Tesis

Kadar Hematokrit Praoperasi Sebagai Faktor Risiko Morbiditas dan Mortalitas Dini Pascaoperasi Total Koreksi Tetralogi Fallot pada Pasien Dewasa = Preoperative Hematocrit levels as Risk Factor for Postoperative Morbidity and Early Mortality of Total Correction Surgery in Adult Tetralogy of Fallot Patients.

Latar belakang: Diperkirakan hanya 10% pasien tetralogi Fallot yang dapat mencapai usia dewasa. Operasi total koreksi tetralogi Fallot di Indonesia seringkali terlambat dilakukan sehingga pasien sudah menderita hipoksia jaringan yang berkepanjangan. Eritrositosis sekunder dengan peningkatan hematokrit merupakan mekanisme kompensasi dari hipoksia jaringan. Penelitian ini bertujuan untuk mengetahui hubungan kadar hematokrit dengan keluaran pascaoperasi tetralogi Fallot dewasa. Metode: Penelitian ini merupakan studi kohort retrospektif berdasarkan data sekunder dari bagian rekam medis RSPJNHK Indonesia pada subjek dewasa yang telah menjalani operasi total koreksi tetralogi Fallot pada periode 2015-2022. Variabel yang dinilai adalah kadar hematokrit sebagai faktor risiko terhadap terjadinya mortalitas dini, waktu rawat ICU memanjang, penggunaan ventilator mekanik berkepanjangan, sindrom curah jantung rendah, dan perdarahan. Analisis bivariat menggunakan uji Chi-square untuk variabel nominal dan uji t independen untuk variabel numerik. Uji diagnostik menggunakan kurva receiver operating characteristic (ROC) dilakukan untuk mendapatkan nilai area under the curve (AUC). Hasil: Terdapat 74 subjek yang dilibatkan pada penelitian ini. Median usia subjek pada studi ini 21 (18-43) tahun dengan rerata kadar hematokrit praoperasi 55,7±10,3%. Terdapat hubungan yang bermakna antara kadar hematokrit dengan insiden waktu rawat ICU memanjang (p=0,018), penggunaan ventilator mekanik berkepanjangan (p=0,011), dan sindrom curah jantung rendah (p < 0,001). Tidak ada hubungan yang bermakna antara kadar hematokrit terhadap mortalitas dini dan perdarahan. AUC dari kadar hematokrit untuk pengguanaan ventilator mekanik berkepanjangan dan sindrom curah jantung rendah adalah 72,1% (IK 95%: 58%-86,1%) dan 72,4% (IK 95%: 61%-83,8%). Pada analisis multivariat, kadar hematokrit memiliki korelasi yang bermakna terhadap sindrom curah jantung rendah (p=0,042, OR 1,067 (1,002-1,136). Simpulan: Terdapat hubungan yang signifikan antara kadar hematokrit terhadap waktu rawat ICU memanjang, penggunaan ventilator mekanik berkepanjangan, dan sindrom curah jantung rendah. Nilai titik batas kadar hematokrit dapat digunakan untuk memprediksi terjadinya morbiditas pascaoperasi.
Kata Kunci: Tetralogi Fallot, hematokrit, hipoksia kronik, total koreksi, dewasa


Background: It is estimated that only 10% of tetralogy of Fallot patients reach adulthood. Total correction surgery in Indonesia is often carried out too late so that the patients suffer from prolonged tissue hypoxia. Secondary erythrocytosis with increased hematocrit is a compensatory mechanism for tissue hypoxia. This study aims to determine the relationship between hematocrit levels and postoperative outcome of total correction surgery in tetralogy of Fallot. Methods: This study is a retrospective cohort study based on secondary data from the medical records section ofHarapan Kita National Cardiovascular Center Hospital in adult patients who had underwent total correction surgery in tetralogy of Fallot in the 2015- 2022 period. The variables assessed were hematocrit levels as a risk factor for early mortality, prolonged ICU stay, prolonged use of mechanical ventilator, low cardiac output syndrome, and bleeding. Bivariate analysis uses the Chi-square test for nominal variables and the independent t test for numerical variables. Diagnostic test using the receiver operating characteristic (ROC) curve was also done to obtain the area under the curve (AUC) value. Result: There were 74 subjects involved in this research. The median age of subjects in this study was 21 (18-43) years with a mean preoperative hematocrit level of 55.7 ± 10.3%. There was a significant relationship between hematocrit levels and the incidence of prolonged ICU stay (p=0.018), prolonged use of a mechanical ventilator (p=0.011), and low cardiac output syndrome (p < 0.001). There was no significant relationship between hematocrit levels between early mortality and bleeding. The AUC of hematocrit levels for prolonged mechanical ventilator use and low cardiac output syndrome was 72.1% (95% CI: 58%-86.1%) and 72.4% (95% CI: 61%-83.8%). In multivariate analysis, hematocrit levels had a significant correlation with low cardiac output syndrome (p=0.042, OR 1.067 (1.002-1.136). Conclusion: There is significant relationship between hematocrit levels and prolonged ICU stay, prolonged use of a mechanical ventilator, and low cardiac output syndrome. The cut-off value of hematocrit levels can be used to predict the occurrence of postoperative morbidity.
Key Words: Tetralogy of Fallot, hematocrit, chronic hypoxia, total correction surgery, adult