• 보건행정학회지
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• 제16권3호
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• pp.37-51
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• 2006

This study evaluates the reliability of the discharge status variable m health insurance claims for identifying in-hospital patient deaths. This study used 2002 national health insurance claims and the cause of death statistics from Korean national statistical office. The Study data set included acute myocardial infarction (AMI) and coronary artery bypass graft (CABG) surgery patients in 133 general and tertiary hospitals. The gold standard containing patient death information was made and then compared with that of claims data. The hospitals were classified into four groups based on the number of deaths in each hospital. Simple kappa coefficients were calculated to evaluate the agreements of patient deaths between the gold standard and the insurance claims. CABG (83.9%) showed higher agreements than AMI(73.0%) in matched in-hospital patient death information between data sets. Simple kappa coefficients of CABG (0.63) and AMI (0.59) showed moderate or good agreements. The agreements, however, varied depending on the disease or hospital types. The fact that the agreements are only moderate to good indicates that the accuracy of in-hospital death information in claims is not high. n the variable is used to identify patient deaths, it may mislead people. Therefore, efforts should be made to improve the reliability of the discharge status variable in health insurance claims.

• 한국의료질향상학회지
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• 제7권2호
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• pp.218-228
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• 2000

Background : Among 'structure', 'process' and 'outcome' approaches, outcome evaluation is considered as the most direct and best approach to assess the quality of health care providers. Risk-adjustment is an essential method to compare outcome across providers. This study has aims to judge performance of hospitals by severity adjusted mortality rates of coronary artery bypass graft (CABG) surgery. Methods : Medical records of 584 patients who got the CABG surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups was used to quantify severity of patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex. For evaluation of hospital performance, we calculated ratio of observed number to expected number of deaths and z score [(observed number of deaths - expected number of deaths)/square root of the variance in the number of deaths], and compared observed mortality rate with confidence interval of adjusted mortality rate for each hospital. Results : The overall in-hospital mortality was 7.0%, ranged from 2.7% to 15.7% by hospital. After severity adjustment the mortality by hospital was from 2.7% to 10.7%. One hospital with poor performance was distinctly divided from others with good performance. Conclusion : In conclusion, severity-adjusted mortality rate of CABG surgery might be applied as an indicator for hospital performance evaluation in Korea. But more pilot studies and improvement of methodologies has to be done to use it as quality indicator.

• 대한간호학회지
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• 제37권7호
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• pp.1159-1165
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• 2007

Purpose: The purpose of this study was to investigate the stages of change in smoking cessation after a Coronary Artery Bypass Graft(CABG) and to identify the related factors. Methods: The subjects (n=157) were patients who underwent a CABG in a university hospital from March 1998 to October 2005 and were smokers before the CABG. Data was collected viachart review and a telephone interview, and analyzed with descriptive statistics, $X^2$ test, one-way ANOVA, and Kruskal-Wallis procedure by the SPSS/PC win 12.0 program. Results: The subjects smoked for an average of 34 years (21 cigarettes per day) before surgery. Eleven percent of the subjects were in pre-contemplation, 6.4% in contemplation, 13.5% in preparation, 4.5% in action, and 64.5% in the maintenance stage. Nicotine dependence and self-efficacy were different among the groups with different stages of change in smoking cessation. Nicotine dependence was the lowest (p=0.00) and self-efficacy was the highest (p=0.00) in the maintenance stage. The number of subjects in pre-contemplation and contemplation significantly increased 6 years after surgery(p=0.05). Conclusions: To implement effective smoking cessation interventions for CABG patients, the intervention should be developed to accommodate individual readiness for smoking cessation, especially so for those who had a CABG more than 6 years previously.

• Journal of Preventive Medicine and Public Health
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• 제39권1호
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• pp.13-20
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• 2006

Objectives: To propose a risk-adjustment model with using insurance claims data and to analyze whether or not the outcomes of non-emergent and isolated coronary artery bypass graft surgery (CABG) differed between the low- and high-volume hospitals for the patients who are at different levels of surgical risk. Methods: This is a cross-sectional study that used the 2002 data of the national health insurance claims. The study data set included the patient level data as well as all the ICD-10 diagnosis and procedure codes that were recorded in the claims. The patient's biological, admission and comorbidity information were used in the risk-adjustment model. The risk factors were adjusted with the logistic regression model. The subjects were classified into five groups based on the predicted surgical risk: minimal (<0.5%), low (0.5% to 2%), moderate (2% to 5%), high (5% to 20%), and severe (=20%). The differences between the low- and high-volume hospitals were assessed in each of the five risk groups. Results: The final risk-adjustment model consisted of ten risk factors and these factors were found to have statistically significant effects on patient mortality. The C-statistic (0.83) and Hosmer-Lemeshow test ($x^2=6.92$, p=0.55) showed that the model's performance was good. A total of 30 low-volume hospitals (971 patients) and 4 high-volume hospitals (1,087 patients) were identified. Significant differences for the in-hospital mortality were found between the low- and high-volume hospitals for the high (21.6% vs. 7.2%, p=0.00) and severe (44.4% vs. 11.8%, p=0.00) risk patient groups. Conclusions: Good model performance showed that insurance claims data can be used for comparing hospital mortality after adjusting for the patients' risk. Negative correlation was existed between surgery volume and in-hospital mortality. However, only patients in high and severe risk groups had such a relationship.

• Journal of Chest Surgery
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• 제33권8호
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• pp.638-642
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• 2000

Background: In an effort t enhance long term patency of coronary bypass grafts, utilization of arterial conduits have been on an icrease. With the same objective, we have been using the right gastroepiploic artery(RGEA)in coronary artery bypass procedures since 1998. The current paper has been undertaken with the aim of assessing the apropriateness, problems, and short term results of using the RGEA as an arterial graft conduit by studying the postoperative clinical results of 100 patients than received coronary artery bypass grafting (CARG) with this artery. Material and Method: Between May of 1998 and May of 1999, an analysis of the mortality, postoperative myocardial infarction, and the need for IABP insertion as a result of low cardiac output were made between 100 consecutive patients undergoing CABG with the RGEA. Result: There was one postoperative death due to cerebral infarction. Postoperative complications/morbidity comprised myocardial infarction in 2, cerebral infarct in 3, reoperation due to bleeding in 1, mediastinitis in 1, and low cardiac output syndrome necessitating IABP in 3 patients. Complicatons related to harvesting of the arterial grafts were not experienced in any of the patients. Conclusion: The results of the current data show that utilization of the RGEA in CABG is not associated with increased mortality/morbidity and demonstrates satisfactory short term results suggesting the usefulnessof this conduit as an arterial graft.

• Journal of Chest Surgery
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• 제38권7호
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• pp.504-506
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• 2005

심강내관상동맥은 전체 관상동맥우회술 환자 중 약 $0.2\~0.3\%$에서 발견되며, 국내에서는 아직 보고된 바 없는 극히 드문 관상동맥기형의 일종이다. 수술 전 관상동맥조영술을 통하여 진단하기 어렵고, 관상동맥우회술 후에 우심실로부터의 출혈이 발생할 수 있으므로 우심실절개 부위의 견고한 봉합이 필요하다. 기존의 증례 보고에 따르면 외과용거즈(pledget)를 이용한 수평매트리스봉합(horizontal mattress suture)이 추천되기는 하나 주위의 심근을 압박하여 관상동맥가지 및 관통동맥의 협착을 유발할 수 있어, 단순단속봉합(simple interrupted suture)을 이용하고도 수술 후 별다른 합병증 얼이 호전된 예를 경험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제46권4호
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• pp.265-273
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• 2013

Background: The safety and efficacy of arterial composite grafts for total arterial revascularization have been demonstrated. The saphenous vein (SV) is a widely used graft because of its accessibility, sufficient length, and ease of manipulation. Our aim was to compare mid-term outcomes of saphenous vein Y-grafts with radial artery Y-grafts joined by anastomosis to the left internal thoracic artery. Materials and Methods: Records of off-pump coronary artery bypass grafting with composite Y-grafts based on the left internal thoracic artery technique in 552 patients were analyzed retrospectively. After propensity score matching, 79 radial arterial (RA) composite grafts (RA group) and 79 saphenous vein composite grafts (SV group) were compared. The duration of mean follow-up was $24.6{\pm}14.6$ months (range, 1 to 55 months). Results: There were no differences in surgical mortality, all-cause mortality, or morbidity among the groups. Rates of 4-year survival were 91.7% and 96.3% in the RA and SV groups, respectively (p=0.519). The coronary reintervention-free survival rate and freedom from major adverse cardiovascular or cerebrovascular events were similar in the two groups (p=0.685, p=0.564). Conclusion: Construction of composite Y-grafts using the radial artery or saphenous vein showed similar mid-term results. Long-term follow-up and randomized trials will be needed to confirm our present conclusions.

• Journal of Chest Surgery
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• 제28권5호
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• pp.453-463
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• 1995

During 42 month period 91 consecutive patient underwent coronary artery bypass surgery. The mean age of these patient was 57 years [range from 28 to 78 years . There were 57 men and 34 women. The preoperative risk factors that include beyond the 50 % of total patients were male sex, obesity, hypo-high-density lipoproteinemia, smoking, hypercholesterolemia, hyper-low-density lipoproteinemia, hypertriglyceridemia and hypertension. Preoperatively 27 patients had stable angina pectoris and 39 patients of unstable angina pectoris. Twenty five patients had previous myocardial infarction history. The patterns of disease were 8 patients of single vessel involvement, 18 patients of double vessel involvement, 54 patients of triple vessel involvement and 11 patients of left main coronary artery disease. Fifty five patients were in Canadian Cardiovascular Society functional class III. Myocardial revascularization was performed under emergency conditions in 5 patients. Nine percent of patients had previous PTCA history. We performed 16 cases of sequential anastomosis, internal mammary artery harvest in 86 percent of total patients and total 284 distal anastomoses[mean 3.1 anastomosis per patient . The mean ACC time was 60.5 minutes and ECC time was mean 110 minutes. The combined surgeries were 16 cases of endarterectomy, 2 cases of LV aneurysmectomy, 1 case of Bentall operation, 1 case of repair of sinus of Valsalva, 1 case of ligation of coronary AV fistula and 1 case of excision of breast mass. The most common complication was wound infection[12 cases, 13 % . There was one hospital death due to postoperative respiratory failure and low output syndrome in patient with postinfarction VSD, LV aneurysm. Postoperative 88 patients were in Functional class I or II. The 99mTc-MIBI myocardial perfusion scan that used as evaluation of postoperative state was well correlated with patient`s symptoms instead of some disadvantages.

• Journal of Chest Surgery
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• 제37권10호
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• pp.839-844
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• 2004

배경 및 목적: 속가슴동맥 편과 유리 노동맥 편의 Y-복합이식편은 관상동맥우회 술에 많이 이용된다. 이 연구의 목적은 속가슴동맥 편의 혈류를 증가시킬 수 있는 방법을 찾고 Y-복합이식편의 혈류역학을 알고자 함이다. 대상 및 방법: 관상동맥우회 술을 받은 15예에서 속가슴동맥 편을 두 가지 방법으로 처치하여 속가슴동맥 혈류량을 측정하였다. 7예에서는 혈관 외부에만 파파베린 액을 처치하였고 8예에서는 혈관 내로 파파베린 액을 주입하였다. 다른 18예에서는 속가슴동맥 편과 유리 노동맥 편으로 Y-복합이식편을 만들어 사용하였고 그 자유 혈류량과 두 분지의 혈류 변화를 조사하였다. 결과: 속가슴동맥 편의 혈관 내로 파파베린을 주사한 경우는 혈관외부에 파파베린을 처치한 경우보다 약 2배의 자유혈류량을 얻을 수 있었다(47.7$\pm$9.6 mL/min와 100.8$\pm$26.3 mL/min, p<0.001). Y-복합이식편의 양측을 다 연 상태에서 총 자유혈류량은 속가슴동맥 측만을 열었을 때나 노동맥 측만을 열었을 경우보다 훨씬 많았다(173.3$\pm$45.3 mL/min와 121.1$\pm$34.3 mL/min 혹은 117.5$\pm$42.8 mL/min, 각각 p<0.001). Y-복합이식편의 양 분지를 다 연 경우 양측의 혈류량은 차이가 없었다(85.4$\pm$27.8 mL/min와 87.9$\pm$42.4 mL/min, p=0.772). Y-복합이식편에서 한 측의 혈류량은 다른 측을 열 때보다 막을 때 훨씬 많았다. 결론: 속가슴동맥 편의 혈관 내에 파파베린 액을 주입하는 방법은 자유혈류량을 올릴 수 있는 매우 효과적인 방법이다. 속가슴동맥 편과 유리 노동맥 편의 Y-복합이식편은 속가슴동맥의 단독이식편보다 더 많은 자유혈류량을 보이며, Y-복합이식편의 한 측의 혈류량은 다른 측의 혈류량의 변화에 따라 변할 수 있다.

• Journal of Chest Surgery
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• 제45권5호
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• pp.301-307
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• 2012

Background: Perioperative transfusion of red blood cell (RBC) may cause adverse effects. Bloodless-cardiac surgery has been spotlighted to avoid those problems. Off pump coronary artery bypass (OPCAB) surgery can decrease the transfusion. However, the risk factors of transfusions in OPCAB have not been investigated properly. Materials and Methods: One hundred and thirteen patients (male:female=35:78, mean age=$66.7{\pm}9.9$ years) who received isolated OPCAB were retrospectively analyzed from March 2006 to September 2007. The threshold of RBC transfusion was 28.0% of hematocrit. Bilateral internal thoracic arteries graft were used for 99 patients (87.6%). One hundred and three (91.1%) and 35 patients (31.5%) took aspirin and clopidogrel just before surgery. Results: Sixty-five patients (47.5%) received the RBC transfusion (mean $2.2{\pm}3.2$ units). Mortality and major complications were not different between transfusion and no-transfusion group. But, ventilator support time, intensive care unit stay and hospitalization period had been reduced in no-transfusion group (p<0.05). In multivariate analysis, patients risk factors for RBC transfusion were preoperative low hematocrit (<37.5%) and clopidogrel medication. Surgical risk factors were longer graft harvesting time (<75 minutes) and total operation time (<5.5 hours, p <0.05). Conclusion: We performed the transfusion according to transfusion guideline; over 40% cases could conduct the OPCAB without transfusion. There were no differences in major clinical results between transfusion and non-transfusion group. In addition, when used together with accurate understanding of transfusion risk factors, it is expected to increase the proportion of patients that do not undergo transfusions.