 2013 – 2018 = Perioperative mortality analysis following elective open abdominal aortic aneurysm repair in RSUP Fatmawati five years eperience.

Latar belakang :Tesis ini membahas tentang analisis kasus kematian pada pasien Aneurisma aorta abdominal di RSUP Fatmawwati yang menjalani operasi elektif. Sampel dan Metode : Data pasien diambil periode 2013 sampai April 2018. Semua pasien yang meninggal dari operasi elektif aneurisma aorta abdominal akan di data. Penelitian ini ditampilkan dalam bentuk deskriptif, dengan data kualitatif dan kuantitatif. Data kualitatif didapatkan dengan melakukan wawancara dengan tim operasi, operator, tim anestesi dan paramedis instrumen. Data kuantitatif didapatkan dengan telusur rekam medis. Hasil : Terdapat 27 kasus, selama periode 2013 sampai April 2018. Hanya 15 kasus yang rekam medis lengkap, 5 kasus hidup, 2 kasus meninggal pada operasi emergency dan 8 kasu meninggal pada operasi elektif. Dari 8 kasus ini, 5 kasus disertai anemia dan trombositopenia yang menetap sampai pada tahap postoperasi, 2 kasus dengan gangguan ginjal dan 1 kasus dengan penyebab yang belum jelas. Pada 8 kasus kematian, lama operasi berkisar dari 4 jam 20 menit sampai 8 jam 10 menit. Jumlah perdarahan berkisar dari 750 cc sampai 7.000 cc. Kadar creatinin preoperasi, berkisar dari 1,0 sampai 4,3 mg/dL. Kadar creatinin postoperasi berubah dari 1,0 sampai 4,5 mg/dL. Kadar hemoglobin postoperasi berkisar 5,9 sampai 9,4 g/dL. Kadar trombosit, berkisar 45.000 sampai 108.000/uL. Rata rata jumlah perdarahan adalah 3.156 cc. Kesimpulan : Penelitian ini menyimpulkan bahwa kasus dengan hasil akhir kematian, sebagian besar disertai oleh jumlah perdarahan yang masif. Perbaikan yang dilakukan untuk resusitasi komponen darah tidak mencapai hasil yang optimal.
Kata Kunci : aneurisma aorta abdominal, analisis perioperatif, elektif open repair, kasus Kematian


Background : The aim of this study is to confirm the factors that affect the mortality following open elective abdominal aortic aneurysm repair. Subject and Methode : This study was a retrospective study. Qualitative and quantitave data were collected from interviewing the team in charge and from the hospital database medical record. The data were collected for five years, from 2013 until April 2018. Data will be displayed in descriptive. Result : Twentyseven cases were hospitalized during the periode of 2016 until April 2018. Ten cases were not availlable to analyze, medical record were missing. Out of two case from these fivteen cases, was an emergency case. Five cases were alive when they discharge from the hospital. The other eight were elective cases and were able to analyze. Five cases, out of this eight, were accompanied by anemia and thrombositopenia, which last until they all move from the surgery room to the ICU. Two cases with renal disfunction, and one case with unclear cause of death. Duration of surgery in all this elective cases, ranged from 4 hours 20 minutes until 8 hours 10 minutes. Bood loss during surgery, estimated from 750 cc to 7.000 cc. Preoperative creatinin level, ranged from 1,0 to 4,3 mg/dL. Postoperative cretainin level, ranged from 1,0 to 4,5 mg/dL. Postoperative hemoglobin level, ranged from 5,9 to 9,4 g/dL. Postoperative platelet count , ranged from 45.000 to 108.000/uL. Mean blood loss during surgery was 3.156 cc. Conclusion : This study concluded that most of the death case was accompanied by massive bleeding. And all those attempt to improve by blood rescusitation, was not promptly worked.
Keywords : abdominal aortic aneurysm, mortality case, elective open repair, perioperative analysis