Model Prediksi Kejadian Pneumonia 30 Hari Pasca Bedah Abdomen pada Pasien Usia Lanjut

Noto Dwimartutie, Harini Oktadiana, Gurmeet Singh, Wifanto Saditya Jeo, Kuntjoro Harimurti

Abstract

Pendahuluan. Perubahan fisiologis sistem pernapasan pada usia lanjut meningkatkan risiko kejadian pneumonia pasca bedah. Pneumonia pasca bedah non-toraks ditemukan paling tinggi pada bedah abdomen. Tujuan penelitian ini adalah mendapatkan model prediksi pneumonia 30 hari pasca bedah abdomen pada pasien usia lanjut.
Metode. Penelitian dengan desain kohort retrospektif dilakukan dengan menggunakan rekam medis pasien usia lanjut yang menjalani bedah abdomen di Rumah Sakit Cipto Mangunkusumo. Analisis multivariat dengan regresi logistik digunakan untuk mendapatkan nilai odds ratio (OR). Performa kalibrasi dinilai dengan uji Hosmer-Lemeshow. Performa diskriminasi dinilai dengan menghitung area under the curve (AUC).
Hasil. Dari 753 subjek yang dilakukan bedah abdomen, sebanyak 9,2% subjek mengalami pneumonia 30 hari pasca bedah. Prediktor independen kejadian pneumonia adalah status fungsional [skor ADL Barthel 0-11, OR 6,908 (interval kepercayaan (IK) 95% 2,933-16,273); skor ADL Barthel 12-19, OR 3,191 (IK 95% 1,53-6,657)], bedah abdomen atas [OR 4,869 (IK 95% 1,805-13,132)], penyakit paru obstruktif kronik/PPOK [OR 6,888 (IK 95% 2,001-23,709)], dan albumin <3 g/dl [OR 2,54 (IK 95% 1,404-4,596)]. Model prediksi pneumonia terbagi menjadi risiko rendah (skor <2; probabilitas 3,4%), risiko sedang (skor 2-3; probabilitas 19,97%), dan risiko tinggi (skor >3; probabilitas 60,42%). Uji Hosmer–Lameshow mendapatkan nilai p=0,452 dan AUC 0,811 (IK 95% 0,75-0,86).
Simpulan. Model prediksi pneumonia 30 hari pasca bedah abdomen pada pasien usia lanjut dengan 4 prediktor yaitu status fungsional, bedah abdomen atas, PPOK, dan kadar albumin <3 g/dl memiliki performa yang baik.
Kata Kunci: Bedah abdomen, model prediksi, pneumonia pasca bedah, usia lanjut

Prediction Model of 30-Days Postoperative Pneumonia in Elderly Patient Undergoing Abdominal Surgery

Introduction. Physiologic changes in respiratory tract in elderly increase incidence of post-operative pneumonia. Post-operative pneumonia in non-thoracic surgery was found higher in abdominal surgery. This study aimed to develop a prediction model of 30-day post-operative pneumonia in elderly patients undergoing abdominal surgery.
Methods. A retrospective cohort study was conducted using elderly patient’s medical records who underwent abdominal surgery in Cipto Mangunkusumo General Hospital. Multivariate analysis using logistic regression was used to determine Odds Ratio (OR). Model’s calibration performance was determined by Hosmer-Lameshow test and its discrimination performance was determined by calculating area under the curve (AUC).
Results. Of 753 subject who underwent abdominal surgery, postoperative pneumonia was found in 9.2% subjects. Independent predictors for 30-day postoperative pneumonia were functional status [ADL Barthel 0-11, odds ratio (OR) 6.908 (95% confidence interval (CI) 2.933-16.273); ADL Barthel 12-19, OR 3.191 (95%CI 1.53-6.657)], upper abdominal surgery [OR 4.869 (95%CI 1.805-13.132)], chronic obstructive pulmonary disease [OR 6.888 (95%CI 2.001-23.709)], and albumin level <3 g/dl [OR 2.54 (95%CI 1.404-4.596)]. Prediction model of pneumonia was stratified into lower risk (score <2; probability 3.4%), moderate risk (score 2-3; probability 19.97%), and high risk (score >3; probabililty 60.42%). Hosmer-Lemeshow test revealed p-value 0.452 and the AUC value is 0.811 (95%CI 0.87-0.97).
Conclusion. A simple prediction model of 30-day post-operative pneumonia for elderly patients undergoing abdominal surgery consisted of 4 predictors (functional status, upper abdominal surgery, COPD and albumin level <3 g/dl) has a good performance.


Keywords

Abdominal surgery, elderly, postoperative pneumonia, prediction model

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