Tesis

Hubungan Asupan Protein Pra-Operasi dengan Perubahan Kapasitas Fungsional pada Pasien Pasca Laparotomi Elektif = Association between Preoperative Protein Intake and PostElective Laparotomy Functional Capacity Changes.

Latar Belakang: Prosedur pembedahan dapat memicu perubahan aktivitas metabolisme yang ditandai dengan respon inflamasi, serta terjadinya peningkatan proses katabolisme protein yang dapat mengakibatkan penurunan kapasitas fungsional. Asupan protein selama periode pra laparotomi elektif merupakan hal yang dapat membantu mencegah penurunan kapasitas fungsional. Berbagai studi sebelumnya menunjukkan adanya hubungan antara asupan protein terhadap luaran klinis pasca laparotomi elektif, namun hasil penelitian ini menunjukkan hasil yang tidak konsisten. Penilaian kapasitas fungsional melalui pengukuran kekuatan genggam, disebut memiliki hubungan dengan luaran klinis pasca laparotomi elektif. Belum ada penelitian yang menilai hubungan asupan protein pra-operasi dengan perubahan kapasitas fungsional pada pasien pasca laparotomi elektif di RSCM. Metode: Studi potong lintang dilakukan pada 85 pasien pasca laparotomi elektif di RSUPN Dr. Cipto Mangunkusumo, Jakarta. Dilakukan pengambilan data berupa pengukuran kekuatan genggam pada hari ke-6 pasca laparotomi elektif. Data-data pra-operasi lain didapatkan melalui rekam medis pasien seperti data demografis, etiologi pembedahan, analisis asupan, dan komposisi tubuh. Analisis bivariat untuk menilai korelasi dilakukan dengan uji Pearson pada data berdistribusi normal dan uji Rank Spearman pada data tidak berdistribusi normal. Hasil: Didapatkan sebanyak 85 subjek dengan mayoritas perempuan. Etiologi pembedahan mayoritas berupa keganasan. Berdasarkan status gizi, sebagian besar subjek memiliki status gizi normal, diikuti dengan obesitas derajat I, dan berat badan lebih. Prosedur ERAS tidak dilakukan pada mayoritas subjek. Sebanyak 36,5% subjek memiliki nilai FFMI yang rendah. Rerata total asupan energi praoperasi subjek penelitian sebesar 26 kkal/kg BB, rerata total asupan protein praoperasi sebesar 50,8 g, dengan total asupan protein per kg BB berkisar 0,5–1,8 g/kgBB. Rerata perubahan kekuatan genggam pra dan pasca laparotomi elektif tangan kanan sebesar 1,1 kg dan tangan kiri sebesar 0,8 kg. Ditemukan korelasi positif lemah antara asupan protein pra operasi dengan perubahan kekuatan genggam kanan (r = 0,18, p = 0,099) dan perubahan kekuatan genggam kiri (r = 0,166, p =0,129). Uji analisis multivariat dengan regresi linear berganda didapatkan bahwa FFMI pra-operasi merupakan faktor yang paling memengaruhi perubahan kekuatan genggam kanan (p = 0,042). Kesimpulan: Tidak didapatkan korelasi signifikan antara asupan protein pra operasi dengan perubahan kekuatan genggam tangan kanan dan kiri
Kata kunci : protein, kapasitas fungsional, kekuatan genggam tangan, pasca laparotomi elektif


Background: Surgical procedures trigger metabolic changes involving inflammatory, hormonal, and immunological responses. Increased protein breakdown can lead to reduced functional capacity. Preoperative protein intake has been suggested as a preventive measure against functional decline. However, research on the relationship between preoperative protein intake and postoperative outcomes has shown conflicting results. Grip strength measurement is a potential surrogate marker for postoperative outcomes, but its association with preoperative protein intake remains unexplored in elective laparotomy patients at RSCM. Methods: We conducted a cross-sectional study on 85 patients who underwent elective laparotomy at RSUPN Dr. Cipto Mangunkusumo, Jakarta. Grip strength was measured on the 6th day postoperatively, and preoperative data on demographics, surgical etiology, intake analysis, and body composition were collected from medical records. Bivariate analysis was performed to assess correlations using Pearson's test for normally distributed data and Spearman's rank correlation test for non-normally distributed data. Results: The majority of the 85 subjects were female, with malignancy being the primary surgical cause. Most subjects had normal nutritional status and did not follow Enhanced Recovery After Surgery (ERAS) protocols. The mean preoperative energy intake was 1374 kcal (26 kcal/kg body weight), and mean preoperative protein intake was 50.8 g. Weak positive correlations were found between preoperative protein intake and changes in grip strength for the right (r = 0.18, p = 0.099) and left (r = 0.166, p = 0.129) hands. Multivariate analysis showed that preoperative Fat-Free Mass Index (FFMI) had the most significant impact on changes in grip strength for the right hand (p = 0.042). Conclusion: There was no significant correlation between preoperative protein intake and changes in grip strength for the right and left hands in patients following elective laparotomy.
Keywords : protein, functional capacity, handgrip, post surgical