• 한국전문물리치료학회지
• /
• 제14권3호
• /
• pp.81-89
• /
• 2007

The purpose of this study was to utilize the K-MBI (Korean Modified Barthel Index) and subscales of K-MBI in predicting the length of hospital stay (LOS) and the discharge destinations for stroke patients. The study population consisted of 97 stroke patients (57 men and 40 women) admitted to the Seoul National University at the Bundang Hospital. All participants were assessed by K-MBI at admission and discharge after rehabilitation therapy and the information available was investigated at admission. The data were analyzed by using the Mann-Whitney U test, the stepwise multiple regression and the logistic regression. The median LOS was 30 days (mean, 32.8 days; range, 22 to 43 days). The K-MBI score at initiation of rehabilitation therapy (p<.001), the type of stroke and living habits before a stroke were the main explanatory indicators for LOS (p<.05). Within the parameters of K-MBI measured at initiation for rehabilitation, feeding and chair/bed transfer were the explanatory factors for LOS prediction (p<.01). Confidence in the prediction of LOS was 20%. Significant predictors of discharge destination in a logistic regression model were the discharge K-MBI score, sex and hemiplegic side. Dressing in items of discharge K-MBI was the significant predictor of discharge destination. The K-MBI score was the most important factor to predict LOS and discharge destination. Knowledge of these predictors can contribute to more appropriate treatment and discharge planning.

• Journal of Chest Surgery
• /
• 제52권6호
• /
• pp.409-415
• /
• 2019

Background: Postoperative chylothorax may be caused by iatrogenic injury of the collateral lymphatic ducts after thoracic surgery. Although traditional treatment could be considered in most cases, resolution may be slow. Radiological interventions have recently been developed to manage postoperative chylothorax. This study aimed to compare radiological interventions and conservative management in patients with postoperative chylothorax. Methods: We retrospectively reviewed periprocedural drainage time, length of hospital stay, and nil per os (NPO) duration in 7 patients who received radiological interventions (intervention group [IG]) and in 9 patients who received conservative management (non-intervention group [NG]). Results: The baseline characteristics of the patients in the IG and NG were comparable; however, the median drainage time and median length of hospital stay after detection of chylothorax were significantly shorter in the IG than in the NG (6 vs. 10 days, p=0.036 and 10 vs. 20 days, p=0.025, respectively). NPO duration after chylothorax detection and total drainage duration were somewhat shorter in the IG than in the NG (5 vs. 7 days and 8 vs. 14 days, respectively). Conclusion: This study showed that radiological interventions reduced the duration of drainage and the length of hospital stay, allowing an earlier return to normal life. To overcome several limitations of this study, a prospective, randomized controlled trial with a larger number of patients is recommended.

• Journal of Yeungnam Medical Science
• /
• 제39권1호
• /
• pp.31-38
• /
• 2022

Background: To prepare for future work stoppages in the medical industry, this study aimed to identify the effects of healthcare worker strikes on the mortality rate of patients visiting the emergency department (ED) at six training hospitals in Daegu, South Korea. Methods: We used a retrospective, cross-sectional, multicenter design to analyze the medical records of patients who visited six training hospitals in Daegu (August 21-September 8, 2020). For comparison, control period 1 was set as the same period in the previous year (August 21-September 8, 2019) and control period 2 was set as July 1-19, 2020. Patient characteristics including age, sex, and time of ED visit were investigated along with mode of arrival, length of ED stay, and in-hospital mortality. The experimental and control groups were compared using t-tests, and Mann-Whitney U-test, chi-square test, and Fisher exact tests, as appropriate. Univariate logistic regression was performed to identify significant factors, followed by multivariate logistic regression analysis. Results: During the study period, 31,357 patients visited the ED, of which 7,749 belonged to the experimental group. Control periods 1 and 2 included 13,100 and 10,243 patients, respectively. No significant in-hospital mortality differences were found between strike periods; however, the results showed statistically significant differences in the length of ED stay. Conclusion: The ED resident strike did not influence the mortality rate of patients who visited the EDs of six training hospitals in Daegu. Furthermore, the number of patients admitted and the length of ED stay decreased during the strike period.

• 보건행정학회지
• /
• 제23권2호
• /
• pp.124-131
• /
• 2013

Background: This study aimed to measure the opportunity income by identifying the economic length of stay (ELOS) which is the intersection point of daily revenue and cost on appendectomy and pneumonia cases. Methods: The research subjects were 460 patients of appendectomy and 606 patients of pneumonia, discharged from a general hospital between July 1, 2009 and June 30, 2010. ELOS calculated with both of total revenue on diagnosis-related group (DRG) and fee-for service (FFS). The cost is calculated by activity-based costing system of the hospital. Results: Average length of stay (ALOS) of appendectomy was 4.48 days and its average revenue per case were 1,710,215 (1,989,105) won by DRG (FFS). The variable cost was 491,262 won which was 28.7% (24.7%) of DRG (FFS) total revenue. And 97.2% of the total variable cost was incurred within 2 days from admission. The ELOS was 4 (5) days in DRG (FFS). Shortening three days (two days) would increase opportunity income 52.0% (82.2%) in DRG (FFS). ALOS of pneumonia case was 4.86 days and its average revenue per case were 489,448 (761,426) won by DRG (FFS). The variable cost was 27,230 won which was 5.6% (3.6%) of DRG (FFS) total revenue. Thirty-eight point nine percent of the daily variable cost was incurred in discharge date. The ELOS was 2 (4) days in DRS (FFS). Shortening three days (one day) would increase opportunity income 27.6% (37.2%) in DRG (FFS). Conclusion: The ELOS would be used by strategic index for achieving minimum profit and developing the ways to get there. But we also should not pass over that the opportunity income obtained by the reducing ALOS may cause some problem of quality.

• Journal of Chest Surgery
• /
• 제33권9호
• /
• pp.729-733
• /
• 2000

Background: Recent trends suggest that minimally invasive cardiac surgery reduces postoperative morbidity and offers a cosmetic benefit. This study was performed to evaluate the CPB time, ACC time, OP time, ICU stay and postoperative hospital stay following a lower partial sternotomy and those of the median sternotomy. Material and Method: A group of 26 adult patients who underwent cardiac surgery through lower partial sternotomy from August 1997 to July 1999(A group) were compared to 45 adult patients who underwent cardiac surgery through median sternotomy from January 1996 to July 1997(B group). The mean ages(46.4$\pm$14.6 years, A group and 46.8$\pm$13.2 years, B group) were similar. Operations were performed with central cannula and antegrade/retrograde blood cardioplegia. Result: There was no death in each group. No differences were found in CPB time, ACC time, OP time, ICU stay and postoperative hospital stay. Postoperative complications were sternal splitting in a patient in group A and a patient with bleeding that required reoperation and a patient with delayed wound closure in group B. Conclusion: The lower partial sternotomy offered a cosmetic benefit, but does not significantly reduced the length of operative time and hospital stay. Minimally invasive cardiac surgery will be applied increasing because of the suggested advantage and choosing a proper operative technique will be helpful.

• Child Health Nursing Research
• /
• 제18권1호
• /
• pp.43-52
• /
• 2012

Purpose: The purpose of this study was to provide basic data for suitable neonate blood glucose maintenance by investigating and analyzing the blood glucose level of post cardiovascular surgery neonates in the ICU for the effect of blood glucose levels on the following outcomes; ICU stay, hospital stay, mechanical ventilation time, morbidity, and mortality. Methods: The participants were 143 neonates in the ICU after having had cardiovascular surgery. The design for this study was an investigation of the blood glucose levels of the neonates and retrospective analysis of patient outcomes according to blood glucose level. Results: The results for the neonate groups showed that the factors of hospital stay, ICU stay, mechanical ventilation time and mortality, for the group with a blood glucose level over 140 mg/dL were longer and higher than for the group with blood glucose of less than 100 mg/dL or the group between 100-139 mg/dL. Conclusion: The results of this study indicate that when caring for neonates after cardiovascular surgery, it is important to recognize the influence of blood glucose levels on patient outcomes like hospital days, ICU stay, length of time on mechanical ventilation and mortality. Further, care guidelines for neonates' glucose level management need to be developed.

• 보건행정학회지
• /
• 제21권2호
• /
• pp.195-212
• /
• 2011

Objectives: This study investigates the relationship between nurse staffing levels and differences in patient outcomes in terms of average length of stay, in-hospital mortality rate and 30-day death rate in order to evaluate the effectiveness of a policy that differentiates fees for inpatients on the basis of nurse-to-bed ratios. Methods: We obtained information on inpatients from health insurance claims data published by the Health Insurance Review and Assessment Service(HIRA) in 2008, organizational factors(type of hospital, ownership) from the records of the hospital report system in 2008, and nurse staffing levels, which were graded on a scale of 1 to 7, from data compiled between December 15, 2007, and September 20, 2008. The data were segregated according to type of hospital and quarter and finally 3,517 records of 1,182 hospitals were analyzed using multi-level analysis. Results: The average length of stay in grade 1~6 hospitals was lower than that in grade 7 ones, but the difference was much below one day. No significant difference was found among different grades in tertiary hospitals. Further, variations in staffing levels did not result in any significant difference in the in-hospital mortality rate and 30-day death rate. Conclusions: High nurse staffing levels did not result in better patient outcomes compared with low staffing levels. We therefore recommend modifying the above nurse staffing policy so as to make it more effective in improving patient outcomes.

• Journal of Cardiovascular Imaging
• /
• 제30권1호
• /
• pp.50-58
• /
• 2022

BACKGROUND: Little is known regarding right ventricular (RV) remodeling immediately after Tetralogy of Fallot (TOF) repair. We sought to describe myocardial deformation by cardiac magnetic resonance imaging (CMR) after TOF repair and investigate associations between these parameters and early post-operative outcomes. METHODS: Fifteen infants underwent CMR without sedation as part of a prospective pilot study after undergoing complete TOF repair, prior to hospital discharge. RV deformation (strain) was measured using tissue tracking, in addition to RV ejection fraction (EF), volumes, and pulmonary regurgitant fraction. Pearson correlation coefficients were used to determine associations between both strain and CMR measures/clinical outcomes. RESULTS: Most patients were male (11/15, 73%), with median age at TOF repair 53 days (interquartile range, 13,131). Most patients had pulmonary stenosis (vs. atresia) (11/15, 73%) and 7 (47%) received a transannular patch as part of their repair. RV function was overall preserved with mean RV EF of 62% (standard deviation [SD], 9.8). Peak radial and longitudinal strain were overall diminished (mean ± SD, 33.80 ± 18.30% and -15.50 ± 6.40%, respectively). Longer hospital length of stay after TOF repair was associated with worse RV peak radial ventricular strain (correlation coefficient (r), -0.54; p = 0.04). Greater pulmonary regurgitant fraction was associated with shorter time to peak radial RV strain (r = -0.55, p = 0.03). CONCLUSIONS: In this small study, our findings suggest presence of early decrease in RV strain after TOF repair and its association with hospital stay when changes in EF and RV size are not yet apparent.

• 사물인터넷융복합논문지
• /
• 제3권2호
• /
• pp.21-32
• /
• 2017

본 연구는 노인 전신마취 환자의 회복실 체류시간에 영향을 미치는 융합적 요인들을 파악하기 위한 서술적 조사연구이다. 경기도 소재 C대학병원에서 2014년 1월 1일부터 2014년 12월 31일까지 전신마취하에 수술을 받고 회복실에 입실하였던 환자 중 65세 이상인 환자 300명을 대상으로 후향적으로 자료 수집을 하였다. 회복실 체류시간은 평균 48.4분으로 나타났으며, 회복실 체류시간 30-59분이 58.0%로 가장 많았다. 수술중 요인에 따른 회복실 체류시간 정도는 근이완제, 수혈, 동맥혈가스 검사, 체온 그리고 총 마취시간에 따라 유의한 차이가 있는 것으로 나타났다. 수술후 요인에 따른 회복실 체류시간 정도는 합병증, 자가 통증 조절기, 순환기계 약물사용에 따라 유의한 차이가 있는 것으로 나타났다. 회복실 체류시간에 영향을 미치는 요인을 알아보기 위해 다중 회귀분석을 실시한 결과 수술 후 '순환기계 약물사용', '수술 중 저체온'이 회복실 체류시간에 영향을 미치는 것으로 확인되었고 설명력은 13%로 나타났다. 이러한 결과를 토대로 회복실 체류시간 관련요인들을 모니터링하고 신속하게 처치하여 교정하는 것이 노인 전신마취 환자의 회복실 체류시간의 단축에 기여할 것으로 사려된다.

• 한국콘텐츠학회논문지
• /
• 제21권4호
• /
• pp.487-497
• /
• 2021

본 연구의 목적은 2008년부터 2017년까지의 결핵환자의 결핵 종류, 환자 특성, 입원 및 질병관련 특성, 의료기관 특성에 따른 재원기간과 사망에 영향을 미치는 요인을 파악하고자 한다. 질병관리청에서 제공하는 퇴원손상심층조사자료를 활용하였고, 제6차 한국표준질병사인분류(KCD)의 퇴원시 진단 코드가 결핵(A15, A16, A17, A18, A19, U88.0, U88.1, U84.30, U84.31)인 환자를 추출하여 총 10,634건을 최종 분석에 사용하였다. 수집된 자료는 통계 프로그램 STATA 13.0 프로그램을 이용하여 빈도분석, 교차분석(chi-square test), Fisher's exact test와 로지스틱 회귀분석을 실시하였다. 연구결과로 재원기간에 영향을 미치는 요인으로 폐결핵을 기준으로 폐외결핵, 복합결핵, 내성결핵일 때, 남자보다는 여자일 때, 연령이 높을수록, CCI(Charlson Comorbidity Index) 점수가 높을수록, 병원소재지 서울을 기준으로 광역시일 때 14일 이상 재원환자가 많았지만 외래경유, 병상규모가 작을수록 14일 이상 재원환자가 적었다. 그리고 사망에 영향을 미치는 요인은 폐결핵을 기준으로 폐외결핵, 내성결핵 일 때, 남자보다는 여자일 때, 연령이 높을수록, CCI 점수가 높을수록, 병원소재지가 서울을 기준으로 광역시, 도지역일 때 사망이 높았으나 거주지가 특별시일때 보다는 농촌, 외래경유 입원인 경우 사망이 낮았다. 결론으로 기존의 결핵관리가 조기발견에 따른 신속한 진단과 치료의 환자 관리였다면 앞으로는 장기재원과 치료결과 사망률이 높은 고위험군을 파악하고 이를 지원하는 제도를 위한 연구들이 추가적으로 진행되어야 할 것이다.