Tesis

Perbandingan Luaran Paska Operasi dan Faktor Pemilihan Operasi Bedah Terbuka dan Ablasi pada pasien Chronic Venous Insufficiency = Comparison of Postoperative Outcomes and Selection Factors for Open Surgery and Ablation in Patients with Chronic Venous Insufficiency.

Latar Belakang: Chronic Venous Insufficiency (CVI) adalah gangguan vena berupa gangguan aliran balik darah dari tungkai bawah ke jantung yang bersifat menahun. Tatalaksana invasif dilakukan terutama pada pasien simtomatik dan klasifikasi C2 ke atas pada CEAP baik dengan tindakan bedah berupa stripping, ligase, dan/atau flebektomi dan tindakan ablasi. Semua pasien CVI yang akan dilakukan prosedur tindakan endovaskular harus diases salah satu sistem penilaian derajat keparahan dengan berbagai skoring seperti VAS dan VCSS. Penelitian ini dibuat untuk mengetahui perbandingan luaran paska operasi dan faktor pemilihan operasi bedah terbuka dan ablasi pada pasien CVI. Metode: Penelitian kohort retrospektif menggunakan rekam medis di RS Cipto Mangunkusumo dan RS jejaring. Jumlah sampel sebanyak 30 subjek dengan operasi bedah terbuka dan 33 subjek dengan tindakan ablasi. Analisis statistik menggunakan SPSS versi 25, nilai p < 0.05 menunjukkan kemaknaan secara statistik. Hasil: Sebanyak 63 subjek penelitian dengan CVI, didapatkan subjek yang menjalani bedah terbuka sebanyak 30 subjek (47,6%) dan ablasi 33 subjek (52,4%) dengan faktor yang mempengaruhi pemilihan tindakan operator yang bermakna yaitu diameter GSV pada regio proksimal femur, mid femur, distal femur, proksimal kruris, dan mid kruris (p=0,000); dan jenis pembiayaan (p=0,049). Outcome pada tindakan bedah terbuka dan ablasi memiliki skor VAS post tindakan (p=0,01) dan selisih skor VCSS pre dan post tindakan (p=0,046) yang berbeda bermakna di mana lebih baik pada tindakan ablasi. Sedangkan outcome waktu pemulihan hingga beraktivitas dan bekerja pada tindakan bedah terbuka dan ablasi tidak berbeda bermakna (p > 0,05). Kesimpulan: Usia, riwayat komorbid hipertensi, jenis pembiayaan, klinis (C) dalam CEAP dan faktor anatomi diameter GSV mempengaruhi faktor pemilihan operator terhadap tindakan bedah terbuka dan ablasi pada pasien CVI. Outcome skor VAS post tindakan, dan selisih skor VCSS pre dan post tindakan berbeda bermakna di mana hasilnya lebih baik pada tindakan ablasi.
Kata kunci: Chronic venous insufficiency, bedah terbuka, ablasi, great saphenous vein, visual analog scale, Venous Clinical Severity Score



Background: Chronic Venous Insufficiency (CVI) is a venous disorder in the form of a chronic disturbance of the return blood flow from the lower limbs to the heart. Invasive treatment is carried out mainly in symptomatic patients and those classified as C2 and above on CEAP, either by surgery in the form of stripping, ligation, and/or phlebectomy and ablation. All CVI patients who will be undergoing endovascular procedures should be assessed by one of the severity assessment systems with various scoring such as VAS and VCSS. This study was made to compare postoperative outcomes and factors for choosing between open surgery and ablation in CVI patients. Method: Retrospective cohort study using medical records at Cipto Mangunkusumo Hospital and Network Hospital. The number of samples were 30 subjects who underwent open surgery and 33 subjects who underwent ablation. Statistical analysis using SPSS version 25, p < 0.05 showed statistical significance. Results: A total of 63 subjects with CVI, found that 30 subjects (47.6%) underwent open surgery and 33 subjects (52.4%) ablation with a significant relationship of selection factor by the surgeons i.e the diameter of the GSV in the proximal femur region, mid femur, distal femur, proximal cruris, and mid cruris (p=0.000); and type of financing or health insurance (p=0.049). The outcome of open surgery and ablation had a significant difference of postoperative VAS score (p=0.01) and a significant difference between the pre and postoperative VCSS scores (p=0.046) where the ablation procedure was better. Meanwhile, the outcome from recovery time to activities and to work in open surgery and ablation was not significantly different (p > 0.05). Conclusion: Age, hypertension, type of health financing or insurance, clinical (C) in CEAP and GSV diameter influence operator selection for open surgery and ablation in CVI patients. The outcome of the postoperative VAS score, and the differences in the pre and postoperative VCSS scores were significantly different where the results were better in the ablation procedure.
Keywords: Chronic venous insufficiency, open surgery, ablation, great saphenous vein, visual analog scale, Venous Clinical Severity Score