WAKTU PENGANGKATAN SELANG DADA DINI (≤24 JAM) SETELAH OPERASI CORONARY ARTERY BYPASS GRAFT: TINJAUAN SISTEMATIS
EARLY (≤24-HOUR) CHEST TUBE REMOVAL AFTER CORONARY ARTERY BYPASS GRAFTING: A SYSTEMATIC REVIEW
Abstract
Selang dada dipasang rutin setelah operasi coronary artery bypass graft (CABG) untuk mencegah tamponade dan efusi pleura. Namun, waktu pengangkatan optimal masih kontroversial karena pengangkatan dini berpotensi mempercepat pemulihan tetapi dikhawatirkan meningkatkan komplikasi. Tujuan penelitian ini adalah untuk menilai keamanan, efektivitas, dan luaran klinis pengangkatan selang dada dini (≤24 jam) dibandingkan pengangkatan standar/tertunda setelah CABG. Tinjauan sistematis mengikuti pedoman PRISMA. Pencarian dilakukan pada PubMed, Scopus, dan Cochrane Library untuk publikasi tahun 2000–2023, mencakup uji acak terkontrol (RCT), studi kohort, dan studi observasional pada pasien dewasa pasca-CABG. Risiko bias dinilai menggunakan RoB 2 (RCT) dan ROBINS-I (studi non-acak). Karena terdapat heterogenitas klinis dan metodologis (misalnya perbedaan ambang volume drainase, lokasi selang, serta definisi luaran), data disintesis secara naratif. Empat belas studi memenuhi kriteria inklusi. Secara umum, pengangkatan selang dada dalam 24 jam dikaitkan dengan nyeri pascaoperasi yang lebih rendah dan lama rawat inap yang lebih singkat, tanpa peningkatan bermakna pada komplikasi mayor (misalnya tamponade atau efusi yang memerlukan intervensi ulang). Faktor yang memengaruhi kelayakan pengangkatan dini meliputi lokasi selang, karakteristik/volume drainase, serta strategi manajemen perikardium. Pengangkatan selang dada dini (≤24 jam) setelah CABG tampak aman dan bermanfaat pada pasien terpilih bila diterapkan dengan protokol klinis terstandar dan pemantauan yang adekuat; keputusan tetap harus mempertimbangkan penilaian klinis individual.
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