risk stratification model.pptx

8/18/2019 Risk Stratification Model.pptx

1/19

M. Orto Witra Wahab1410029022

Pembimbing : dr. Ivan Joalsen, S.!"#$

%is& Strati'(ation Model


2/19

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


3/19

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


4/19

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


5/19

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


6/19

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


7/19

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


8/19

)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


9/19

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


10/19

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


11/19

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


12/19

)roSFO%

0 8 2 ?o> ris& M%0,3A

6 8 7 Medi)m ris& M%6A


13/19

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


14/19

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;


15/19

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.


16/19

Pembahasan*alam enelitian oleh /ilsson et al 200C,

)roSFO% men)n+)&&an erorma dana&)rasi ang s)erior ada oerasi +ant)ngterb)&a.


17/19

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.


18/19

%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.


19/19

"erima &asih

risk stratification model.pptx

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