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Prevalence and Risk Factors of Suspected Case Primary Bloodstream Infection in Chronic Renal Failure Patients with Catheter Double Lumen at Dr. Mohammad Hoesin General Hospital Palembang Sholekhuddin Wahyu; Kemas Muhammad Dahlan; Jaka Fahmi; Novadian; Theodorus
Sriwijaya Journal of Surgery Vol. 5 No. 2 (2022): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v5i2.78

Background: Primary bloodstream infection (BSI) is an infection that occurs without any other organ or tissue suspected as a source of infection. BSI is often found in patients who have a catheter double lumen (CDL) attached device. The use of CDL causes a lot of risk of infection in patients with renal failure. Factors that influence the occurrence of BSI can be endogenous and exogenous factors. This study aimed to determine the prevalence rate and the factors that influence BSI in chronic renal failure patients with double-lumen catheters undergoing hemodialysis at the Dr. Mohammad Hoesin General Hospital, Palembang. Methods: This study was an analytical observational study with a cross-sectional design undertaken in the hemodialysis unit, medical record installation, and clinical laboratory of Dr. Mohammad Hoesin General Hospital Palembang from February to December 2021. There were 93 patients who met the inclusion criteria. The relationship between risk factors and the incidence of BSI was analyzed using the Chi-Square and Fisher Exact tests. All data were analyzed by SPPS version 22.0. Results: In this study, 44 people (47.3%) had primary bloodstream infection (BSI). In addition, there was a significant relationship between gender (PR = 2.508 (CI5% 1.087 â€“ 5.784); p = 0.049); BMI (PR = 6.150 (CI5% 2.349 â€“ 16.099); p = 0.000); and catheter type (p = 0.000) with the incidence of BSI. However, there was a non-significant relationship between age, catheter location, and duration of catheter insertion with the incidence of BSI (p > 0.05). Conclusion: Body mass index and gender are risk factors for primary bloodstream infection.

The Lung Organ Failure Score (LOFS) as an Early Predictor of Mortality in Blunt Thoracic Trauma: A Preliminary Validation Study in a Southeast Asian Cohort Charita Ulfah Widyawan; Arie Hasiholan Lumban Tobing; Theodorus
Sriwijaya Journal of Surgery Vol. 8 No. 2 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i2.133

Introduction: Blunt thoracic trauma is a leading cause of trauma-related mortality. Early and accurate risk stratification is essential for optimizing outcomes, yet many prognostic scores lack validation in diverse populations. This study aimed to perform a preliminary evaluation of the prognostic value of the lung organ failure score (LOFS) for predicting in-hospital mortality in patients with blunt thoracic trauma in an Indonesian tertiary trauma center. Methods: This retrospective, single-center, exploratory cohort study included adult patients (≥18 years) admitted with blunt thoracic trauma to Dr. Mohammad Hoesin General Hospital from January 2023 to January 2025. Data on demographics, injury characteristics, initial physiological parameters, and clinical outcomes were collected. The LOFS was calculated for each patient. The primary outcome was in-hospital mortality. Statistical analyses included bivariate comparisons, Kendall's Tau correlation, and Receiver Operating Characteristic (ROC) curve analysis. Results: A total of 32 patients were included. The overall in-hospital mortality rate was 21.9% (n=7). The non-survivor group had a significantly higher mean LOFS than the survivor group (21.00±5.29 vs. 14.16±3.92, p=0.001). LOFS demonstrated a moderate, positive correlation with mortality (Kendall's Tau r=+0.568, p=0.001). ROC analysis showed that LOFS had excellent discriminative ability for mortality, with an Area Under the Curve (AUC) of 0.840 (95% CI: 0.685–0.995, p=0.001). An optimal cut-off score of ≥18 yielded a sensitivity of 85.7% and a specificity of 80.0%. Conclusion: In this preliminary study, LOFS was strongly associated with in-hospital mortality and demonstrated excellent discriminative performance. The findings suggest LOFS is a promising and simple tool for early risk stratification in this high-risk population. However, the study's small sample size precluded a reliable assessment of its independence from other risk factors. Further validation in larger, prospective multicenter studies is essential to confirm these findings.

A Preliminary Retrospective Analysis of the Blunt Abdominal Trauma Scoring System (BATSS) in a High-Prevalence Cohort: A Single-Center Indonesian Experience Akbar Rizky Wicaksana; Alsen Arlan; Theodorus
Sriwijaya Journal of Surgery Vol. 8 No. 2 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i2.136

Introduction: The triage of blunt abdominal trauma (BAT) is a critical challenge, and the utility of clinical scoring systems like the blunt abdominal trauma scoring system (BATSS) requires validation in diverse clinical settings. This study aimed to provide a preliminary, critical appraisal of the BATSS's diagnostic performance and the behavior of its individual components in a unique, high-risk cohort at a tertiary Indonesian trauma center. Methods: A retrospective analysis was conducted on 37 BAT patients who underwent definitive diagnostic evaluation (CT scan or laparotomy) between July 2021 and July 2025 in Palembang, Indonesia. The cohort was noted to have a significant selection bias, with an intra-abdominal injury (IAI) prevalence of 91.9% (34 injured, 3 uninjured). A component-level analysis of the seven BATSS variables was performed alongside a standard diagnostic accuracy assessment using an ROC curve to determine the optimal cut-off. Results: The cohort was predominantly young males injured in traffic accidents. The ROC analysis demonstrated poor discriminatory power (AUC = 0.525). At an optimal cut-off of 8.5, BATSS showed a sensitivity of 82.4% and a statistically unstable specificity of 33.3% (95% CI: 0.8% to 90.6%). The PPV was 93.3%, while the NPV was critically low at 14.3%. Component analysis revealed that sensitivity was primarily driven by high-point variables like a positive FAST scan, while low specificity was associated with non-specific signs like abdominal tenderness. Conclusion: In this high-prevalence, pre-selected cohort, BATSS failed to perform as a reliable triage tool. Its poor specificity and dangerously low NPV render it unsuitable and unsafe for ruling out IAI. The score's apparent sensitivity was driven by variables that already indicate a high-risk patient, suggesting the score adds little value to standard clinical assessment. This preliminary study highlights the critical need for robust, large-scale validation before clinical adoption and suggests BATSS may be inappropriate for settings with a high pre-test probability of injury.

Elevated Serum Lactate as an Indicator of Neurometabolic Derangement and its Independent Correlation with Clinical Outcomes in Traumatic Brain Injury Satya Agusmansyah; Anugerah Onie Widhiatmo; Theodorus
Sriwijaya Journal of Surgery Vol. 8 No. 2 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i2.137

Introduction: Traumatic brain injury (TBI) is a primary cause of global death and disability, where early and accurate prognostication is critical but remains a clinical challenge. Serum lactate is emerging as a biomarker of the complex neurometabolic derangement following TBI, extending beyond its traditional role as a marker of hypoxia. This study aimed to determine if serum lactate is an independent predictor of outcomes in TBI patients. Methods: We conducted a prospective, single-center observational study of 33 TBI patients at Dr. Mohammad Hoesin General Hospital. Serial venous serum lactate levels were measured at admission, 24, and 48 hours. The primary outcome was unfavorable functional status (Glasgow Outcome Scale [GOS] 1-3) at hospital discharge. Multivariate logistic regression was used to assess lactate as an independent predictor of unfavorable outcome, controlling for age and initial Glasgow Coma Scale (GCS) score. Survival was analyzed using Kaplan-Meier curves and a Cox proportional hazards model. Results: The cohort (N=33) was predominantly male (63.6%) with a mean age of 37.91 years. Higher admission lactate was strongly associated with worse GOS categories (p=0.002). After adjusting for age and initial GCS score, admission serum lactate remained a significant independent predictor of unfavorable outcome at discharge. For every 1 mmol/L increase in lactate, the odds of an unfavorable outcome increased by over twofold (Adjusted Odds Ratio: 2.15; 95% CI: 1.12-4.13; p=0.021). Similarly, lactate was an independent predictor of in-hospital mortality in the Cox proportional hazards model (Adjusted Hazard Ratio: 1.78; 95% CI: 1.05-3.01; p=0.032). Conclusion: Elevated admission serum lactate is a strong, independent predictor of unfavorable in-hospital functional outcome and mortality in TBI patients. As a readily available biomarker, it reflects the severity of the underlying neurometabolic crisis and provides crucial prognostic information beyond initial clinical and demographic assessments, aiding in early risk stratification.

Dissecting the Triad of Distress: A Multivariate Analysis of Clinical, Surgical, and Sociodemographic Determinants of Quality of Life in Indonesian Breast Cancer Patients Undergoing Chemotherapy Muhammad Yufimar Riza Fadilah; Mulawan Umar; Theodorus
Sriwijaya Journal of Surgery Vol. 8 No. 2 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i2.138

Introduction: The assessment of health-related quality of life (HRQoL) is a paramount outcome in breast cancer survivorship, yet the interplay of disease-specific, treatment-related, and patient-level factors is not fully understood in Southeast Asian populations. This study aimed to comprehensively model the predictors of HRQoL and fatigue by simultaneously evaluating clinical, surgical, and sociodemographic variables among Indonesian breast cancer patients. Methods: A cross-sectional study was conducted with 102 female breast cancer patients undergoing chemotherapy at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Data on clinical variables (AJCC stage, chemotherapy cycles, treatment intent), surgical procedures (breast and axillary surgery type), and sociodemographic characteristics were collected. HRQoL was assessed using the validated Indonesian versions of the Functional Assessment of Cancer Therapy-General (FACT-G) and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaires. Bivariate correlations and a hierarchical multivariate linear regression analysis were performed to identify significant independent predictors of FACIT-F scores. Results: The cohort was characterized by advanced disease (Stage III/IV: 62.7%) and aggressive surgical management (Mastectomy: 75.5%; Axillary Lymph Node Dissection: 68.6%). In the multivariate analysis, several factors emerged as significant independent predictors of poorer HRQoL. These included advanced cancer stage (β = -0.41, p < 0.001), having undergone a mastectomy versus breast-conserving surgery (β = -0.28, p = 0.002), having had an axillary lymph node dissection versus sentinel node biopsy (β = -0.25, p = 0.005), and a higher number of chemotherapy cycles (β = -0.19, p = 0.018). The final model explained a substantial portion of the variance in HRQoL (Adjusted R² = 0.58). In contrast, sociodemographic factors including age, income, and education were not significant predictors in the final model (p > 0.05). Conclusion: HRQoL in this cohort is not determined by a single factor but by a triad of distress: the biological burden of the disease (stage), the physical and psychological morbidity of surgical treatment, and the cumulative toxicity of chemotherapy. These treatment-related realities powerfully override the influence of sociodemographic characteristics. These findings mandate a paradigm shift towards an integrated supportive care model that proactively addresses surgical morbidity alongside systemic side effects from the point of diagnosis.

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