Status gizi pasien bedah mayor preoperasi berpengaruh terhadap penyembuhan luka dan lama rawat inap pascaoperasi di RSUP Dr Sardjito Yogyakarta

Susetyowati Susetyowati; Maya Ija; Akhmad Makhmudi

doi:10.22146/ijcn.17608

Status gizi pasien bedah mayor preoperasi berpengaruh terhadap penyembuhan luka dan lama rawat inap pascaoperasi di RSUP Dr Sardjito Yogyakarta

https://doi.org/10.22146/ijcn.17608

Susetyowati Susetyowati^(1*), Maya Ija⁽²⁾, Akhmad Makhmudi⁽³⁾

(1) Program Studi Gizi dan Kesehatan Universitas Gadjah Mada
(2) Rumah Sakit Dr. Mohammad Hoesin Palembang
(3) Bagian Anak RSUP Dr. Sardjito Yogyakarta
(*) Corresponding Author

Abstract

Background: Severe malnutrition affects morbidity due to disrupted wound healing and decreased endurance against infection. There are some factors that cause malnutrition in surgical patients. Two major factors are lack of food intake and process of inflammation that cause increase of catabolism and decrease of anabolism. The condition can be identified from the decrease of albumin serum and muscle hypothrophy.

Objective: The study aimed to identify impact of nutrition status of preoperative major surgical patients based on Nutritional Risk Index (NRI) indicator to wound healing and post operative length of stay.

Method: The study was observational with prospective cohort study design. Nutrition screening was undertaken to the group that met inclusion criteria at the preliminary process of hospitalization using NRI indicator to identify nutrition status of surgical patients. Next, the group was split into two, one with undernourished nutrition status and the other with good nutrition status. Assessment of nutrition status of patients was based on NRI obtained from level of serum albumin and current and usual weight ratio within the last 6 months. Weight assessment was made during early hospitalization or weight within the last 6 months.

Result: The result of the study showed there was signifiant association between nutrition status and wound healing and post operative length of stay (p<0.05). The result of logistic regression test showed there was impact of nutrition status to wound healing and post operation length of stay. Patients with undernourished nutrition status based on NRI contributed 4.8 times greater for the prevalence of poor wound healing than those with good nutrition status (95%CI: 1.179-19.880). Patients with undernourished nutrition status based on NRI contributed 5.5 times greater for extended length of stay > 7 days than those with good nutrition status (95% CI:4.701-50.914).

Conclusion: There was impact of nutrition status of preoperative major surgical patients based on NRI indicator to wound healing and post operative length of stay.

Keywords

nutrition status; nutritional risk index; wound healing; length of stay; surgical patients

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References

Sjamsuhidajat R, Jong WD. Buku Ajar Ilmu Bedah Edisi2. Jakarta: Penerbit Buku Kedokteran EGC 2005.

Hill GL. Disorders Of Nutrition And Metabolism In Clinical Surgery : Understanding and Management. Darmawan, I.(2000) (Alih Bahasa). Jakarta: Farmedia; 2000

Gibson RS. Principles of Nutritional Assessment Second Edition. New York: Oxford University Press; 2005.

Kyle UG, Pirlich M, Schuetz T, Lochs H, Pichard C. Is Nutritional Depletion by Nutritional Risk Index Associated with Increased Length of Hospital Stay? A Population Based Study. Journal of Parental and Enteral Nutrition 2004; 28 (2): 99-104.

Sungortelein H, Sungortelein U, Balci C, Zenci M, Eroem E. The Inflence of Nutritional Status on Complication After Major Intra Abdominal Souberg. Journal of the American of Nutrition 2004; 23 (3): 227.32.

Livianna SR, Wahyuningrum. Gambaran Perubahan Berat Badan Pasien Bedah Pra dan Pasca Bedah di Irna A RSUP-CM. Prosiding Temu Ilmiah Kongres XIII PERSAGI. Jakarta; 2005.

Maryanto A.Pengaruh kadar Albumin Serum terhadap lamanya Penyembuhan Luka Operasi [Tesis]. Yogyakarta; Universitas Gadjah Mada; 2004.

Lemeshow, S., Hosmer Jr, D.W., Klar, J., & Lwanga S.K. (1990). Adequasi of Sample size in health studies. Pramono, D. (1997) (Alih Bahasa), Gadjah Mada University Press, Yogyakarta, pp. 27-30.

Wardana GI. Pengaruh Status Gizi Prabedah terhadap Penyembuhan Luka Operasi Prostatektomi Terbuka Irisan Transversal dan Irisan Longitudinal pada Penderita Pembesaran Prostat Jinak. Laporan Penelitian. Tidak dipublikasikan. Yogyakarta: Universitas Gadjah Mada; 1999.

Guinningberg L, Persson C, Akerfeldt T, Stridsberg M, Swenne CL. Pre and Postoperative Nutritional Status and Predictors for Surgical-Wound Infections in Elective Orthopaedic and Thoracic Patients. Eur J Clin Nutr 2008; 3: 93-101.

Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist A, Soeters P. (ESPEN Guidelines on Enteral Nutrition: Surgery Including Organ Transplantation. Clin Nutr 2006; 25: 224-44.

Huddleston JM, Withford KJ. Medical Care of Elderly Patients with Hip Fractures. Mayo Clin Proc 2001; 76: 295-8.

Wysznski DF, Crivelli A. Ezquerro S. Assesment of Nutritional Status in a Population of Recently Hospitalized Patient, Medicina (Buenos Aires) 1997; 58: 51-7.

Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr 2003; 22(4): 415-21

Veterans Affairs Total Paranteral Nutrituon Cooperative Study Group. Perioperative Total Paranteral Nutrition in Surgical Patiens. New England journal of Medicine 1991; 325: 525-32

Susetyowati. Penatalaksanaan gizi pada pasien bedah digestif. Naskah presentasi dalam Pertemuan Ilmiah Nasional ASDI. Semarang; 2007.

Rusmanti S, Asdie H, Budiningsari RD. Peran Status Albumin Perioperatif Sebagai Prediktor Lama Rawat Inap pasca Operasi Ortopedi di Rumah Sakit Islam Kustati Surakarta. Sains Kesehatan,2006; 19(2):167-81.

Chima CS, Barco K, Dewitt M. LA Maeda M, Teran JC, Mullen KD. Relationship of Nutritional Status to Length of Stay, Hospital Costs, and Discharge Status of Patients Hospitalized in the Medicine Service. J Am Diet Assoc 1997: 97: 975-8.

Allred CG, Voss AC, Fin, SC, McCamish MA. Malnutritionutrition and Clinical Outcomes : The case of medical nutrition therapy. J Am Diet Assoc 1996; 361-6.

DOI: https://doi.org/10.22146/ijcn.17608