• Journal of Korean Neurosurgical Society
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• v.48 no.5
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• pp.412-418
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• 2010

Objective : To evaluate the clinical and radiological outcomes of lumbar interbody fusion and its correlation with various factors (e.g., age, comorbidities, fusion level, bone quality) in patients over and under 65 years of age who underwent lumbar fusion surgery for degenerative lumbar disease. Methods : One-hundred-thirty-three patients with lumbar degenerative disease underwent lumbar fusion surgery between June 2006 and June 2007 and were followed for more than one year. Forty-eight (361%) were older than 65 years of age (group A) and 85 (63.9%) were under 65 years of age (group B). Diagnosis, comorbidities, length of hospital stay, and perioperative complications were recorded. The analysis of clinical outcomes was based on the visual analogue scale (VAS). Radiological results were evaluated using plain radiographs. Clinical outcomes, radiological outcomes, length of hospital stay, and complication rates were analyzed in relation to lumbar fusion level, the number of comorbidities, bone mineral density (BMD), and age. Results : The mean age of the patients was 61.2 years (range, 33-86 years) and the mean BMD was -2.2 (range, -4.8 to -2.8). The mean length of hospital stay was 15.0 days (range, 5-60 days) and the mean follow-up was 23.0 months (range, 18-30 months). Eighty-five (64.0%) patients had more than one preoperative comorbidities. Perioperative complications occurred in 27 of 133 patients (20.3%). The incidence of overall complication was 22.9% in group A, and 18.8% in group B but there was no statistical difference between the two groups. The mean VAS scores for the back and leg were significantly decreased in both groups (p < 0.05), and bony fusion was achieved in 125 of 133 patients (94.0%). There was no significant difference in bony union rates between groups A and B (91.7% in group A vs. 95.3% in group B, p = 0.398). In group A. perioperative complications were more common with the increase in fusion level (p = 0.027). Perioperative complications in both groups A (p = 0.035) and B (p = 0.044) increased with an increasing number of comorbidities. Conclusion : Elderly patients with comorbidities are at a high risk for complications and adverse outcomes after lumbar spine surgery. In our study, clinical outcomes, fusion rates, and perioperative complication rates in older patients were comparable with those in younger populations. The number of comorbidities and the extent of fusion level were significant factors in predicting the occurrence of postoperative complications. However, proper perioperative general supportive care with a thorough fusion strategy during the operation could improve the overall postoperative outcomes in lumbar fusion surgery for elderly patients.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.18-23
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• 2019

As the population grows older and medical treatments are advancing, the number of spine surgeries in elderly patients has been increasing. To obtain a successful outcomes of spine surgery in elderly patients, surgeons should prepare meticulously because elderly patients can have osteoporosis and surgery can be more extensive than in younger patients. Therefore, this study reviewed the perioperative medical treatment, particularly for osteoporosis, to improve the surgical outcomes in elderly patients.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.16
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• pp.6841-6843
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• 2015

Omega-3 polyunsaturated fatty acids (${\omega}$-3 PUFAs) are essential nutrients for human beings and their potential roles against cancer development and progression have become of wide concern recently. Some studies have suggested that perioperative supplementation with omega-3 fatty acids may have beneficial effects in gastrointestinal cancer patients undergoing surgery, while other researchers reported contrary results. This paper reviews recent research to establish therapeutic effects as well as possible underlying mechanisms of ${\omega}$-3 PUFA actions, and to help explain possible reasons for inconsistent results from different institutions.

• Annals of Geriatric Medicine and Research
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• v.20 no.3
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• pp.125-130
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• 2016

Background: Conventionally, elderly hip fracture patients are assessed by orthopedists to decide whether they need geriatric intervention. We aimed to evaluate the effect of perioperative geriatric intervention on healthcare outcomes in patients undergoing surgery for hip fractures. Methods: Our care model for hip fracture surgery resembles a combination of a routine geriatric consultation model and a geriatric ward model. We retrospectively reviewed the medical records of patients aged ${\geq}65years$ undergoing surgery for hip fracture at a single tertiary hospital from January 2010 to December 2013. We assessed comorbidity, indwelling status, fracture type, and mode of anesthesia. We also evaluated in-hospital expenditure, duration of admission, disposition at discharge and 1-year mortality as clinical outcomes. We developed a propensity score model using the variables of age, cholesterol, and creatinine and examined the effect of perioperative geriatric intervention on intergroup differences of clinical variables. Results: Among 639 patients, 138 patients received the geriatric intervention and 501 patients received the usual care. Univariate analysis showed that factors such as age; Charlson comorbidity index; and serum levels of cholesterol, albumin, and creatinine differed significantly between these 2 groups. There was no significant difference between the groups in terms of 1-year mortality, disposition at discharge, and in-hospital expenditure in the propensity matched model. However, the duration of hospitalization was shorter in the intervention group ($8.9{\pm}0.8days$) than in the usual care group ($14.2{\pm}3.7days$, p=0.006). Conclusion: This care model of geriatric intervention for patients with hip fracture is associated with reduced hospitalization duration.

• The Korean Journal of Nuclear Medicine
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• v.33 no.3
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• pp.273-281
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• 1999

Purpose: We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. Materials and Methods: 118 patients (M: F=66: 52, $62.7{\pm}10.5$ years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest T1-20l/ stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heart failure and unstable angina) were surveyed through perioperative periods ($14.6{\pm}5.6$ days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Results: Perioperative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease, Multivariate analysis sorted out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. Conclusion : We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.

• Journal of Korean Neurosurgical Society
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• v.62 no.1
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• pp.106-113
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• 2019

Objective : The efficacy of preoperative embolization for hypervascular metastatic spine disease (MSD) such as renal cell and thyroid cancers has been reported. However, the debate on the efficacy of preoperative embolization for non-hypervascular MSD still remains unsettled. The purpose of this study is to determine whether preoperative embolization for non-hypervascular MSD decreases perioperative blood loss. Methods : A total of 79 patients (36 cases of preoperative embolization and 43 cases of non-embolization) who underwent surgery for metastatic spine lesions were included. Representative hypervascular tumors such as renal cell and thyroid cancers were excluded. Intraoperative and perioperative estimated blood losses (EBL), total number of transfusion and calibrated EBL were recorded in the embolization and non-embolization groups. The differences in EBL were also compared along with the type of surgery. In addition, the incidence of Adamkiewicz artery and complications of embolization were assessed. Results : The average age of 50 males and 29 females was $57.6{\pm}13.5$ years. Lung (30), hepatocellular (14), gastrointestinal (nine) and others (26) were the primary cancers. The demographic data was not significantly different between the embolization and the non-embolization groups. There were no significant differences in intraoperative EBL, perioperative EBL, total transfusion and calibrated EBL between two groups. However, intraoperative EBL and total transfusion in patients with preoperative embolization were significantly lower than in non-embolization in the corpectomy group (1645.5 vs. 892.6 mL, p=0.017 for intraoperative EBL and 6.1 vs. 3.9, p=0.018 for number of transfusion). In addition, the presence of Adamkiewicz artery at the index level was noted in two patients. Disruption of this major feeder artery resulted in significant changes in intraoperative neuromonitoring. Conclusion : Preoperative embolization for non-hypervascular MSD did not reduce perioperative blood loss. However, the embolization significantly reduced intraoperative bleeding and total transfusion in corpectomy group. Moreover, the procedure provided insights into the anatomy of tumor and spinal cord vasculature.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.13
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• pp.5359-5364
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• 2014

Background: To determine surgical outcomes, perioperative complications, and patient outcomes in gynecologic cancer patients undergoing robotic surgery. Materials and Methods: Surgical outcomes, including docking time, total operative time, console time, estimated blood loss (EBL), conversion rate and perioperative complications were retrospectively reviewed in 30 gynecologic cancer patients undergoing robotic surgery. Patient outcomes included recovery time and patient satisfaction, as scored by a visual analogue scale (VAS) from 0-10. Results: The operations included 24 hysterectomies with pelvic lymphadenectomy (PLD) and/or para-aortic lymphadenectomy, four radical hysterectomies with PLD, and two radical trachelectomies with PLD. Mean docking time was $12.8{\pm}9.7min$, total operative time was $345.5{\pm}85.0min$, and console time was $281.9{\pm}78.6min$. These times were decreased in the second half of the cases. There was no conversion rate. Three intraoperative complications, including one external iliac artery injury, one bladder injury, and one massive bleeding requiring blood transfusion were reported. Postoperative complications occurred in eight patients, most were minor. Only one patient had port herniation that required reoperation. Mean hospital stay was $3.5{\pm}1.7days$, and recovery time was $14.2{\pm}8.1days$. Two-thirds of patients felt very satisfied and one-third felt satisfied; the mean satisfaction score was 9.4 +0.9. Two patients with stage III endometrial cancer developed isolated port site metastasis at five and 13 months postoperatively. Conclusions: Robotic surgery for gynecologic cancer appears to be feasible, with acceptable perioperative complication rate, fast recovery time and high patient satisfaction.

• Journal of Chest Surgery
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• v.57 no.4
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• pp.342-350
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• 2024

Background: The maintenance of antiplatelet therapy increases the risk of bleeding during lung cancer surgery. Conversely, the perioperative interruption of antiplatelet therapy may result in serious thrombotic complications. This study aimed to investigate the safety of continuing antiplatelet therapy in the context of lung cancer surgery. Methods: We retrospectively reviewed a cohort of 498 elderly patients who underwent surgery for lung cancer. These patients were categorized into 2 groups: group N, which did not receive antiplatelet therapy, and group A, which did. Group A was subsequently subdivided into group Am, where antiplatelet therapy was maintained, and group Ai, where antiplatelet therapy was interrupted. We compared the incidence of bleeding-related and thrombotic complications across the 3 groups. Results: There were 387 patients in group N and 101 patients in group A (Ai: 70, Am: 31). No significant differences were found in intraoperative blood loss, thoracotomy conversion rates, transfusion requirements, volume of chest tube drainage, or reoperation rates for bleeding control between groups N and A or between groups Am and Ai. The duration of hospital stay was longer for group A compared to group N (7 days vs. 6 days, p=0.005), but there was no significant difference between groups Ai and Am. The incidence of cardiovascular or cerebrovascular complications did not differ significantly between groups Ai and Am. However, group Ai included a severe case of in-hospital ST-elevation myocardial infarction. Conclusion: The maintenance of antiplatelet therapy was found to be safe in terms of perioperative bleeding and thrombotic complications in elderly lung cancer surgery patients.

• Journal of Korean Academy of Nursing
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• v.35 no.1
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• pp.125-134
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• 2005

Purpose: The purpose of this study was to identify the influencing factors on the development of pressure ulcers in patients undergoing surgery which lasted more than two hours. Method: One hundred nineteen surgical adult patients were included in the study. Data was measured on each participant from December 2003 to February 2004. It was collected using a structured researcher-administered sheet and analyzed by descriptive statistics, t-test, chi-square test and logistic regression analysis. Result: The prevalence of a perioperative pressure ulcer was 26.1%. The level of moisture, friction and shear, length of surgery, and perioperative irrigation were significantly higher in the pressure ulcer group than those in the non-pressure ulcer group. The level of activity and level of consciousness were significantly lower in the pressure ulcer group than those in the non-pressure ulcer group. Significant influencing factors on the development of pressure ulcer were 'moisture' and 'irrigation' and those variables explained 23.1% of varience in the development of a pressure ulcer during surgery. Conclusion: It is necessary to develop a strategy to prevent pressure ulcer by taking 'moisture' and 'irrigation' into account during the preoperative, perioperative and postoperative period.

• The Korean Journal of Pain
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• v.29 no.2
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• pp.71-72
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• 2016