Tesis

Hubungan Status Nutrisi Praoperatif terhadap Keluaran Pascalobektomi pada Pasien Tuberkulosis Paru = Association Between Preoperative Nutritional Status and Postoperative Outcome After Lobectomy in Lung Tuberculosis Patients.

Tuberkulosis (TB) masih menjadi masalah kesehatan di dunia, dengan angka kesembuhan setelah pemberian obat TB hanya sekitar 85%. Pada TB yang resisten atau berulang, pembedahan merupakan salah satu pilihan terapi. Dalam proses penyembuhan penyakit maupun pascaoperasi, status nutrisi berperan penting terhadap keluaran pengobatan. Akan tetapi, belum terdapat penelitian yang melaporkan hubungan status nutrisi terhadap keluaran pascalobektomi pada pasien TB paru di Indonesia. Penelitian ini merupakan studi kohort retrospektif yang melibatkan pasien tuberkulosis yang menjalani lobektomi di Rumah Sakit Umum Pusat (RSUP) Persahabatan pada tahun 2019-2023. Pasien yang menjalani lobektomi dicatat karakterisik usia, jenis kelamin, komorbid diabetes, status HIV, indeks massa tubuh, kadar albumin, hitung limfosit absolut, dan kejadian anemia mikrositik hipokrom. Seluruh subjek dilakukan pengamatan sampai selesai perawatan di rumah sakit kemudian dikelompokkan berdasarkan durasi penggunaan ventilator, penggunaan selang dada, perawatan di ICU, perawatan di rumah sakit, dan kematian dalam perawatan. Didapatkan 49 subjek penelitian dengan 32,7% subjek memiliki indeks massa tubuh kurus, 22,4% subjek memiliki anemia mikrositik hipokrom, 30,6% hipoalbuminemia praoperasi, dan 18,4% memiliki kadar limfosit absolut rendah. Angka kematian dalam perawatan pascalobektomi didapatkan sebanyak 14,3%. Selain itu, 71,4% pasien mengalami perpanjangan masa rawat inap, 44,9% memerlukan perawatan ICU yang lebih lama, 77,6% membutuhkan penggunaan selang dada lebih lama, dan 40,8% memiliki durasi penggunaan ventilator yang meningkat. Terdapat hubungan bermakna antara indeks massa tubuh yang rendah terhadap durasi rawat inap di rumah sakit yang memanjang pascalobektomi (p=0,011; RR 1,55, IK 95% 1,14-2,09; aRR 32,03, IK 95% 2,20-466,53). Terdapat hubungan bermakana antara indeks massa tubuh yang rendah terhadap durasi perawatan di rumah sakit pascalobektomi.
Kata Kunci: Tuberkulosis, status nutrisi praoperatif, keluaran pascalobektomi


Tuberculosis (TB) remains a global health concern, with a recovery rate of approximately 85% after TB medication. In cases of resistant or recurrent TB, surgical intervention becomes a viable alternative. The patient’s nutritional status is crucial in the recovery phase and post-operative outcomes. However, there is currently no research on the association between the nutritional status of patients with pulmonary TB and the rates of outcomes following a lobectomy in Indonesia. This is a retrospective cohort study involving tuberculosis patients who underwent lobectomy at Persahabatan General Hospital from 2019 to 2023. Patients who underwent lobectomy were recorded for characteristics such as age, gender, comorbid diabetes, HIV status, body mass index, albumin levels, absolute lymphocyte count, and the occurrence of hypochromic microcytic anemia. All participants were monitored throughout their hospitalization and subsequently categorized according to the length of time they required a ventilator, the use of a chest tube, their stay in the ICU and hospital, and instances of mortality during treatment. There were 49 study subjects, with 32.7% having a low body mass index, 22.4% having hypochromic microcytic anemia, 30.6% having preoperative hypoalbuminemia, and 18.4% having a low absolute lymphocyte count. The mortality rate after lobectomy procedures was recorded at 14.3%. Additionally, 71.4% of patients experienced an extended hospital stay, 44.9% required prolonged ICU care, 77.6% needed longer chest tube usage, and 40.8% had an increased duration of ventilator use. There was a significant association between low body mass index and an extended hospital stay after a lobectomy (p = 0.011; RR 1.55, 95% CI 1.14–2.09; aRR 32.03, 95% CI 2.20–466.53). There is a significant relationship between low body mass index and the length of hospital stay post-lobectomy.
Keywords: Tuberculosis, preoperative nutritional status, post-lobectomy outcome