• Journal of Chest Surgery
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• 제48권1호
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• pp.25-32
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• 2015

Background: We evaluated operative outcomes after third or more cardiac operations for valvular heart disease, and analyzed whether pericardial coverage with artificial membrane is helpful for subsequent reoperation. Methods: From 2000 to 2012, 149 patients (male : female=70 : 79; mean age at operation, $57.0{\pm}11.3$ years) underwent their third to fifth operations for valvular heart disease. Early results were compared between patients who underwent their third operation (n=114) and those who underwent fourth or fifth operation (n=35). Outcomes were also compared between 71 patients who had their pericardium open during the previous operation and 27 patients who had artificial membrane coverage. Results: Intraoperative adverse events occurred in 22 patients (14.8%). Right atrium (n=6) and innominate vein (n=5) were most frequently injured. In-hospital mortality rate was 9.4%. Total cardiopulmonary bypass time ($225{\pm}77$ minutes vs. $287{\pm}134$ minutes, p=0.012) and the time required to prepare aortic cross clamp ($209{\pm}57$ minutes vs. $259{\pm}68$ minutes, p<0.001) increased as reoperations were repeated. However, intraoperative event rate (13.2% vs. 20.0%), in-hospital mortality (9.6% vs. 8.6%) and postoperative complications were not statistically different according to the number of previous operations. Pericardial closure using artificial membrane at previous operation was not beneficial in reducing intraoperative events (25.9% vs. 18.3%) and shortening operation time preparing aortic cross clamp ($248{\pm}64$ minutes vs. $225{\pm}59$ minutes) as compared to no-closure. Conclusion: Clinical outcomes of the third or more operations for valvular heart disease were acceptable in terms of intraoperative adverse events and in-hospital mortality rates. There were no differences in the incidence of intraoperative adverse events, early mortality and postoperative complications between third cardiac operation and fourth or more.

• Journal of Trauma and Injury
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• 제35권4호
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• pp.268-276
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• 2022

Purpose: Rib fractures are common injuries that can lead to morbidity and mortality. Methods: Data on all patients with rib fractures admitted to a single trauma center between January 1, 2008 and December 31, 2018 were reviewed. Results: A total of 1,671 admissions for rib fracture were examined. Patients' median age was 57 years, the median Injury Severity Score (ISS) was 14, and the median number of fractured ribs was three. The in-hospital mortality rate was 4%. Age, the number of rib fractures, and Charlson Comorbidity Index scores were poor predictors of mortality, while the ISS was a slightly better predictor, with area under the receiver operating characteristic curve values of 0.60, 0.55, 0.58, and 0.74, respectively. Multivariate regression showed that age, ISS, and Charlson Comorbidity Index score, but not the number of rib fractures, were associated with significantly elevated adjusted odds ratios for mortality (1.03, 1.14, and 1.28, respectively). Conclusions: Age, ISS, and comorbidities were independently associated with the risk of mortality; however, they were not accurate predictors of death. The factors associated with rib fracture mortality are complex and cannot be explained by a single variable. Interventions to improve outcomes must be multifaceted.

• 한국병원경영학회지
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• 제3권1호
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• pp.238-260
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• 1998

This article describes the theoretical foundations of government policy for hospitals in terms of correcting market failure and enhancing equity. It then discusses the characteristics that desirable payment systems should have, and the effects of the DRG-based prospective payment system on hospital behavior, its financial performance, hospital industry, and health care expenditure. The rationales and impacts of other public policies for hospitals such as antitrust and fair trade regulation, dissemination of practice guidelines and hospital mortality information, regulation of hospital capital investment, and tax policy are also discussed.

• 한국병원경영학회지
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• 제26권1호
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• pp.17-25
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• 2021

This study aimed to analysis factors related to in-hospital death of injured patients by patient safety accident. A total of 1,529 inpatients were selected from Korea Centers for Disease Control and Prevention database(2013-2017). Frequency, Fisher's exact test, t-test, ANOVA, logistic regression analyses by using STATA 12.0 were performed. Analysis results show that the mortality rate was lower for female than male but the mortality rate was higher for the older age, the higher the CCI, head (or neck), multiple, systemic damage sites, internal and others, metropolitan cities based on Seoul and 300-499 based on the bed size of 100-299. Based on these findings, the possibility of using the in-depth investigation of discharge damage from the Korea Centers for Disease Control and Prevention as a data source for the patient safety survey conducted to understand the actual status of patient safety accident types, frequency, and trends should be reviewed. Also, it is necessary to prevent injury and minimize death by identifying factors that affect death after injury by patient safety accident.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.253-257
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• 2023

A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.

• 한국의료질향상학회지
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• 제27권2호
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• pp.18-29
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• 2021

Purpose: Patients with hematologic malignancy (HM) typically have a high mortality rate when their condition deteriorates. The chronic progressive course of the disease makes it difficult to assess the effect of intervention on acute events. We investigated the effectiveness of a rapid response team (RRT) on in-hospital mortality in patients with HM. Methods: We retrospectively analyzed the data of patients with HM who admitted to the medical intensive care unit between 2006 and 2015. Clinical outcomes before and after RRT implementation were evaluated. Results: A total of 228 patients in the pre-RRT period and 781 patients in the post-RRT period were included. The overall in-hospital mortality was 55.4%. Patients in the post-RRT period had improved survival; however, they required more vasopressor therapy, continuous renal replacement therapy, and extracorporeal membrane oxygenation. Multivariate analysis revealed that in-hospital mortality was associated with RRT activation (hazard ratio [HR], 0.634; 95% confidence interval [CI], 0.498-0.807; p < .001), neurological disease (HR, 2.007; 95% CI, 1.439-2.800; p < .001), sequential organ failure assessment score (HR, 1.085; 95% CI, 1.057-1.112; p < .001), need for continuous renal replacement therapy (HR, 1.608; 95% CI, 1.206-1.895; p< .001), mechanical ventilation (HR, 1.512; 95% CI, 1.206-1.895; p< .001), vasopressor (HR, 1.598; 95% CI, 1.105-2.311; p = .013), and extracorporeal membrane oxygenation (HR, 1.728; 95% CI, 1.105-2.311; p = .030). Conclusion: RRT activation may be associated with improved survival in patients with HM.

• Journal of Chest Surgery
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• 제52권4호
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• pp.195-204
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• 2019

Lobectomy is considered the standard strategy for early-stage non-small cell lung cancer (NSCLC). However, sublobar resection for NSCLC has recently received increased attention. The objective of this study was to compare 5-year survival, recurrence-free survival, postoperative mortality, and postoperative morbidities in patients who received segmentectomy versus those who received lobectomy through a meta-analysis. Sixteen studies were included and the combined hazard ratios or odds ratios were calculated. The results revealed that the 5-year survival rate after segmentectomy was comparable to that of lobectomy for stage IA NSCLC. However, segmentectomy for stage I NSCLC had lower rates of postoperative mortality and morbidities than lobectomy.

• Journal of Korean Neurosurgical Society
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• 제65권3호
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• pp.334-341
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• 2022

Traumatic brain injury (TBI) is one of the leading causes of death in the pediatric population in Korea. In addition, it can cause disability in children and adolescents, with physical and mental consequences. This causes a substantial burden on the health care system and occurs globally and not just in Korea. We searched and reviewed current data on the epidemiologic characteristics of pediatric TBI in Korea. Our review provides the recent epidemiological trend mainly focusing on incidence and mortality along with worldwide reported data. This review will be helpful to understand the global epidemiology of pediatric TBI and its differences between countries.

• Tuberculosis and Respiratory Diseases
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• 제60권2호
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• pp.205-214
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• 2006

배 경 : 만성폐쇄성폐질환의 급성 악화는 주요한 사회경제적 부담이다. 이 질환의 높은 사망률이 잘 알려져 있지만, 아직까지 급성악화로 입원했던 환자의 장기 예후에 대해서는 잘 알려져 있지 않다. 본 연구의 목적은 만성폐쇄성폐질환의 급성악화로 입원했던 환자에서 장기간 사망의 예측인자를 알아보기 위함이다. 방 법 : 2000년부터 2004년 사이에 만성폐쇄성폐질환의 급성 악화로 입원한 환자를 대상으로 후향적으로 조사하였다. 입원 중 또는 퇴원 후 6개월 이내에 사망하거나 흉부 X-선 촬영에서 결핵반흔, 흉막비후나 기관지확장증이 동반된 경우, 추적기간 중 악성종양을 진단받은 환자는 제외하였다. 결 과 : 평균 연령은 69.5세였고, 추적기간은 49개월이었으며, 평균 $FEV_1$은 1.00L(예측치의 46%)였다. 사망률은 35%(17/48)였다. 다중 Cox 회귀분석 결과 분당 100회 이상의 빈맥과(p=0.003; 상대위험도, 11.99; 95% 신뢰구간, 2.34-61.44) 35mmHg이상의 우심실수축기압이(p=0.019; 상대위험도, 6.85; 95% 신뢰구간, 1.38-34.02) 사망 위험을 높이는 독립적인 예측인자였다. 결 론 : 만성폐쇄성폐질환의 급성악화로 입원했던 환자의 장기간 사망 위험을 예측하는 데 안정시 심장박동수와 우심실수축기압이 유용할 것이다.

• Tuberculosis and Respiratory Diseases
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• 제54권1호
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• pp.5-14
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• 2003

연구배경 : ICOPER 보고에 의하면 급성 폐혈전색전증 발생 3개월내 사망률이 17.4%이며, 일본 조사에서는 사망률이 14%라고 보고하였다. 그러나 국내에서는 급성 폐혈전색전증의 전국 규모의 대단위 연구가 없어서, 그 현황에 대해 보고된 바 없었다. 따라서 본 학회에서는 급성 폐혈전색전증에 대한 전국 실태조사를 시행하였다. 방법 : 1998년 1월 1일부터 2000년 12월 31일까지 전국수련병원급 이상 종합병원에서 급성 폐혈전색전증으로 진단받은 환자를 대상으로 역학적 특성, 임상양상, 진단법, 위험인자, 치료, 임상경과 등을 조사하였다. 결과 : 환자들의 평균연령은 $58.3({\pm}16.3)$세 였고, 남자가 40.3%였다. 발생 위험인자로는 장기간의 부동상태, 수술, 악성종양이 각각 22.9, 19.2, 15.8% 였다. 가장 흔한 증상으로는 호흡곤란과 흉통이었다. 진단을 위한 검사방법으로는 폐관류 스캔을 시행한 경우가 가장 많았다. 흉부 방사선 검사상 정상 소견을 보인 경우가 53.5%로 가장 많았고, 이상 소견으로는 흉막 삼출액이 가장 흔하였다. 치료방법으로는 86.8%에서 헤파린 항 응고법을 시행하였고 혈전 용해요법은 시행한 경우는 12.3%였다. 사망을 예측할 수 있는 인자로는 병원내에서 이환된 경우, 폐암, 빈호흡, 쇼크, 청색증의 5가지로 분석되었고, 사망 위험도는 각각 1.88, 9.20, 3.50, 6.74, 3.45배 였다. 전체 사망률은 16.9%였고 그 중에서 급성 폐혈전색전증과 연관된 사망률은 9.0%였다. 결론 : 본 조사는 급성 폐혈전색전증에 대한 최초의 전국규모의 실태조사로서, 이 결과가 향후 국내 급성폐혈전색전증의 연구와 치료에 기여할 수 있을 것으로 사료된다.