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Predictors of Readmission after Inpatient Plastic Surgery

  • Jain, Umang;Salgado, Christopher;Mioton, Lauren;Rambachan, Aksharananda;Kim, John Y.S.
    • Archives of Plastic Surgery
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    • v.41 no.2
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    • pp.116-121
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    • 2014
  • Background Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. Methods The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. Results A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD) (odds ratio [OR], 2.01; confidence interval [CI], 1.12- 3.60; P=0.020), previous percutaneous coronary intervention (PCI) (OR, 2.69; CI, 1.21-5.97; P=0.015), hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P<0.001), bleeding disorders (OR, 1.70; CI, 1.01-2.87; P=0.046), American Society of Anesthesiologists (ASA) class 3 or 4 (OR, 1.57; CI, 1.15-2.15; P=0.004), and obesity (body mass index ${\geq}30$) (OR, 1.43; CI, 1.09-1.88, P=0.011) to be significant predictors of readmission. Conclusions Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations.

The Importance of Basel Style in the Evolution of Modern Typography in the 20th Century (20세기 모던 타이포그래피의 전개와 바젤 스타일의 위상)

  • 강현주
    • Archives of design research
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    • v.13 no.3
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    • pp.135-144
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    • 2000
  • In the 1930s modernist approaches in graphic design and typography had emerged and were exported as Swiss Style or the International Typographic Style in the late 1950s. Basel's school of Design has played an important role in the further development of the style and acted as a bridge between modern typographic traditions and new technology. This school was one of the most influential design institutes during the past half-century. Leading practitioners at this school developed a new visual vocabulary which was a revolutionary precursor to a digital era. Those ideas were widely appropriated in the'70s and'80s, becoming one of the most profound influences on American New Wave. The influence has continued into the 1990s. The intent of this study is to inquire into the history of 20th-century modern typography in a social and aesthetic context.

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A Study on the Korean Red Ginseng Packaging (홍삼의 패키지 현황과 디자인 개선 방안)

  • 김미자
    • Archives of design research
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    • v.17 no.2
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    • pp.373-382
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    • 2004
  • The value of Korean ginseng has been known in the world since the 4th century B. C. Red ginseng is hot-steamed, and then dried for the purpose of long-term storing. Through the steaming and drying process, its moisture rate is reduced to 14% and its color becomes citrine or light yellowish brown. Its hardened structure enables long-term storage without any deformation. Especially, Korean red ginseng contains substances that promote micro-physiological activities which are not found in American or Sanchi ginseng. Ginseng is produced in diverse forms for the customer's convenience. In this study, these are classified as sliced, dried, and honeyed ginseng, granulated tea, extract, powder, capsules, tablets, drinks and candy. Package design is one of the most effective method in the marketing fields. However, in this research, we found that red ginseng packages are not variously and properly developed in materials and designs. The research pointed out the problems and discuss ways and means of the package design.

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Early Surgical Site Infection Following Tissue Expander Breast Reconstruction with or without Acellular Dermal Matrix: National Benchmarking Using National Surgical Quality Improvement Program

  • Winocour, Sebastian;Martinez-Jorge, Jorys;Habermann, Elizabeth;Thomsen, Kristine;Lemaine, Valerie
    • Archives of Plastic Surgery
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    • v.42 no.2
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    • pp.194-200
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    • 2015
  • Background Surgical site infections (SSIs) result in significant patient morbidity following immediate tissue expander breast reconstruction (ITEBR). This study determined a single institution's 30-day SSI rate and benchmarked it against that among national institutions participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Methods Women who underwent ITEBR with/without acellular dermal matrix (ADM) were identified using the ACS-NSQIP database between 2005 and 2011. Patient characteristics associated with the 30-day SSI rate were determined, and differences in rates between our institution and the national database were assessed. Results 12,163 patients underwent ITEBR, including 263 at our institution. SSIs occurred in 416 (3.4%) patients nationwide excluding our institution, with lower rates observed at our institution (1.9%). Nationwide, SSIs were significantly more common in ITEBR patients with ADM (4.5%) compared to non-ADM patients (3.2%, P=0.005), and this trend was observed at our institution (2.1% vs. 1.6%, P=1.00). A multivariable analysis of all institutions identified age ${\geq}50$ years (odds ratio [OR], 1.4; confidence interval [CI], 1.1-1.7), body mass index ${\geq}30kg/m^2$ vs. < $25kg/m^2$ (OR, 3.4; CI, 2.6-4.5), and operative time >4.25 hours (OR, 1.9; CI, 1.5-2.4) as risk factors for SSIs. Our institutional SSI rate was lower than the nationwide rate (OR, 0.4; CI, 0.2-1.1), although this difference was not statistically significant (P=0.07). Conclusions The 30-day SSI rate at our institution in patients who underwent ITEBR was lower than the nation. SSIs occurred more frequently in procedures involving ADM both nationally and at our institution.

A Study on the Fine Art and Cultural Policy under the U.S. Military Government in Korea, 1945~1948 (미군정의 문화정책과 미술, 1945~1948)

  • Ahn, Jin-Ie
    • The Journal of Art Theory & Practice
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    • no.4
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    • pp.7-32
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    • 2006
  • This study is about the cultural policy related to fine art under the U. S. Military Government in Korea(USAMGIK), from September 8, 1945, to August 15, 1948. Drawing on the previous studies of Korean art history in the 'Liberation Period', this study especially concentrates on intention, attitude and activities of the USAMGIK. Particularly the historical documents, stored at the National Archives at the College Park, Maryland, U.S.A., were valuable to do research on the cultural policy of USAMGIK. The cultural policy was subordinated to the political objectives of occupation that can be summarized to building a stronghold of anti-communism in South Korea. Under the U.S. Military government control, cultural matters were assigned to the Cultural Section, the Bureau of Education, which later turns into the Bureau of Culture, the Department of Education. The Bureau of Culture dealt with matters of the ancient Korean art treasures and of the Korean contemporary art. USAMGIK reopened the Korean National Museum which had been closed by the Japanese since the World War II period. After that, U.S. Department of State sent arts & monuments specialists to South Korea for investigating ancient Korean art and culture. Although some of the destructed art treasures were restored during the occupation, th ere were many negative cases including intentional destruction of historic sites or loot of art treasures by U.S. army. In contrast to their interest in the Korean antiquities, USAMGIK payed little attention to promoting the Korean contemporary artists and their arts. USAMGIK distrusted and suppressed the artists of leftism, while they kept good relations with the pro-American artists and the right-wing artists. In conclusion, the visual-cultural policy of USAMGK was mainly planned and carried out in order to preserve the national interest of the United States. This period produced long-term effects on the fine art and visual culture of South Korea, in terms of institution, policy, and reorganization of art community based on anti-cummunism.

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Sex-related and racial variations in orbital floor anatomy

  • Moon, Seung Jin;Lee, Won Jai;Roh, Tai Suk;Baek, Wooyeol
    • Archives of Craniofacial Surgery
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    • v.21 no.4
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    • pp.219-224
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    • 2020
  • Background: Repair of the orbital floor following trauma or tumor removal remains a challenge because of its complex three-dimensional shape. The purpose of the present study is to understand normal orbital floor anatomy by investigating its differences across four groups (Caucasian American and East Asian, males and females) via facial bone computed tomography (CT). Methods: A total of 48 orbits in 24 patients between 20 and 60 years of age were evaluated. Although most patients underwent CT scanning following trauma, the orbital walls were intact in all patients. Linear and angular measurements of the orbital floor were obtained from CT images. Results: Orbital floor width, length, angle between the orbital floor and medial wall, and distance from the inferior orbital rim to the lowest point of the orbital floor did not show a statistically significant difference between groups. Angles made by the infraorbital rim, the lowest point of the floor, and the anterior border of the infraorbital fissure were statistically significantly wider in East Asian females than in male groups. The floor depth in East Asian females was significantly smaller compared to all the other groups. Conclusion: East Asian female population had smaller curvature and depth of an orbital floor than the other groups, which means racial and sex-related differences should be considered in the orbital floor reconstruction.

Interposition Arthroplasty with Pectoralis Major Muscle Transfer for the Shoulder Arthropathy - 2 Cases Report - (견관절 관절증에서 대흉근 이전술을 이용한 삽입 성형술)

  • Park, Jin-Soo;Lee, Yong-Beom;Yoo, Jung-Han;Park, Yong-Wook;Rowe, Kyu-Cheol;Chung, Kook-Jin;Kim, Hong-Kyun;Hwang, Ji-Hyo;Kim, Hyung-Nyeon;Song, Young-Suk;Son, Won-Su
    • Archives of Reconstructive Microsurgery
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    • v.19 no.1
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    • pp.7-11
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    • 2010
  • Interpostion arthroplasty with allograft has been known as a useful option for the shoulder arthropathy, but it has a limitation to immune response. We performed the pectoralis major muscle transfer for shoulder arthropathy. From January 2007 to December 2007, we performed the pectoralis major muscle transfer in 2 patients. They were 1 man and 1 woman, and the mean age of the patients was 70 years (range, 65 to 75). The average follow-up after surgery was 13 months (range, 12 to 14). We analyzed the clinical results by the American Shoulder and Elbow Surgeons (ASES) Score, and evaluated the pain by Visual Analogue Scale. The level of pain reduced from a preoperative average of 10 to a postoperative average of 1. The ASES scores increased from a preoperative mean of 9 to a postoperative mean of 58. These results indicated that interposition arthroplasty with the pectoralis major muscle transfer is a reliable treatment method for the shoulder arthropathy improving shoulder pain, and patient satisfaction.

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Incidence and Risk Factors of Pulmonary Thromboembolism in Pedicled TRAM Breast Reconstruction (유경횡복직근피판을 이용한 유방복원술시 폐색전증의 발병률과 위험인자)

  • Lee, Sang Hyuk;Lee, Taik Jong;Eom, Jin Sup;Son, Byung Ho;Ahn, Sei Hyun;Lee, Sang Do
    • Archives of Plastic Surgery
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    • v.33 no.2
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    • pp.193-197
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    • 2006
  • Pulmonary thromboembolism is often clinically silent and difficult to diagnose, and can be fatal to patients with belated treatment. This complication is seen in patients who underwent TRAM breast reconstruction. Multiple factors are involved in this disease such as the presence of malignancy itself, major surgery and therapy-related interventions. TRAM surgery is a lengthy procedure involving mastectomy, flap surgery and abdominoplasty. The purpose of this study is to evaluate the incidence and the correlation between presurgical risk factors(BMI and age) of symptomatic pulmonary thromboembolism after TRAM surgery and the incidence. From July 2001 to March 2005 a total of 384 pedicled TRAM reconstruction of breast was performed in 382 patients at Asan Medical Center. The average of Body mass index was $21.9kg/m^2$ and mean age of the patients was 37.9 years old. We diagnosed symptomatic pulmonary thromboembolism using ventilation/perfusion lung scan and pulmonary embolism computed tomography. Incidence of in-hospital symptomatic pulmonary thromboembolism was 1.3%. BMI and age showed no significant statistical relationship to pulmonary thromboembolism. But the incidence of symptomatic pulmonary thromboembolism in obese patients (BMI > 25) was 3.75%. According to the guideline of the 7th American College of Chest Physicians Consensus Conference on Antithrombotic and Thrombolytic Therapy, the incidence of 3.75% was classified as high risk group. The prevention of pulmonary thromboembolism should be considered in cases of obese patients with low molecular weight heparin(BMI > 25).

A study on formative speciality through Emilio Pucci's work (Pucci 작품에 나타난 조형적 특징에 관한 연구)

  • 박선경
    • Archives of design research
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    • v.9
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    • pp.501-510
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    • 1994
  • Discovered as designer of own ski loths by American potographer Toni Frissell, !n 1947; designed ski wear for Lord '||'&'||' Taylor store in New York follewing year. He opened a shop on Capri in 1949 and in 1950 he founded "Emilio", his couture house. His fortune was simple silk jersey chemises and very strong prints using bold colour in abstract patterns. A pucci print was immediately recognizable and, although often based on medieval heraldic banners of the sort waved at the "Siena Palio", so utterly of the moment that it could be taken as a classic symbol of the late 1950s and early 1960s. He was a brilliant colourist and his colours became the colours of the decade: hot pink, lime blue, purple. He seemed able to capture the sun and fun of Italy in his print and, along with Galitzine, he can take the credit for creating the concept of relaxed, informal elegance in Italian faslion.ian faslion.

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A Study of April Greiman's Work (에이프릴 그레이만의 작품에 관한 연구)

  • 홍석일
    • Archives of design research
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    • v.9
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    • pp.1201-1208
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    • 1994
  • During the 1970s, as Los Angeles-based designer April Greiman made her professional way, her work was popularly labeled "New Wave: The term no longer seems to fit. Today, Greiman refers to her brand of design as "hybrid imagery." For combining photography, drawing, video, computer-generated images and typography in her designs, she creates a crossbreed that blends but is unlike any of its parts. To her credit, Greiman was one of the first designers who saw potential in the "textures" of video and computer-based imagery, and was brave enough to integrate this new visual language into the mainstream design work she was creating. She was also one of the designers to use the Macintosh computer as her primary design tool. Despite her pioneering work, she refuses the label of "experimental" designer. She prefers to say she, is interested in process, in layering images to evoke both a thoughtful and emotional response. thoughtful and emotional response.

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