• Title/Summary/Keyword: Mortality Improvement

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Mass Reduction and Functional Improvement of the Left Ventricle after Aortic Valve Replacement for Degenerative Aortic Stenosis

  • Shin, Su-Min;Park, Pyo-Won;Han, Woo-Sik;Sung, Ki-Ick;Kim, Wook-Sung;Lee, Young-Tak
    • Journal of Chest Surgery
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    • v.44 no.6
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    • pp.399-405
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    • 2011
  • Background: Left ventricular (LV) hypertrophy caused by aortic valve stenosis (AS) leads to cardiovascular morbidity and mortality. We sought to determine whether aortic valve replacement (AVR) decreases LV mass and improves LV function. Materials and Methods: Retrospective review for 358 consecutive patients, who underwent aortic valve replacement for degenerative AS between January 1995 and December 2008, was performed. There were 230 men and 128 women, and their age at operation was $63.2{\pm}10$ years (30~85 years). Results: There was no in-hospital mortality, and mean follow-up duration after discharge was 48.9 months (2~167 months). Immediate postoperative echocardiography revealed that LV mass index and mean gradient across the aortic valve decreased significantly (p<0.001), and LV mass continued to decrease during the follow-up period (p<0.001). LV ejection fraction (EF) temporarily decreased postoperatively (p<0.001), but LV function recovered immediately and continued to improve with a significant difference between preoperative and postoperative EF (p<0.001). There were 15 late deaths during the follow-up period, and overall survival at 5 and 10 years were 94% and 90%, respectively. On multivariable analysis, age at operation (p=0.008), concomitant coronary bypass surgery (p<0.003), lower preoperative LVEF (<40%) (p=0.0018), and higher EUROScore (>7) (p=0.045) were risk factors for late death. Conclusion: After AVR for degenerative AS, reduction of left ventricular mass and improvement of left ventricular function continue late after operation.

Incidence, mortality, and survival of liver cancer using Korea central cancer registry database: 1999-2019

  • Sung Yeon Hong;Mee Joo Kang;Taegyu Kim;Kyu-Won Jung;Bong-Wan Kim
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.26 no.3
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    • pp.211-219
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    • 2022
  • Backgrounds/Aims: Historically, incidence and survival analysis and annual traits for primary liver cancer (LC) has not been investigated in a population-based study in Korea. The purpose of the current study is to determine incidence, survival rate of patients with primary LC in Korea. Methods: We conducted a retrospective cohort study using Korea Central Cancer Registry based on the Korea National Cancer Incidence Database. Statistical analysis including crude rate and age-standadized rate (ASR) of incidence and mortality was performed for LC patients registered with C22 code in International Classification of Diseases, tenth revision from 1999 to 2019. Subgroup analysis was performed for hepatocellular carcinoma (HCC, C22.0) and intrahepatic cholangiocarcinoma (IHCC, C22.1). Results: The crude incidence rate of HCC (21.0 to 22.8 per 100,000) and IHCC (2.3 to 5.6 per 100,000) increased in the observed period from 1999 to 2019. The ASR decreased in HCC (20.7 to 11.9 per 100,000) but remained unchanged in IHCC (2.4 to 2.7 per 100,000). The proportion of HCC patients diagnosed in early stages (localized or regional Surveillance, Epidemiology, and End Results or SEER stage) increased significantly over time. As expected, 5-yeat survival rate of HCC was greatly improved, reaching 42.4% in the period between 2013 and 2019. This trait was more prominent in localized SEER stage. On the other hand, the proportion of IHCC patients diagnosed in localized stage remained unchanged (22.9% between 2013 and 2019), although ASR and 5-year survival rate showed minor improvements. Conclusions: A great improvement in survival rate was observed in patients with newly diagnosed HCCs. It was estimated to be due to an increase in early detection rate. On the contrary, detection rate of an early IHCC was stagnant with a minor improvement in prognosis.

Effectiveness of Rapid Response Team on In-hospital Mortality in Patients with Hematologic Malignancy (혈액암 환자의 원내 사망률에 미치는 신속대응팀의 효용성)

  • Park, So-Jung;Hong, Sang-Bum;Lim, Chae-Man;Koh, Youn-Suck;Huh, Jin-Won
    • Quality Improvement in Health Care
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    • v.27 no.2
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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.

Study on the Establishment of Threshold Criteria for Heat Health Watch Warning System in Korea; Part II: Improvement of Criteria (고온건강경보시스템 기준 설정에 관한 연구 ( II ) - 설정 기준 개선 -)

  • Jung, Woo-Sik;Park, Jong-Kil;Kim, Eun-Byul;Song, Jeong-Hui
    • Journal of Environmental Science International
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    • v.18 no.7
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    • pp.781-796
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    • 2009
  • The current standard level of Heat Health Watch Warning System consider both daily maximum temperature and daily maximum heat index(HI), but current standard could not consider daily maximum HI due to the difficulties in forecasting when we consider both daily maximum temperature and daily maximum HI and no considering HI because relative humidity could not observed for some regions. So, Newly established standard level of Heat Health Watch Warning System is based on daily maximum temperature exceeding $30^{\circ}C$ for two consecutive days or daily minimum temperature exceeding $25^{\circ}C$ and daily maximum temperature exceeding $30^{\circ}C$. These days are called "extreme heat days". On extreme heat days, the standard of extreme heat advisory is based on daily maximum temperature among exceeding $32.7^{\circ}C$ and not exceeding $34.8^{\circ}C$, and extreme heat warning is based on daily maximum temperature exceeding $34.8^{\circ}C$. ANOVA analysis was carried out using the data of Seoul Metropolitan City in 1994 to check the robustness of the new standard level of Heat Health Watch Warning System from this study, in particular for mortality variable. The results reveal that the new standard specifies excess mortality well, showing significance level of 0.05 in the difference of excess mortality for each phase.

Isolated Aortic Valve Replacement with the Ionescu-Shiley Xenograft Valve (대동맥판 치환수술의 임상성적)

  • 김종환
    • Journal of Chest Surgery
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    • v.18 no.1
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    • pp.46-53
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    • 1985
  • A single aortic valve replacement using the lonescu-Shiley bovine pericardial xenograft valve was performed in 66 consecutive patients during the period from February, 1979 to June, 1984. They were 49 males and 17 females with ages ranging from 9 to 61 [mean, 31.113.1] years, and 9 of them were children younger than 15 years of age. Twenty-seven patients [40.9%] required the combined operative procedures to either other valvular lesions or congenital defects. There were 9 early deaths within 30 days of surgery [operative mortality rate, 13.6%] and 2 late deaths thereafter [late mortality rate, 3.0%; or 1.75%/patient-year]. The 57 early survivors were followed for a total duration of 114.2 patient-years [mean, 24.016.0 months]. Four patients experienced thromboembolic complication with no death [3.50%/patient-year]; one died from intracranial bleeding related to anticoagulation [0.88%/patient-year]; one recovered from prosthetic valve endocarditis [0.88%/patient-year]; and four developed aortic regurgitant murmur with none or minimal cardiac symptoms and they were classified into cases of tissue valve failure [3.50%/patient-year]. The actuarial survival rate was 82.34.7% at 6 years, and the actuarial probabilities of freedom from thromboembolism and valve failure were 93.33.9% and 89.15.8% at postoperative 6 years respectively Symptomatic improvement was excellent in most late survivors at the follow-up end with the mean of NYHA Classes of 1.040.19 while the one was 2.290.67 at the time of operation. Excluding the higher operative mortality rates, these clinical results are fully comparable with the ones of reports from the major institutions using the porcine aortic or the bovine pericardial tissue valves and warrants the continued use of the xenograft valve in the aortic position. The importance of more detailed preoperative evaluation of the myocardial function and the need of improved myocardial preservation during surgery for the improved early clinical results were discussed.

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A clinical study of acute respiratory failure following open heart surgery (개심술후 급성 호흡부전에 관한 임상적 고찰)

  • Lee, Jae-Seong;Kim, Gyu-Tae
    • Journal of Chest Surgery
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    • v.17 no.3
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    • pp.409-417
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    • 1984
  • In the early days of open heart surgery, acute respiratory failure following extracorporeal circulation was a significant deterrent to an uncomplicated recovery. Although a marked improvement in prevention and treatment of postoperative respiratory failure has been achieved, the problem has not been completely eliminated and continues to be a causative factor in morbidity and mortality Fates following open heart surgery. We have attempted to evaluate postoperative respiratory failure in patients undergoing cardiac operation with the aid of extracorporeal circulation. Our series comprised 92 patients who underwent elective open heart surgery at the Department of Thoracic and Cariodvascular Surgery, School of Medicine, Kyungpook National University, from January, 1980 to December, 1982. In our study, the overall incidence of acute respiratory failure following open heart surgery was 18.8 percent. The duration of extracorporeal circulation in a series of 18 patients who developed postoperative respiratory failure [Group B] was longer in the mean value [120.3 minutes] than the uncomplicated 74 patients [Group A] [85.8 minutes]. The duration of artificial ventilation after open heart surgery in Group A averaged 13.4 hours as contrasted with 76.5 hours in Group B. In Group B, the inspired oxygen concentration [FiO2] in artificial ventilation was continued in the higher level than Group A until 18 hours after operation. Upon pulmonary function test performed pre-and postoperatively, residual volume[RV], RV/TLC and FEV 1.0/FVC were remained essentially unchanged following extracorporeal circulation, whereas forced vital capacity [FVC], FEV 1.0 and FEF 25-75% were significantly decreased in the early postoperative days. The incidence of acute respiratory failure was significantly higher in a series of patients who developed postoperative complications, such as re- exploration due to massive bleeding, low cardiac output, acute renal failure and arrhythmias. A total of 9 patients died, giving an overall mortality was 33.3 percent whereas the mortality was only 1.1 percent for patients without respiratory failure.

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Investigation on changes in pig farm productivity after ban of antibiotics growth promoter in commercial mixed feed (배합사료 내 항생제 사용금지 이후 양돈농가 생산성적 변화 조사)

  • Kim, Ki-Hyun;Cho, Eun-Seok;Kim, Kwang-Sik;Kim, Jo-Eun;Seol, Kuk-Hwan;Park, Jun-Cheol;Kim, Young-Hwa
    • Korean Journal of Agricultural Science
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    • v.42 no.3
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    • pp.223-229
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    • 2015
  • This study was conducted to investigate the changes in the pig productivity after ban of antibiotics growth promoter in commercial pig farms. A total 74 pig farms that herd size is from less than 100 sows to more than 500 sows were selected for survey. Changes of pig productivity before/after ban of antibiotics were analyzed by comparing with our survey results and report of KPPA (Korean Pork Producers Association, 2013). In the results, no difference on pig productivity was observed by herd size among our survey farms. Live born piglets have been raised as time passes since 2003, and then it reach to 10.6 head per sow in 2012. The numbers of weaning piglet tended to increase, but sow turnover ratio was found to be a tendency to decrease after ban of antibiotics in our survey results. There was no effect of using antibiotics on mortality of pre- and post- weaning. Marketing per sow per year (MSY) does not be improved because the post-weaning mortality was maintained at a high level, despite live pig born and weaning piglet have increased after 2003. In conclusion, a ban of antibiotics growth promoter does not directly affect to pig productivity, but it needs the efforts to reduce the mortality of post-weaning for improvement of pig productivity. We suggest that this data will be useful to swine industry as the fundamental information.

A Study of Life Table of Korean People : Based on 1986 Data (한국인의 생명표 작성에 관한 연구)

  • 김연희
    • Korea journal of population studies
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    • v.12 no.2
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    • pp.45-55
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    • 1989
  • In recent years the life expectancy of the Korean people has been increasing appreciably because of the improvement in living conditions and public health facilities as well. However, there exist considerable constraints in the measurement of Korea's mortality rate. In elaboration, there are quite a few persons who do not submit birth and death reports, thereby lowering the reliability of statistical data. The 1978-1979 life table of the Korean people is still considered the latest one. Nevertheless, a decade has passed since its publication, and the need for a better life table reflecting realities is inc-reasingly growing. Capitalizing on the annual report of demographic statistics and demographic sample survey data m 1988, I have worked out the 1986 tentative life table of the Korean people and found out the following : 1. The male life expectancy in the 1978-1979 life table of the Korean people is 62.7 years old, and that of the female sex is 69.1 years old whereas the average life expectancy of the male sex in the 1986 life table stands at 66.3 years old, and that of the female sex is 74.5 years old. The average life expectancy is up by 3.5 years old for the male sex and also, up 5.4 years old for the female sex, res-pe ctively. 2. A gap between the male and female life expectancies in the 1978-1979 life table was 6.4 years old, while that of the 1986 life table was 8.2 years old. It means the female life expectancy has increased substantially. 3. The infant mortality rate has decreased, compared with the 1978-1979 level, yet it is still above those of Japan and Taiwan. 4. The mortality rate of the middle - aged men in the forties remains high, as was the case in the 1978-1979 period.

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PARK Index and S-score Can Be Good Quality Indicators for the Preventable Mortality in a Single Trauma Center

  • Park, Chan Yong;Lee, Kyung Hag;Lee, Na Yun;Kim, Su Ji;Cho, Hyun Min;Lee, Chan Kyu
    • Journal of Trauma and Injury
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    • v.30 no.4
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    • pp.126-130
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    • 2017
  • Purpose: Preventable Trauma Death Rate (PTDR) using Trauma and Injury Severity Score (TRISS) has been most widely used as a quality indicator in South Korea. However, this method has a small number of deaths corresponding to the denominator. Therefore, it is difficult to check the change of quality improvement for annual mortality, and there is a disadvantage that variation is severe. Therefore, we attempted to improve the quality of the mortality evaluation by reducing the variation by applying the PARK Index (preventable major trauma death rate, PMTDR) which can increase the number of denominator significantly. And the Save score (S-score) was also examined as another quality indicator. Methods: In the PARK Index, the denominator is number of all patients who have survival probability (Ps) larger than 0.25. Numerator is the number of deaths among these. The PARK Index includes only patients with ISS >15. The S-score is calculated in the same way as the W-score, but the S-score includes only patients with ISS >15, which is a difference from the W-score. Results: PARK Index decreased annually and was 12.9 (37/287) in 2014, 9.6 (33/343) in 2015, and 7.3 (52/709) in 2016. S-score increased annually and was -0.29 in 2014, 4.21 in 2015, and 8.75 in 2016. Conclusions: PARK Index and S-score improved annually. This shows that both quality indicators are improving year by year. PARK Index (PMTDR) has 9.5-fold increase in denominator overall compared to PTDR by TRISS. The S-score used only ISS >15 patients as a denominator. Therefore, there is an advantage that the numerical value change is larger than the W-score. In addition, S-score is not affected by the ratio of major trauma patients to minor trauma patients.

Effect of Dietary Essential Oils on Growth, Feed Utilization and Meat Yields of White Leg Shrimp L. vannamei

  • Kim, J.D.;Nhut, T.M.;Hai, T.N.;Ra, C.S.
    • Asian-Australasian Journal of Animal Sciences
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    • v.24 no.8
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    • pp.1136-1141
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    • 2011
  • Effect of dietary essential oils on growth, feed utilization and meat yields of white leg shrimp L. vannamei was investigated. White shrimp fry weighing 0.62 g were kept in one of 12 tanks (75 head/500 L holding tank) in a closed recirculation system. Four experimental diets, a commercial diet (control), phytoncide oil (PO), oregano oil (OO) and fermented garlic liquid (GL) were fed for 16 weeks. The mean water quality values for the whole experimental period were $27.8{\pm}1^{\circ}C$, $7.6{\pm}0.3$, $15.5{\pm}0.3$ g/L and $6.1{\pm}0.3$ mg/L for water temperature, pH, salinity and dissolved oxygen, respectively. At the end of the trial, 10 shrimp per tank were randomly sampled and meat yields (%) were evaluated after peeling the shell and removing the head. After a 16 week feeding trial, final weight of shrimp ranged from 21.9 g to 23.6 g. Feed conversion was not significantly different among groups (p>0.05), which was the lowest (1.95) in the control and highest (2.30) in the PO. Specific growth rate was also not significantly different (p>0.05) and ranged from 3.18% to 3.25%. Average daily gain of 0.2 g was obtained in all treatments. Mortality varied from 35.1% for control to 44.9% for OO. Meat yields maintained constant at 52.1% for control to 53.0% for PO. The study suggested that natural essential oils could not exert any improvement in growth performance, mortality and meat yields of white leg shrimp.