Tesis

Hubungan Antara Indeks Trigliserida Glukosa Pra Operasi Terhadap Komplikasi Pasca Operasi Pembedahan Abdomen Mayor = Relationship Between Preoperative Triglyceride Glucose Index and Postoperative Complications of Major Abdominal Surgery.

Latar Belakang: Komplikasi pascaoperasi pembedahan abdomen mayor merupakan salah satu masalah klinis yang sering terjadi dan dapat meningkatkan morbiditas dan mortalitas pasien. Resistensi insulin praoperasi merupakan salah satu faktor utama yang memengaruhi kejadian komplikasi. Indeks Trigliserida-Glukosa (TyG) merupakan salah satu marker sederhana dan terjangkau untuk menilai resistensi insulin. Hingga saat ini belum banyak penelitian yang mengevaluasi hubungan antara indeks TyG praoperasi dengan komplikasi pascaoperasi pembedahan abdomen mayor. Metode: Studi kohort prospektif ini melibatkan pasien dewasa yang akan menjalani pembedahan abdomen mayor elektif di RS pendidikan tersier, RSCM. Dilakukan pengukuran kadar trigliserida dan glukosa darah untuk menentukan indeks TyG yang dihitung dengan formula logaritmik Ln[trigliserida (mg/dL) x glukosa darah (mg/dL)]/2. Kadar trigliserida dan glukosa darah diambil pada hari pasien akan menjalani operasi setelah pasien menjalani puasa minimal 3 jam per-oral maupun perparenteral. Komplikasi pasca operasi dipantau selama 30 hari yang diklasifikasikan berdasarkan grading Clavien-Dindo. Ada komplikasi pascaoperasi didefinisikan bila pasien termasuk dalam grading Clavien-Dindo derajat II-V. Analisis bivariat digunakan untuk menilai hubungan antara indeks TyG praoperasi dan komplikasi pascaoperasi. Hasil:Dari total 92 subjek penelitian, didapatkan nilai tengah indeks TyG 4,69 ±0,30. Sebanyak 47,8% subjek mengalami komplikasi pasca operasi dengan derajat komplikasi terbanyak adalah derajat III (17,4%) dan jenis komplikasi tersering adalah infeksi daerah operasi (26%). Analisis bivariat menunjukkan adanya hubungan antara indeks TyG praoperasi dengan komplikasi pascaoperasi pasien pembedahan abdomen mayor. (RR=1,588, p=0,037, CI=1,014-2,487). Kesimpulan: Pasien pembedahan abdomen mayor dengan indeks TyG praoperasi tinggi memiliki peningkatan risiko 1,58 kali lebih tinggi dibandingkan dengan populasi dengan indeks TyG normal terhadap terjadinya komplikasi pascaoperasi. Identifikasi dini menggunakan indeks TyG dapat membantu klinis dalam menerapkan pencegahan untuk meningkatkan hasil klinis dan mengurangi beban komplikasi pascaoperasi.
Kata Kunci: Indeks Trigliserida Glukosa, resistensi insulin, komplikasi pasca operasi, Clavien Dindo, pembedahan abdomen mayor


Background: Postoperative complications following major abdominal surgery remain a significant challenge in perioperative management, directly impacting patient morbidity and mortality. One of the key factors influencing these complications is insulin resistance, which is often exacerbated by surgical stress. The Triglyceride-Glucose (TyG) index is a simple, cost-effective, and accessible marker for assessing insulin resistance. However, there is limited evidence evaluating the relationship between preoperative TyG index levels and the incidence of postoperative complications in major abdominal surgery. Methods: This prospective cohort study included 92 adult patients undergoing elective major abdominal surgery at Dr. Cipto Mangunkusumo National General Hospital, a tertiary teaching hospital. Triglyceride and blood glucose levels were mearsured to calculate the TyG Index using the formula Ln[trigliserida (mg/dL) x glukosa darah (mg/dL)]/2. Blood triglyceride and glucose levels were taken on the day of surgery after the patient has undergone a minimum of 3 hours of fasting, either orally or parenterally. Patients were monitored for postoperative complications within 30 days, classified according to the Clavien-Dindo grading system. Postoperative complications were defined as patients included in Clavien-Dindo grading II-V. Bivariate analysis was used to evaluate the relationship between preoperative TyG Index levels and postoperative complications. Results: The mean TyG index in this study was 4.69 ± 0.30. Postoperatvie complications occurred in 47,8% of patients, with the most frequent severity was grade III complications (17.4%), while surgical site infections were the most common type (26%). Bivariate analysis showed a relationship between preoperative TyG index and postoperative complications of major abdominal surgery patients. (RR = 1.588; p = 0.037; 95% CI: 1.014–2.487). Conclusion: The preoperative TyG index is an effective predictive marker for postoperative complications in patients undergoing major abdominal surgery. Patients with high TyG index levels are at increased risk of complications. Early identification using the TyG index could assisst clinicians in implementing preventive interventions to improve clinical outcomes and reduce the burden of postoperative complications.
Keywords: Triglyceride-Glucose Index, insulin resistance, postoperative complications, major abdominal surgery, Clavien-Dindo