Background: Peritonitis requires emergency surgery, and delays in treatment can lead to death. We aimed to determine the correlation between the periods from onset to hospital admission with postoperative mortality for patients with peritonitis and to compare it with the effect of national health insurance implementation. Methods: This study was a cross-sectional study conducted at a tertiary health center in Indonesia. We ascertained 150 patients with peritonitis from January 2012–December 2015. Results: One hundred and fifty patients were ascertained, including 72 patients before National Health Insurance (NHI) era and 78 patients after the NHI era (Males: 90 vs females: 60). The most frequent age group was age 46–65 years (44.67%). The period between onsets to hospital mainly occurred within 24–72 h (42%). Most of the patients had some comorbidity with one or more diseases (52.67%). Mortality was found in as many as 61 people (40.67%). The highest etiology of peritonitis was appendix perforation (28%) and gastric perforation (22%). Mortality was most common in the period between onset to time treated within 24–72 h (N:35; 23.33%) (P < 0.05). Before the NHI era, the period between onset to time treated was mostly after > 72 h (18.66%), whereas after the NHI era it was mostly within 24–72 h (25.33%) (p < 0.05). Conclusion: The multilevel referral system implemented in the NHI era significantly affects the time-to-treat and outcome of patients with peritonitis. Highlights

Background: Sarcopenia is a negative predictor of colorectal cancer outcomes, while colorectal cancer is at risk of developing malnutrition due to the disease process. This study aims to determine the relationship between sarcopenia and nutritional status and analyze the effect of sarcopenia on the outcome of rectal cancer patients. Method: A cross-sectional study was conducted on colorectal cancer patients of Javanese ethnicity who performed preoperative abdominal CT scans at dr. Sardjito Hospital in Yogyakarta between June and December 2019. Sarcopenia is based on measuring muscle mass index at the third lumbar vertebra level <36.0 cm2/m2 for men and < 29.0 cm2/m2 for women. Statistical analyzes using SPSS version 20 for Windows were performed to find out the correlation. Results: Of 46 patients, 56.5% were male and 43.5% female, with a mean age of 53.57. Sarcopenia was found in 47.8% of patients, mostly in women than men (63.6% vs. 36.4% p=0.019). Underweight was mostly found in the sarcopenia group compared to non-sarcopenia (59.1% vs. 20.8% p=0.019). The sarcopenia group has longer LOS than non-sarcopenia (14.73±13.474 vs. 12.29 ±4.165; p=0.404). The mortality of the sarcopenia group was 1.56 times higher compared to the non-sarcopenia (57.1% vs. 42.9%; OR=1.56; 95%CI=0.307-7.890; p=0.964). Haemoglobin, albumin, total protein, CEA, histopathology, tumor location and procedure were not significantly correlated to sarcopenia. Conclusion: Underweight nutritional status and females are correlated with sarcopenia. Sarcopenia tends to be treated longer and has higher mortality than non-sarcopenia.