Risk Stratification Model.pptx
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Transcript of Risk Stratification Model.pptx
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8/18/2019 Risk Stratification Model.pptx
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M. Orto Witra Wahab1410029022
Pembimbing : dr. Ivan Joalsen, S.!"#$
%is& Strati'(ation Model
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Pendah)l)an*engan ening&atan te&nologi,oerasi +ant)ng masih memili&i risi&o &ematianang tinggi
-nalisa mengenai outcome dari oerasi +ant)ng P/"I/.
#eb)t)han a&an data a&tor risi&o,
rognosis, &)alitas tinda&an!ahan etimbangan bagi asien
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Pendah)l)an-ng&a &ematian di+adi&an sebagai alat )&)r
ang m)dah )nt)& menilai hasil oerasi
*ib)at s)at) )&)ran )nt)& menent)&anrisi&o ang dimili&i asien dalam men+alanioerasi +ant)ng
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Parsonnet S(oreParsonnet score 1939 oleh $i(tor
Personnet
Sistem elaoran ang m)dah )5 risi&o&ematian ada oerasi +ant)ng.
*i&embang&an di -S, mengg)na&an data6700 asien se+a& 19328193
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Factor Defnition Score
Patient related a(tor
ender emale 1Morbid obesit !od mass inde; o o((asions
6
?$ ds)n(tion ood @70Aair 60849APoor B60A
024
-ge 084 ears old789 ears old< 30 ears old
1220
%e8oeration Se(ond oeration "hird or more
710
Intra aorti( balloon)m Prior to s)rger. 2
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Recently failedintervention
Within 24 ho)rs o oeration< 24 ho)rs, o on same admission
105
Renal *ialsis deenden( 10
Catastrophic states e.g. a()te str)(t)ral dee(t, (ardiogeni(sho(&, a()te renal ail)re
10870
Other rarecircumstances
e.g. aralegia, a(ema&erdeenden(, (ongenital heart diseasein ad)lts, severe asthma
2810
S)rger related a(tor
Mitral valve surgery Sstoli( P- ress)re BC0 mm=gSstoli( P- ress)re @C0 mm=g
73
Aortic valve surgery -$ ress)re gradient D120 mm=g-$ ress)re gradient
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Parsonnet S(ore084 low risk M% 1A789 elevated risk M% 7A
10 E 14 signicantly elevated risk M%
9A17 E 19 high risk M% 1A
over 19 very high risk M% 61A
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)roSFO%)roean sstem or (ardia( oerative
ris& eval)ationPredi&si a>al &ematian ada oerasi +ant)ngdan enilaian &)alitas era>atan bedah
+ant)ng
*i&embang&an di roa se(ararose&ti dengan mengg)na&an data
dari 16.602 asien dari 3 negara diroa se+a& Setember 8 *esember1997
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Faktor Defnisi Sk or
-ge Per 7 ears or art thereo over C0
ears
1
Se; emale 1
Fhroni()lmonardisease
?ongterm )se o bron(hodilators orsteroids or l)ng disease
1
;tra(ardia(arterioath
-n one or more o the ollo>ing:(la)di(ation, (arotid o((l)sion or .70Astenosis, revio)s or lannedintervention on the abdominal aorta,
limb arteries or (arotids
2
/e)rologi(alds)n(tion
*isease severel aGe(ting amb)lationor da8to8da )n(tioning
2
Previo)s (ardia(s)rger
%eH)iring oening o the eri(ardi)m 6
Ser)m < 200 mol5l 2
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Friti(alreoerativestate
-n one or more o the ollo>ing:ventri()lar ta(h(ardia or brillation oraborted s)dden death, reoerative(ardia( massage, reoerative
ventilation beore arrival in theanaestheti( room, reoerative inotroi(s)ort, intraaorti( balloon(o)nter)lsation or reoerative a()terenal ail)re an)ria or olig)ria,10 ml5h
6
Fardia( related a(torKnstable angina %est angina reH)iring i.v. nitrates )ntil
arrival in the anaestheti( room2
?$ ds)n(tion Moderate or ?$ 60L70APoor or ?$ B 60
16
%e(entmo(ardialinar(t
B 90 das 2
P)lmonarhertension
Sstoli( P- ress)re < C0mm=g 2
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Operation related actor
mergen( Farried o)t on reerral beore the beginning othe ne;t >or&ing da
2
Other than isolatedF-!
Ma+or (ardia( ro(ed)re other than or inaddition to F-!
2
S)rger onthora(i( aorta
or disorder o as(ending, ar(h or des(endingaorta
6
Postinar(t setal
r)t)re
4
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)roSFO%
0 8 2 ?o> ris& M%0,3A
6 8 7 Medi)m ris& M%6A
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S"S %is& S(ore "he So(iet o "hora(i( S)rgeons /ational
Fardia( *atabaseS"S /F* di&embang&antah)n 1939 dan mer)a&an )sat data&lini& terbesar.
)5 mend)&)ng &ebi+a&an emerintah.
Penelitian dan ening&atan elaanan danoutcome
S"S ris& model di&embang&an se+a& 1999dan telah mengalami beberaa revisi
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S"S %is& S(ore "erdaat 26 a&tor ang termas)& dalam S"S %is&
S(oreAge Pulmonaryhypertensian
Se; mergen( s)rger
Fhroni( ?)ng *isease -nother s)rger ratherthan F-!
;tra(ardia( arterialdisease
S)rger on thora(i( -orta
/e)rologi(al *s)n(tion Post Inar(tion setalr)t)r s)rger
=eart S)rger =ertension
%enal *s)n(tion *iabetes
ndo(arditis Preoerative -rrhthmia
Friti(al reoerative !od Mass Inde;
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PembahasanMen)r)t W#, -)., et al 200, )roSFO%
lebih bai& dariada arsonnet dalammemredi&si mortalitas di r)mah sa&it.
!orde et al 2016, )roSFO% dan S"S
%is& S(ore memili&i &emam)an angsama dalam memredi&si mortalitas asienbedah +ant)ng. /am)n ada &elomo&risi&o tinggi,ter+adi overprecition ada
&ed)a risk model.
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Pembahasan*alam enelitian oleh /ilsson et al 200C,
)roSFO% men)n+)&&an erorma dana&)rasi ang s)erior ada oerasi +ant)ngterb)&a.
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PembahasanPrins et al 2012 dan -) et al 200
mengata&an bah>a setia risk straticationmodels sehar)sna dila&)&an modi'&asi diagar ses)ai dengan &ondisi o)lasi
engg)na. Mere&a +)ga berendaatbah>a masing8masing >ilaah har)smemili&i risk stratication models angses)ai dengan >ilaahna.
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%erensi!orde, *., andhe, K., =argave /eha, Pande, #.,
#h)llar, $. 2016. "he -li(ation o )roean
sstem or (ardia( oerative ris& a(tor II )roSFO%II and So(iet o "hora(i( S)rgeons S"S ris& s(ore orris& strati'(ation in Indian atient )ndergoing (ardia(s)rger. Annals of Cardiac Anaesthesia, 1C681CC.
)roSFO% St)d ro). 1999. )roean sstem or
(ardia( oerative ris& eval)ation )roSFO%.!uropean "ournal of cardio#thoracic $urgery , 9816.
/ilsson, J., -lgotsson, ?., =ogl)nd, P., ?)hrs, F., !randt, J. 200C. Fomarison o 19 re8oerative ris&strati'(ation models in oen heart s)rger. !uropean%eart "ournal, 3C834.
Prins, F., Jon&er, I., !otes, ?., Smit, . . 2012. Fardia(S)rger ris& strati'(ation models. Cardiovascular "ournalof Africa, 1C081C4.
W#, -., MP, S., #", ?., ?F, F., SW, F., S%, *. 200.Mortalit redi(tion in ad)lt (ardia( s)rger atients.
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"erima &asih