• Quality Improvement in Health Care
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• v.4 no.2
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• pp.184-195
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• 1997

Background : The purpose of this research was to evaluate the appropriateness of preoperative hospital days in a tertiary care hospital and to examine the reasons of the inappropriateness, so as to provide basic information and policy for enhancing appropriateness of preoperative hospitalization and benefit of patients and hospital. Methods : The subjects of the research were the 344 patients who received operation among discharged patients during January, 1996 in surgical departments including general surgery, neurosurgery, orthopedic surgery, plastic surgery and ophthalmology. Their medical records were reviewed and appropriateness of hospital days was evaluated by the Appropriateness Evaluation Protocol. Result : The results of evaluating the appropriateness of preoperative hospitalization showed that inappropriate hospital days were 80.8%. The reasons of inappropriate hospital stays were the tests or preparation which could be done in outpatient basis' followed by 'possible tests or preparation on the operation day' and 'cancelation of operation'. Conclusion : In order to shorten the inappropriate preoperative length of stay, it is recommended that lengthening of laboratory running time and doing most of tests necessary for operations on the outpatient basis prior to admission should be considered. In addition, the operation at the same day of hospitalization and usage of day surgery should be encouraged. Finally there should be changes in the inpatient management system and attitudes and behaviors of surgeons to shorten unnecessary preoperative and maximize the benefit for patients and hospital.

• Journal of Korean Biological Nursing Science
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• v.21 no.4
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• pp.292-299
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• 2019

Purpose: The purpose of this study was to determine whether poor preoperative nutritional status in elderly patients exhibited a negative influence on postoperative clinical outcomes. Methods: The medical records of 645 elderly patients were examined retrospectively. The patients had undergone major surgery between January 2017 and January 2018. Their nutritional status was measured using the Nutritional Risk Screening 2002. The data were analyzed using the chi-squared test, the Mann-Whitney U test, logistic regression, linear regression, Cox proportional hazards regression, and the Kaplan-Meier analysis. Results: Preoperative malnutrition was found in 73 patients (11.3%). Poor preoperative nutritional status was significantly associated with pressure ulcers, length of hospitalization, discharge to patient care facilities rather than home, and mortality rate at three months. Conclusion: Preoperative malnutrition in elderly patients was associated with negative postoperative clinical outcomes. These results indicate that an effective nutritional program before surgery can lead to a more rapid postoperative recovery.

• Journal of Korean Foot and Ankle Society
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• v.17 no.3
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• pp.225-233
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• 2013

Purpose: This study was performed to evaluate the impact of the lesser toe operation on the overall clinical outcomes, and to analyze the clinical results of concomitant surgery for hallux valgus and lesser toe deformities. Materials and Methods: Forty-six cases underwent surgery for hallux valgus with concomitant lesser toe deformities were followed up for at least 1 year. Lesser toe deformities consisted of 9 crossover toes, 10 claw toes, 12 hammer toes and 15 bunionettes. Clinical evaluation was performed according to AOFAS (American Orthopaedic Foot and Ankle Society) score, patient's satisfaction score, and pain VAS (visual analogue scale) score. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and period to union were measured. Preoperative expectation about lesser toe deformities, postoperative satisfaction, complication rate, hospitalization period, medical expenses, and frequency of outpatient follow-up were analyzed. Results: AOFAS score, VAS score, HAV and IMA had improved significantly. On preoperative expectation of patients, correction of lesser toe deformities was ranked third, following the improvement of big toe(bunion) pain and the correction of hallux valgus. Patient's satisfaction score was average 92.8 points, and the importance of lesser toe operation was 30.2%. When compared to hallux valgus operation only, there were average 2.5 days of additional hospitalization, 2.4 times of additional outpatient follow-up, 386000 won of additional medical expenses. Conclusion: Combined operation for hallux valgus and concomitant lesser toe deformities showed good clinical results. When compared to hallux valgus operation only, there were longer hospitalization, more frequent follow-up, more medical expenses, more complications. However, lesser toe deformity correction in patients underwent hallux valgus operation is considerable, because of high preoperative expectation and postoperative satisfaction.

• Biomedical Science Letters
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• v.11 no.3
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• pp.407-416
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• 2005

Cardiopulmonary bypass (CPB) for cardiac surgery induces the production and release of numerous chemotactic substances and cytokines, ensuing systemic inflammatory response that causes postoperative major organ dysfunctions. We performed a randomized, prospective study to investigate clinical effects of preoperative treated-methylprednisolone for preventing inflammation in pediatric cardiac surgery with CPB. Thirty pediatric patients scheduled for elective cardiac surgery were randomized to either control(n=15) or steroid group (n=15, 10 mg/kg of methylprednisolone). Arterial blood samples were taken before and after the operations for measuring total leukocyte (T-WBC) and differential counts, platelet counts, interleukin-6 (IL-6), myeloperoxidase (MPO), neuron specific enolase (NSE), troponin-I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine levels. Postoperative parameters such as pulmonary index (PI, $PaO_2/FiO_2$), 24 hrs and total bleeding volumes, mechanical ventilating (MVP) and intensive care unit (ICU)-staying periods, and hospitalization were assessed. T-WBC, neutrophil fraction, IL-6, MPO, NSE, TNI, AST and creatinine levels, bleeding volumes, PI, and MVP at the postoperative periods were lower or shorter in steroid group than in control group (P<0.05). These findings indicated that preoperative administration of methylprednisolone attenuated CPB-induced inflammatory reactions, contributing to postoperative recovery of patients underwent cardiac surgery.

• Biomedical Science Letters
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• v.16 no.4
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• pp.247-258
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• 2010

The objective of this research was to evaluate the relationships of preoperative (Pre-OP) levels of hematological and biochemical indices to perioperative variables in patients that underwent coronary artery bypass graft surgery (CABG). Pre-OP levels of hematological factors [total white blood cells (T-WBC), erythrocytes, hemoglobin, hematocrit, glycohemoglobin A1c (HbA1c), or platelet] were negatively or positively related with biochemical indices [alanine aminotransferase (ALT), bilirubin, glucose, fructosamine, triglyceride, and high density lipoprotein cholesterol (HDL)]. Pre-OP levels of hematological factors and biochemical indices were negatively or positively correlated with echocardiographic variables. Pre-OP level of HbA1c had a relationship with C-reactive protein. Pre-OP levels of aspartate aminotransferase (AST), ALT, HDL, glucose, fructosamine, or blood urea nitrogen (BUN) were positively or negatively associated with Pre-OP levels of cardiac markers (brain natriuretic peptide, troponin-I, creatine kinase isoenzyme 2, or CRP). Pre-OP levels of hematological factors (excepting T-WBC) related with operation time (OPT), postoperative mechanical ventilation time (POMVT), intensive care unit-period (ICU-period) or hospitalization. Pre-OP levels of AST, ALT, bilirubin, triglyceride, HDL, low dwensity lipoprotein, fructosamine, or BUN were positively or negatively correlated with OPT, graft numbers, POMVT, ICU-period or hospitalization. Retrospective this study reveals that Pre-OP levels of hematological and biochemical markers are associated with echocardiographic variables, several cardiac markers and postoperative outcomes, suggesting that Pre-OP levels of hematological and biochemical markers may be useful predictors for the diagnosis and prognosis of coronary artery disease.

• Journal of Chest Surgery
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• v.22 no.6
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• pp.1101-1105
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• 1989

Fifty one patients with empyema thoracic were managed at the Kyung Hee University Medical Center during 5 years between December, 1982, and December, 1987. The patients were classified into two groups; group A [early minithoracotomy-9 patients] and group B[conventional chest tube insertion-42 patients]. Each group was retrospectively analyzed to compare the results in terms of leukocyte count change, body temperature change, duration of hospitalization, elapsed time to chest tube removal and the need for subsequent decortication and tube change. There was no statistical difference between two groups in terms of etiology, age and sex. l. In the group A, mean preoperative leukocyte count [19,300/mme] decreased to 8,688/mme postoperatively. In the group B, leukocyte count changed from 16,985/mme to 14,433/mme. Their differences were significant [P< 0.05]. 2. In the group A, mean preoperative body temperature [38.5] decreased to 36.7. In the group B, body temperature changed from 38.1oC to 37.5 oC. Their differences were significant [P < 0.05]. 3. Mean duration of Hospitalization; 18.2 days [group A], 30.2 days [group B]. Their differences were significant [P < 0.01]. 4. Mean elapsing time for chest tube removal; 15.2 days [group A], 28.5 days [group B]. Their differences were significant [P < 0.01]. 5. There was no need for subsequent decortication and chest tube change in the group A. There were 22 cases [52.3 %] for subsequent decortication and 12 cases [28.6 %] for chest tube change in the group B. Early minithoracotomy in treating empyema thoracis resulted in a shorter hospital stay and a shorter period of tube drainage than conventional method.

• Journal of Korean Academy of Nursing
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• v.2 no.1
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• pp.97-113
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• 1971

The purpose of this study was to investigate the preoperative anxiety of surgical patients and to observe the effects of an experimental nursing process on the incidence of vomiting, the number of analgesics used and the voiding ability of surgical patients within a 48 hour postoperative period and also the number of postoperative days in the hospital. This study me based on a sample of 51 patients who were scheduled for abdominal surgery. They were assigned alternately to experimental and control groups. Patients assigned to the experimental group were given nursing care by the writer, using an experimental nursing process. This is a process directed toward helping the patient obtain a suitable psychological state for surgery. This process was performed by use of the following steps: 1. The nurse approached the patient with interest and concern, and observed the patient's behavior to determine the presence of anxiety. 2. The nurse explored further to find out what was causing the anxiety and what was needed too relieve it. 3. The nurse listened carefully lo the patient. 4. The nurse gave an opportunity for expression of individuality. 5. The nurse showed friendliness and reassured the patient 6. The nurse gave instruction about deep berating, turing and coughing and gave an explanation of routine preoperative preparation which decreased the unknown and so decreased the patient's anxiety- The findings of this study are as follows: 7. The investigation of preoperative anxiety through observing and interviewing revealed patients were concerned about the following: a. Length of stay in the hospital 69.7% (31 cases) b. Condition unimproved o. worse 48.,8% (30 cases) c. Postoperative pain and discomfort .56.8% (29 cases) 2. The results of the study regarding the four hypothesis were as follows: a. Preoperative psychological care not reduce the number of analysis needed during the 48 hour period following surgery. b. Preoperative psychological care did not reduce the Postoperative incidence of vomiting c. Preoperative psychological care had no influence on voiding ability following surgery. d. Preoperative psychological care significantly reduced the number of postoperative days in tile hospital. The experimental nursing process proved to be successful in decreasing the length of postoperative hospitalization (improving rate of healing). This study has demonstrated further that the relief of anxiety (emotional distress) is part of the nurse's professional role. In order to be sure psychological care is given it is important to make a nursing care plan which .includes a plan for the psychological care needed by the patient. As this care is given it can be charted off by each nurse just as medication and treatments are checked after they are given.

• Journal of Life Science
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• v.20 no.10
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• pp.1458-1467
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• 2010

The present study was retrospectively designed to define whether preoperative levels of leukocytes and D-dimer are potentially useful factors in predicting perioperative outcomes of coronary heart disease (CHD). There was no relationship between preoperative leukocyte counts (Pre-OP leukocyte) and preoperative D-dimer levels (Pre-OP D-dimer). Pre-OP leukocyte counts each had positive correlation with cardiac troponin-I, creatine kinase-MB or C-reactive protein (cardiac markers) levels at preoperative and postoperative periods. Pre-OP D-dimer levels were positively associated with each cardiac marker at the same periods. Pre-OP leukocyte counts positively related with aspartate aminotransferase and alanine aminotransferase (liver markers), whereas Pre-OP D-dimer level positively or negatively correlated with bilirubin (liver marker), creatinine (renal marker) or glucose levels at preoperative and/or postoperative periods. Pre-OP leukocyte and Pre-OP D-dimer were inversely associated with Pre-OP high density lipoprotein cholesterol levels or left ventricular ejection fraction. Pre-OP leukocyte counts each had positive correlation operation duration and postoperative mechanical ventilation-time (PMVT), whereas Pre-OP D-dimer levels had positive relationship with PMVT, intensive care unit-staying period and hospitalization. The retrospective data suggest that Pre-OP leukocyte and Pre-OP D-dimer levels may be clinically useful factors for predicting perioperative outcomes in patients with CHD.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.398-406
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• 2018

Background: Hypoalbuminemia (serum albumin < 3.5 g/dL) is associated with increased morbidity and mortality in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, costs associated with hypoalbuminemia remain unknown. This study investigated the effect of serum albumin on direct treatment costs, length of stay (LOS), and readmissions for primary and revision THA and TKA patients. Methods: All adult patients at a single institution undergoing primary or revision THA or TKA between January 2014 and December 2016 were retrospectively reviewed. Patients were stratified by preoperative serum albumin level. The primary outcome was total direct costs at index hospitalization. Secondary outcomes included LOS and readmission within 30 days. Multivariable regressions were utilized to adjust for demographics and comorbidities. Results: Of 3,785 patients, 114 (3.0%) had hypoalbuminemia. After adjustment, hypoalbuminemia was associated with a 16.2% increase in costs (${\beta}=0.162$; 95% confidence interval [CI], 0.112 to 0.213; p < 0.001), representing an average cost increase of $3,383 (95% CI, $2,281 to $4,485) relative to costs for serum albumin > 4.5 g/dL. The increased total costs were significantly higher in revision ($4,322, p = 0.034) than in primary ($3,446, p < 0.001) procedures. In adjusted regression, each 1.0 g/dL increase in serum albumin yielded a 6.6% reduction in costs (${\beta}=-0.066$; 95% CI, -0.090 to -0.042]; p < 0.001), for average savings of $1,282 (95% CI, $759 to $1,806) per unit albumin. Adjusted regressions demonstrated that a 1-point increase in serum albumin reduced readmissions by 53% (odds ratio, 0.47; 95% CI, 0.31-0.73; p = 0.001) and LOS by 0.6 days (${\beta}=-0.60$; 95% CI, -0.76 to -0.44; p < 0.001). Conclusions: Hypoalbuminemia is associated with increased total direct costs, LOS, and readmissions following primary and revision THA and TKA. Future efforts to predict and address total costs should take into consideration the patient's preoperative serum albumin levels.

• Journal of Chest Surgery
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• v.23 no.6
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• pp.1139-1145
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• 1990

Seven infants less than age 3 months underwent patch aortoplasty and tube graft bypass for relief of coarctation of aorta. All had intractable congestive heart failure, despite aggressive medical therapy Each infant had other cardiac anomalies including patent ductus arteriosus, ventricular septal defect, atrial septal defect and congenital mitral stenosis. All patients underwent closure of the ductus arteriosus and patch angioplasty of the aorta to produce a luminal diameter of at least 15mm or tube graft interposition utilizing the Gortex tube graft diameter larger than 10mm. In 5 patients who had ventricular defect, they underwent pulmonary arterial banding. &ere was one hospital death 17 days after operation secondary to the hydronephrosis and renal failure. Hospitalization was less than 10 days after operation except one case. In 3 patients who had associated VSD, open heart surgery[VSD closure+PA debanding]was done without difficulty. Surgical repair of critical coarctation of the aorta in infants can safely be offered despite the poor preoperative condition and presence of other cardiac anomalies.