Accuracy of SVS-WIfI Classification in Predicting Major Amputation in Critical Limb Ischemic Patients

Teguh Marfen Djajakusumah, Rani Septrina, Putie Hapsari, Rendy Susanto

Abstract


In 2014, The Society for Vascular Surgery revealed a new classification system for Critical Limb Ischemia (CLI) referred as the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System based on Wound, Ischemia, and foot Infection (SVS WIfI). This scoring system was created to stratify major amputations risk within 1 year and benefit of revascularization for the patient. This study aimed to assess the accuracy of SVS WIFi in predicting major amputations in patients with lower limb ischemia underwent revascularization at Department of Surgery, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin General Hospital in 2016 - 2019. This was a retrospective observational analytic study with cohort design. Patients who fulfilled the inclusion criteria were assessed with SVS WIfI and results after 1 year of revascularization were identified. Data were analyzed statistically using the Chi-square test. 0f 56 subjects, 39 had limb salvage and 17 underwent major amputations within 1 year. In high revascularization benefit group, 31 had limb salvage and 7 underwent amputation. Meanwhile, in moderate-low revascularization benefits group, 8 had limb salvage and 10 underwent amputation. The accuracy of the SVS WIfI recommendation was 73.2%. Therefore, WIfI SVS classification accurately predicts the incidence of major amputations in patients with lower limb ischemia who underwent revascularization.

 

Akurasi Klasifikasi SVS-WIfI dalam Memprediksi Amputasi Mayor pada Pasien Iskemik Tungkai Bawah

Pada tahun 2014, The Society for Vascular Surgery mengemukakan sistem klasifikasi baru untuk CLI yaitu SVS-WIfI. Sistem skoring ini dibuat untuk menstratifikasi risiko amputasi mayor dalam 1 tahun bila dilakukan revaskularisasi pada pasien. Penelitian ini dilakukan untuk melihat akurasi SVS WIfI dalam memprediksi kejadian amputasi mayor pada pasien iskemia tungkai bawah yang menjalani revaskularisasi dan di lakukan di Departemen Ilmu Bedah Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin pada tahun 2016-2019. Penelitian ini merupakan penelitian observasional analitik dengan rancangan retrospective cohort study. Pasien yang memenuhi persyaratan dilakukan penilaian dengan SVS WIfI dan di-follow up selama 1 tahun, hasil hasilnya dianalisis menggunakan tes Chi-square dan dilakukan perhitungan sensitivitas, spesifisitas, dan akurasi. Berdasarkan penelitian yang dilakukan terhadap 56 pasien yang menjalani revaskularisasi, didapatkan sebanyak 39 pasien yang tidak mengalami amputasi mayor dan 17 pasien yang mengalami amputasi mayor dalam 1 tahun. Dari penelitian ini kelompok pasien dengan manfaat revaskularisasi yang tinggi didapatkan 31 pasien tidak mengalami amputasi, sedangkan 7 pasien mengalami amputasi, pada kelompok pasien dengan manfaat revaskularisasi sedang-rendah, 8 pasien tidak mengalami amputasi, sedangkan 10 pasien mengalami amputasi dan didapatkan hasil uji chi square berdasarkan manfaat vaskularisasi dan kejadian amputasi diperoleh nilai P=0,005, dan Akurasi dari rekomendasi SVS WIfI adalah 73,2%. Dari hasil penelitian didapatkan Klasifikasi SVS WIfI akurat dalam memprediksi kejadian amputasi mayor pada pasien iskemia tungkai bawah yang menjalani revaskularisasi.


Keywords


Amputation, Revascularization, SVS WIFi

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DOI: https://doi.org/10.15395/mkb.v52n4.2029

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