Tesis

Perbandingan P-POSSUM dan ASA-PS dalam Memprediksi In-Hospital Mortality Pasien Pascalaparotomi Emergensi = Comparison of P-POSSUM and ASA-PS in Predicting InHospital Mortality of Patient Undergoing Emergency Laparotomy.

Latar Belakang: Angka mortalitas pasien yang menjalani laparotomi emergensi masih tergolong tinggi, berkisar antara 9-27% di seluruh dunia. Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) merupakan suatu sistem skoring yang memprediksi morbiditas dan mortalitas berdasarkan 12 parameter fisiologis dan 6 parameter pembedahan yang dijalani oleh pasien. Sementara American Society of Anesthesiologist’s Physical Status (ASA-PS), yang biasa dikenal dengan sebutan status ASA terdiri dari 6 tingkatan status, adalah sistem skoring prediksi risiko pembedahan yang pertama kali dikembangkan dan paling sering digunakan saat ini. P-POSSUM memiliki lebih banyak parameter dalam memprediksi mortalitas sehingga seharusnya model prediksi ini lebih baik dibandingkan ASA-PS. Penelitian ini bertujuan untuk menilai apakah kemampuan prediksi in-hospital mortality skoring P-POSSUM pada pasien yang menjalani laparotomi emergensi lebih baik dibanding skoring ASA-PS. Metode: Penelitian ini merupakan studi kohort retrospektif di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo selama bulan Mei hingga Juli 2018. Sebanyak 230 rekam medis diambil sesuai kriteria inklusi yaitu pasien dewasa yang menjalani laparotomi emergensi pada periode 1 Januari 2016 hingga 31 Desember 2017. Penilaian status ASA dicatat sesuai dengan data rekam medis dan dilakukan penilaian skor P-POSSUM untuk melihat angka prediksi mortalitas. Analisis data dilakukan dengan komparatif Area Under the Curve (AUC), Hosmer Lemeshow goodness of fit dan multivariat regresi logistik. Hasil: Angka in-hospital mortality pasien pascalaparotomi emergensi pada periode Januari 2016 hingga Desember 2017 adalah sebesar 21,3% (49 pasien). Hasil analisis statistik menunjukkan bahwa nilai kalibrasi ASA-PS lebih baik dibanding dengan P-POSSUM (p 0,072 vs 0,043). Nilai diskriminasi P-POSSUM lebih baik dibanding dengan ASA-PS (AUC 87,9% vs 76,2%). Komponen P-POSSUM yang paling berhubungan dengan in-hospital mortality adalah usia, riwayat gangguan napas, GCS, kadar hemoglobin, kadar natrium, kontaminasi intraperitoneal dan hasil EKG. Simpulan: Skor P-POSSUM lebih baik dibanding ASA-PS dalam memprediksi in-hospital mortality pasien pascalaparotomi emergensi.
Kata Kunci: P-POSSUM, ASA-PS, in-hospital mortality, laparotomi emergensi.


Background: Mortality rate of patient undergoing emergency laparotomy is high, 9-27% around the globe. Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) is a scoring system which predicts morbidity and mortality based on 12 physiologic and 6 operative parameter. Meanwhile, American Society of Anesthesiologist’s Physical Status (ASA-PS), common term used as ASA status which consists of 6 categories, is the first scoring system predicting risk preoperatively and mostly use to this date. It is important to evaluate and compare the ability of these two score in predicting mortality as we strive for a better tool to use in RSCM. Method: This study is a retrospective cohort that was taken place in RSCM within period May to July 2018. There was 230 medical records taken as samples in accordance with the inclusion criteria, which was adult patient who underwent emergency laparotomy within period 1 January 2016 to 31 December 2017. ASA physical status was recorded and P-POSSUM score was assessed corresponding to data in each medical records. Data were analyzed to compare Area Under the Curve (AUC), Hosmer Lemeshow goodness of fit and multivariate of logistic regression. Result: In-hospital mortality of patient undergoing emergency laparotomy within period January 2016 to December 2017 is 21.3% (49 patients). Whereas statistical analysis shows that calibration value of ASA-PS is better than P-POSSUM (p 0,072 vs 0,043). Discrimination value of P-POSSUM is better than ASA-PS (AUC 87,9% vs 76,2%). Parameters of P-POSSUM, which most related with in-hospital mortality, are age, respiratory disorder, GCS, hemoglobin level, sodium level, intraperitoneal contamination and ECG. Conclusion: P-POSSUM is better than ASA-PS in predicting in-hospital mortality of patient undergoing emergency laparotomy.
Keywords: P-POSSUM, ASA-PS, in-hospital mortality, emergency laparotomy.