Tesis

Insidensi Komplikasi Kardiopulmoner Intra- dan Pascatindakan Endoskopi pada Pasien Usia Lanjut dan Faktor-faktor yang Memengaruhi = The Incidence of Intra- dan Postendoscopy Cardiopulmonary Complications in Elderly Patients and Its Affecting Factors.

Latar belakang: Tingginya insidensi penyakit saluran cerna, bilier, dan pankreas pada pasien usia lanjut membuat kebutuhan endoskopi tinggi. Komplikasi kardiopulmoner intra- dan pascatindakan endoskopi pada pasien usia lanjut lebih tinggi dari kelompok usia lebih muda. Penilaian faktor-faktor risiko komplikasi penting untuk menimbang risiko dan manfaat endoskopi pada pasien usia lanjut. Tujuan: Mengetahui insidensi dan faktor-faktor yang memengaruhi komplikasi kardiopulmoner intra- dan pascatindakan endoskopi pada pasien usia lanjut. Metode: Studi kohort prospektif dilakukan terhadap subjek berusia ≥60 tahun yang menjalani endoskopi di PESC RSUPN-CM sejak Agustus-Oktober 2023. Dilakukan analisis bivariat antara usia, komorbiditas, kelas ASA, status nutrisi, status fungsional, durasi tindakan, jenis sedasi, jenis tindakan, dan tingkat kompleksitas tindakan terhadap komplikasi kardiopulmoner intra- dan pascatindakan endoskopi. Selanjutnya, analisis multivariat dilakukan untuk mengetahui faktor risiko independen. Hasil: Dari 194 subjek, sebanyak 49,52% subjek mengalami komplikasi kardiopulmoner. Komplikasi tersering adalah takikardia (23,20%), hipoksemia (15,03%), dan hipotensi (6,20%). Hasil analisis multivariat menemukan faktor yang memengaruhi komplikasi kardiopulmoner intra- dan pascatindakan endoskopi ialah anestesi umum (RR 1,636 [IK 95% 1,260 – 2,124]) dan sedasi sedang (RR 0,654 [IK 95% 0,450 – 0,951]). Kesimpulan: Insidensi komplikasi kardiopulmoner intra- dan pascatindakan endoskopi pada pasien usia lanjut adalah 49,52%. Anestesi umum menjadi faktor independen, sedangkan sedasi sedang menurunkan risiko komplikasi kardiopulmoner intra- dan pascatindakan endoskopi. Sementara itu, usia lanjut, komorbiditas banyak, kelas ASA buruk, durasi tindakan lama, status nutrisi buruk, status fungsional buruk, jenis tindakan, dan tingkat kompleksitas tindakan tinggi tidak berpengaruh.
Kata kunci: endoskopi, kardiopulmoner, komplikasi, usia lanjut


Latar belakang: High incidence of gastrointestinal, biliary, and pancreatic diseases in elderly population prompts high need of endoscopy. Intra- and post-endoscopy cardiopulmonary complications were higher in elderly population compared to younger population. Evaluation of affecting factors is essential to consider endoscopy risk and benefit in elderly population. Tujuan: Identifying incidence and affecting factor of intra- and post-endoscopy cardiopulmonary complications in elderly population. Metode: This prospective cohort study was conducted in subjects aged ≥60 years who underwent endoscopy in PESC RSUPN-CM from August-October 2023. Bivariate analysis between age, comorbidity, ASA class, nutritional status, functional status, duration of procedure, type of sedation, type of procedure, and complexity of procedure towards intra- and post-endoscopy cardiopulmonary complications was performed. Then, multivariate analysis was done to identify independent risk factors. Hasil: Among 194 subjects, 49.52% experienced cardiopulmonary complications. The most common complications included tachycardia (23.20%), hypoxemia (15.03%), and hypotension (6.20%). Multivariate analysis revealed that general anesthesia (RR 1.636 [95% CI 1.260 – 2.124]) and moderate sedation (RR 0.654 [95% CI 0.450 – 0.951]) were significantly related to intra- and post-endoscopy cardiopulmonary complications. Kesimpulan: The incidence of intra- and post-endoscopy cardiopulmonary complications was 49.52%. General anesthesia was an independent factor, whereas moderate sedation showed a reduced risk of intra- and post-endoscopy cardiopulmonary complications. On the contrary, older age, multicomorbidities, high ASA class, longer duration of procedure, poor nutritional status, poor functional status, type of procedure, and higher complexity of procedure did not show any impacts.
Keywords: endoscopy, cardiopulmonary, complications, elderly