Kwak, Bong Jun;Kim, Dong Goo;Han, Jae Hyun;Choi, Ho Joong;Bae, Si Hyun;You, Young Kyoung;Choi, Jong Young;Yoon, Seung Kew
Annals of Surgical Treatment and Research
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제95권5호
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pp.267-277
/
2018
Purpose: The aim of this study was to analyze survival outcomes in 1,000 consecutive liver transplantations (LTs) performed at a single institution from 1993 to April 2017. Methods: The study population was divided into 2 groups based on donor type: deceased donor LT (DDLT; n = 181, 18.1%) and living donor LT (LDLT; n = 819; 81.9%), and into 3 periods based on the number of cases (first 300 cases, middle 300 cases, last 400 cases). Results: Infection was the most common cause of death, accounting for 34.8% (95 of 273). Mortality due to hepatocellular carcinoma recurrence occurred most frequently between 1 and 5 years after transplantation. Mortality rate by graft rejection was highest between 5 and 10 years after transplantation. And mortality by de novo malignancy occurred most frequently after 10 years after transplantation. The patient survival rates for the entire population at 5 and 10 years were 74.7%, and 68.6%, respectively. There was no difference in survival rate between the LDLT and DDLT groups (P = 0.188). Cause of disease, disease severity, case period, and retransplantation had a significant association with patient survival (P = 0.002, P = 0.031, P = 0.003, and P = 0.024, respectively). Conclusion: Surgical techniques and perioperative management for transplant patients have improved and undergone standardization. Controlling perioperative infection and managing patients with HCC as LT candidates will result in better outcomes.
EunKyo Kang;Won Mo Jang;Min Sun Shin;Hyejin Lee;Jin Yong Lee
Journal of Preventive Medicine and Public Health
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제56권2호
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pp.180-189
/
2023
Objectives: The coronavirus disease 2019 (COVID-19) pandemic has led to a global shortage of medical resources; therefore, we investigated whether COVID-19 impacted the quality of non-COVID-19 hospital care in Korea by comparing hospital standardized mortality rates (HSMRs) before and during the pandemic. Methods: This retrospective cohort study analyzed Korean National Health Insurance discharge claim data obtained from January to June in 2017, 2018, 2019, and 2020. Patients' in-hospital deaths were classified according to the most responsible diagnosis categories. The HSMR is calculated as the ratio of expected deaths to actual deaths. The time trend in the overall HSMR was analyzed by region and hospital type. Results: The final analysis included 2 252 824 patients. In 2020, the HSMR increased nationwide (HSMR, 99.3; 95% confidence interval [CI], 97.7 to 101.0) in comparison to 2019 (HSMR, 97.3; 95% CI, 95.8 to 98.8). In the COVID-19 pandemic zone, the HSMR increased significantly in 2020 (HSMR, 112.7; 95% CI, 107.0 to 118.7) compared to 2019 (HSMR, 101.7; 95% CI, 96.9 to 106.6). The HSMR in all general hospitals increased significantly in 2020 (HSMR, 106.4; 95% CI, 104.3 to 108.5) compared to 2019 (HSMR, 100.3; 95% CI, 98.4 to 102.2). Hospitals participating in the COVID-19 response had a lower HSMR (HSMR, 95.6; 95% CI, 93.9 to 97.4) than hospitals not participating in the COVID-19 response (HSMR, 124.3; 95% CI, 119.3 to 129.4). Conclusions: This study suggests that the COVID-19 pandemic may have negatively impacted the quality of care in hospitals, especially general hospitals with relatively few beds. In light of the COVID-19 pandemic, it is necessary to prevent excessive workloads in hospitals and to properly employ and coordinate the workforce.
Worldwide, stroke is the 2nd or 3rd leading cause of death and a major health problem. Recent advances in medical technology have significantly improved diagnosis and treatment strategies of ischemic stroke. The ischemic stroke subtype is an important determinant of mortality and long-term prognosis of patients. To estimate excess-risks of the ischemic stroke subtype, recently published article, Korean cohort study of stroke, was used as a source article. According to mortality analysis methodology from American academy of insurance medicine, the overall mortality ratio and excess death rate was the highest in patients with SOD, followed by those with CE. Calculated mortality ratio and excess death rate for subtype in this review are SOD, 920%/34‰; CE 267%/34‰; UI 209%/25‰; UM 190%/23‰; UN 188%/15‰; LAA 162%/15‰; LAC 117%/3‰.
Objective: This study compared the prognosis of patients who visited the trauma center directly (direct visit group) with those transferred from the non-trauma center (transferred group). Methods: The patients, who were 18 or older with Injury Severity Score of 15 or more in the trauma center at Busan, were studied from October 2015 to October 2016. To compare the treatment time between the direct visit and transferred group, first treatment time, final treatment time, and time to visit the trauma center were examined. To compare the prognosis, this study compared the 48-hour, 7-day, and in-hospital mortality rate as well as the duration of intensive care unit (ICU) and total hospital stay. To analyze the factors affecting the outcome of transferred group, the physician's level and procedures that had been performed at the non-trauma center were examined. Results: The mortality was similar in the direct visit and transferred group (48-hour 7.6% vs. 4.6%, P=0.111; 7-day 11.1% vs. 7.2%, P=0.89; and in-hospital 14.6% vs. 11.3%, P=0.214). The length of ICU and total hospital stay were similar in the two groups. The mortality was higher in the patients in the transferred group when using intubation, transfusion, and pressure intensifier. The intubated patients showed higher mortality according to logistic regression. Conclusion: The mortality, length of ICU, and hospital stay were similar but the time to visit the trauma center and the final treatment time were longer in transferred group. Stabilizing the patient at the near non-trauma center may be more helpful for some patients.
Jo, Yong Suk;Choi, Sun Mi;Lee, Jinwoo;Park, Young Sik;Lee, Chang-Hoon;Yim, Jae-Joon;Yoo, Chul-Gyu;Kim, Young Whan;Han, Sung Koo;Lee, Sang-Min
Tuberculosis and Respiratory Diseases
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제80권3호
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pp.296-303
/
2017
Background: Acute respiratory distress syndrome (ARDS) is related to high mortality and morbidity. There are no proven therapeutic measures however, to improve the clinical course of ARDS, except using low tidal volume ventilation. Metformin is known to have pleiotropic effects including anti-inflammatory activity. We hypothesized that pre-admission metformin might alter the progress of ARDS among intensive care unit (ICU) patients with diabetes mellitus (DM). Methods: We performed a retrospective cohort study from January 1, 2005, to April 30, 2005 of patients who were admitted to the medical ICU at Seoul National University Hospital because of ARDS, and reviewed ARDS patients with DM. Metformin use was defined as prescribed within 3-month pre-admission. Results: Of 558 patients diagnosed with ARDS, 128 (23.3%) patients had diabetes and 33 patients were treated with metformin monotherapy or in combination with other antidiabetic medications. Demographic characteristics, cause of ARDS, and comorbid conditions (except chronic kidney disease) were not different between metformin users and nonusers. Several severity indexes of ARDS were similar in both groups. The 30-day mortality was 42.42% in metformin users and 55.32% in metformin nonusers. On multivariable regression analysis, use of metformin was not significantly related to a reduced 30-day mortality (adjusted ${\beta}-coefficient$, -0.19; 95% confidence interval, -1.76 to 1.39; p=0.816). Propensity score-matched analyses showed similar results. Conclusion: Pre-admission metformin use was not associated with reduced 30-day mortality among ARDS patients with DM in our medical ICU.
Purpose: Nitric oxide (NO) is a vasodilator and inhaled NO (iNO) is used in acute respiratory distress syndrome (ARDS) to improve alveolocapillary gas exchange. The mechanism to improve oxygenation is likely to redistribute blood flow from unventilated areas to ventilated areas. Though improvement of oxygenation, iNO therapy has not been shown to improve mortality and considered as only rescue therapy in severe hypoxemia. We conducted the study to investigate an efficacy of iNO in trauma patients with severe hypoxemia. Methods: We reviewed the trauma patients who underwent iNO therapy retrospectively from 2010 to 2014. Degree of hypoxemia was represented as $PaO_2/FiO_2$ ratio (PFR) and the severity of patient was represented with sequential organ failure assessment (SOFA) score. Patients were divided into the survivor group and non-survivor group according to the 28-day mortality. Results: A total of 20 patients were enrolled. The mortality of 28-day was 40%. There were no significant differences between survivor and non-survivor group in age, sex, severity of injury, PFR and SOFA score. There was significant difference in initiation time of iNO after injury (p=0.047). Maximum combinations of sensitivity and specificity for timing of iNO therapy were observed using cut-off of 3-day after injury with a sensitivity of 88% and specificity of 75%. Conclusion: Though iNO therapy does not influence the mortality, iNO therapy may decrease the mortality caused by respiratory failure in the early phase of trauma.
Background: A number of randomized trials addressing alternative operative and multimodality approaches to gastric cancer have characterized early postoperative morbidity and mortality rates. The aim of this study was to compare mortality and morbidity and disease free survival after D1 and D2 gastrectomy for adenocarcinomas of the stomach Materials and Methods: From June 2006 to January 2012, patients were selected according to information of the cancer administrator center of Ahvaz Jundishapur Medical University. The inclusion criteria were age between 20-85 years and histologically proven adenocarcinoma of the stomach without evidence of distant metastasis. Patients were excluded if they had previous or coexisting cancer or disability disease. In this research, D1 was compared to D2 gastrectomy. Results: 131 patients were randomised, 49 allocated to D1 and 82 to D2 gastrectomy. The two groups were comparable for age, sex, site of tumors, and type of resection performed. The overall post-operative morbidity rate was 17.5%. Complications developed in 14.2% of patients after D1 and in 19.5% of patients after D2 gastrectomy (p=0.07). Postoperative mortality rate was 0.8% (one death); it was 2% after D1 and 0% after D2 gastrectomy. In this research disease free-survival after 3 years was 71.2 % with 63.2% after D1 and 76.8% after D2 gasterctomy. Conclusions: This study indicates that D2 gastrectomy with pancreas preservation is not followed by significantly higher morbidity and mortality than D1 resection. Based on the results of present study, D2 resection should be recommended as the standard surgical approach for resectable gastric cancer.
Purpose: Numerous studies have investigated the pattern of traumatic death with a focus on the injury mechanism, the severity of the injury and the presence of hemorrhage. Acute coagulopathy has been treated as only one of many complications. The purpose of this study was to investigate the influence of acute coagulopathy on acute and early death due to trauma. Methods: A retrospective analysis of trauma patients with injury severity score (ISS)${\geq}25$ who had been treated between January 2011 and December 2012 was conducted. Based on the time of injury, traumatic death was categorized into acute (within 48 hours) and early (from 3 to 7 days). The correlations between various parameters within 24 hours after injury and time of death were analyzed. Results: A total of 124 patients were enrolled. Of them, 8.1% (n=10) of the patients experienced acute mortality. For those patients, significant differences in initial systolic blood pressure, coagulopathy score, amount of transfusion, abbreviated injury scale of the head and neck, the abdomen and the extremities were noted. Early mortality was experienced by 7.0% (n=8) of the patients, only coagulopathy score was found to be a significant independent risk factor for acute (odds ratio: 3.127; 95% confidence interval: 1.185-8.252; p=0.021) and early mortality (odds ratio: 2.470; 95% confidence interval: 1.029-5.929; p=0.043). Conclusion: Acute traumatic coagulopathy has an important role in the mortality, even after the acute phase. Early management and prevention of acute coagulopathy may improve survival of trauma patients.
Objectives: This study aims to investigate the effects of Korean Medicine Hospital Utilization (KMHU) on major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke, and death in hypertensive patients taking antihypertensives. Methods: Using the Korean National Health Insurance Service-National Sample Cohort database, this study identified and diagnosed 68,457 hypertensive patients taking antihypertensives between 2003 and 2006. They were divided into KMHU and non-KMHU groups. The follow-up period ended with the diagnosis of myocardial infarction, stroke, or death. After propensity score matching (PSM), there were 18,242 patients each in the non-KMHU and KMHU groups. We calculated the incidence rate, hazard ratio (HR), and 95% confidence interval (CI) for MACE, myocardial infarction, stroke, and death in patients with hypertension using a stratified Cox proportional hazard model. In addition, secondary outcome analyses for stroke and cardiovascular mortality were performed. Results: After PSM, the HRs for MACE (HR: 0.84, 95% CI: 0.81-0.87), all-cause mortality (HR: 0.75, 95% CI: 0.72-0.79), and myocardial infarction (HR: 0.90, 95% CI: 0.83-0.97) were significantly lower in the KMHU group than in the non-KMHU group. Moreover, the HRs for stroke-related mortality, haemorrhage and ischaemic stroke-related mortality, and ischaemic heart disease-related and circulatory system disease-related mortality were significantly lower in the KMHU group than in the non-KMHU group. Conclusions: On long-term follow-up observation, this study supported the effect of KMHU for managing hypertension and reducing the burden of cardiovascular diseases.
BACKGROUND: Right ventricular (RV) dysfunction is a significant risk of major adverse cardiac events in patients with acute heart failure (AHF). In this study, we evaluated RV-pulmonary artery (PA) coupling, assessed by tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) and assessed its prognostic significance, in AHF patients. METHODS: We measured the TAPSE/PASP ratio and analyzed its correlations with other echocardiographic parameters. Additionally, we assessed its prognostic role in AHF patients. RESULTS: A total of 1147 patients were included in the analysis (575 men, aged 70.81 ± 13.56 years). TAPSE/PASP ratio exhibited significant correlations with left ventricular (LV) ejection fraction(r = 0.243, p < 0.001), left atrial (LA) diameter(r = -0.320, p < 0.001), left atrial global longitudinal strain (LAGLS, r = 0.496, p < 0.001), mitral E/E' ratio(r = -0.337, p < 0.001), and right ventricular fractional area change (RVFAC, r = 0.496, p < 0.001). During the median follow-up duration of 29.0 months, a total of 387 patients (33.7%) died. In the univariate analysis, PASP, TAPSE, and TAPSE/PASP ratio were significant predictors of mortality. After the multivariate analysis, TAPSE/PASP ratio remained a statistically significant parameter for all-cause mortality (hazard ratio [HR], 0.453; p = 0.037) after adjusting for other parameters. In the receiver operating curve analysis, the optimal cut-off level of TAPSE/PASP ratio for predicting mortality was 0.33 (area under the curve = 0.576, p < 0.001), with a sensitivity of 65% and a specificity of 47%. TAPSE/PASP ratio < 0.33 was associated with an increased risk of mortality after adjusting for other variables (HR, 1.306; p = 0.025). CONCLUSIONS: In AHF patients, TAPSE/PASP ratio demonstrated significant associations with RVFAC, LA diameter and LAGLS. Moreover, a decreased TAPSE/PASP ratio < 0.33 was identified as a poor prognostic factor for mortality.
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