Delirium Pascaoperasi sebagai Prediktor Mortalitas pada Geriatri yang Menjalani Operasi Non-Kardiak

Aida Rosita Tantri, Muncieto Andreas, Clarissa Emiko Talitaputri, Saur Maruli Evan Johannes

Abstract


Delirium postoperatif merupakan suatu bentuk delirium yang sering tidak disadari serta dapat meningkatkan morbiditas dan mortalitas. Studi yang telah dilakukan sebelumnya menunjukkan masih terdapat konflik terkait hubungan delirium pascaoperasi sebagai prediktor mortalitas, terutama pada pasien geriatri. Oleh karena itu, tinjauan sistematis ini bertujuan mengetahui hubungan delirium pascaoperasi sebagai prediktor mortalitas pada pasien geriatri yang menjalani anestesi pada pembedahan non-kardiak. Penelusuran dilakukan melalui database online seperti Medline®, ClinicalKey®, Science Direct®, EBSCO®, ProQuest®, dan Cochrane®. Telaah kritis terhadap artikel ilmiah yang memenuhi kriteria inklusi dan tidak termasuk eksklusi dilakukan berdasarkan Center of Evidence-Based Medicine, University of Oxford for prognosis study.Berdasarkan hasil penelusuran diperoleh tiga studi yang memenuhi kriteria inklusi dan tidak termasuk eksklusi. Hasil telaah kitis terhadap ketiga studi tersebut menunjukkan tidak terdapat cukup bukti kuat yang mendukung delirium pascaoperasi merupakan prediktor independen terhadap mortalitas pada pasien geriatri. Delirium pascaoperasi bukan merupakan prediktor independen, namun meningkatkan risiko mortalitas bersama faktor lain seperti frailty, usia, jenis operasi, urgensi operasi, dan komorbid, hingga terdapat studi yang cukup kuat untuk mendukung delirium pascaoperasi bukan sebagai prediktor mortalitas. Klinisi tetap harus berupaya mencegah kondisi delirium pascaoperasi agar tidak menjadi mediator yang meningkatkan risiko mortalitas.

 

Postoperative Delirium as Mortality Predictor in Geriatrics Undergoing Non-Cardiac Surgery: A Systematic Review

Postoperative delirium is a form of delirium that often goes unrecognized and can increase morbidity and mortality. However, there are still conflicts in previous studies regarding the relationship between postoperative delirium as a predictor of mortality, especially in geriatric patients. Therefore, this systematic review aimed to determine the relationship to postoperative delirium as a predictor of mortality in geriatric patients undergoing anesthesia for non-cardiac surgery. Searches were conducted through online databases such as Medline®, Clinical Key®, Science Direct®, EBSCO®, ProQuest®, and Cochrane®. A critical review of scientific articles that met the inclusion and exclusion criteria was carried out by the Center for Evidence-Based Medicine, University of Oxford, for prognostic studies. The search resulted in three studies that met the inclusion criteria. A clinical review of these three studies has shown insufficient evidence to support that postoperative delirium is an independent predictor of death in geriatric patients. Postoperative delirium is not an independent predictor but increases the risk of death and other factors such as frailty, age, type of surgery, urgency of surgery, and co-morbidities. Until there are sufficiently robust studies to support postoperative delirium rather than as a predictor of mortality, clinicians should continue to strive to prevent postoperative delirium from becoming a mediator that increases the risk of death.

 

 

Keywords


Anestesi, delirium pascaoperasi, geriatri, mortalitas, operasi non-kardiak

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References


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DOI: https://doi.org/10.15851/jap.v10n3.2975

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