Tesis

Model Prediksi Kebutuhan Tranfusi Packed Red Cell Perioperatif pada Operasi Tumor Tulang: Studi Retrospektif di Unit Pelayanan Bedah Terpadu Rumah Sakit Cipto Mangunkusumo = The prediction model for Red Blood Cell Tranfusion in Bone Tumor Surgery : a retrospective study in the surgical centre of Cipto Mangunkusumo Hospital.

Pendahuluan. Pembedahan tumor tulang merupakan salah satu pembedahan yang banyak dilakukan. Dua puluh persen dari operasi tumor tulang membutuhkan tranfusi darah intrabedah. 1 Tranfusi yang diberikan umumnya adalah tranfusi Packed Red Cell (PRC) dengan volume tranfusi rata-rata 1200 ml atau 4-6 unit. 1,2 Permintaan darah yang berlebih dan tidak digunakan dapat menimbulkan kerugian biaya. 21 Selama bulan januari-juli 2017, di RSCM terdapat 7972 kantung darah Packed Red Cells (PRC) dan Whole Blood terbuang menyebabkan kerugian senilai Rp 5,381,100,000. Tujuan penelitian ini adalah untuk membuat suatu model prediksi kebutuhan tranfusi PRC perioperatif pada operasi tumor tulang berdasarkan faktor-faktor letak tumor, ukuran tumor, karakteristik keganasan tumor, nilai Hb prabedah dan nilai ASA prabedah. Metode. Penelitian ini memiliki desain kohort retrospektif dan dilakukan pada pasien yang menjalani pembedahan tumor tulang pada tahun 2015 sampai 2017. Data diambil dari rekam medik. Analisis dilakukan secara bivariat dan multivariat. Hasil. Delapan puluh dua subjek masuk dalam penelitian. Analisis bivariat menunjukkan letak tumor, ukuran tumor, karakteristik keganasan tumor, nilai Hb prabedah dan nilai ASA prabedah memiliki hubungan bermakna terhadap kebutuhan tranfusi PRC perioperatif. Analisis multivariat regresi linier menunjukan hanya letak tumor dan nilai Hb prabedah yang merupakan prediktor bermakna. Model alternatif dari regresi logistik dan analisis tambahan dibuat untuk menentukan probabilitas diperlukannya tranfusi PRC perioperatif. Simpulan. Model prediksi untuk menghitung kebutuhan tranfusi PRC perioperatif pada operasi tumor tulang terdiri atas faktor letak tumor dan nilai Hb prabedah. Letak tumor, ukuran tumor, karakteristik keganasan tumor, nilai Hb prabedah dan nilai ASA prabedah memiliki hubungan bermakna terhadap kebutuhan tranfusi PRC perioperatif pada operasi tumor tulang.
Kata Kunci : Model prediksi tranfusi PRC; Operasi tumor tulang, Prediktor tranfusi perioperatif; Tranfusi PRC perioperatif


Introduction. Bone tumor surgery is considered as one of the most frequently conducted surgery. Twenty percent of bone tumor surgery requires intraoperative blood tranfusion, mostly Packed Red Cell (PRC). Approximately 1200ml or 4-6 unit of PRC transfusion is given in a bone tumor surgery. Less accurate estimation of the need of transfusion caused excessively wasted blood requests and led to high expense loss. In January-July 2017 there were 7972 wasted bags of Packed Red Cells (PRC) and Whole Blood, resulting in a loss of Rp. 5,381,100,000 in Cipto Mangunkusumo Hospital. This study aimed to develop a prediction model for the need of perioperative red blood cell transfusion in bone tumor surgery based tumor location, size, malignancy, preoperative hemoglobin level and preoperative ASA physical status. Methods. This is a retrospective cohort of patients underwent bone tumor surgery between 2015 to 2017. Data was retrieved from the medical records. Bivariate correlation and multivariate regression were conducted in the analysis. Results. Eighty two subjects were included. The bivariate analysis showed that tumor location, size, malignancy, preoperative hemoglobin level and ASA physical status were significantly correlated with perioperative needs of red blood cell transfusion. However, the linear regression showed that only tumor location and preoperative hemoglobin level were considered as significant predictors. Therefore we obtained an alternative model from logistic regression to determine the probability of the need for perioperative PRC transfusion and add additional factors in the analysis. Conclusion. The prediction model for red blood cell tranfusion in bone tumor surgery included tumor location and preoperative hemoglobin level as predictors. Tumor location, tumor size, malignancy, preoperative hemoglobin level and preoperative ASA physical status are significantly correlated with perioperative red blood cell transfusion in bone tumor surgery.
Keywords : prediction model for red blood bell tranfusion; bone tumor surgery; perioperative tranfusion predictors; red blood cell tranfusion perioperative