Search

Purpose: The correlation between perioperative blood transfusions and the prognosis after major cancer surgery remains controversial. We investigated the association between perioperative blood transfusion and survival outcomes following major cancer surgeries and analyzed trends in perioperative blood transfusions. Methods: Data for this population-based cohort study were obtained from the National Health Insurance Service of South Korea. Adult patients who underwent major cancer surgery between January 1, 2016, and December 31, 2020, were included. The primary endpoint was 90-day mortality. Results: The final analysis included 253,016 patients, of which 55,094 (21.8%) received perioperative blood transfusions. In the multivariable logistic regression model, select factors, including neoadjuvant/adjuvant chemotherapy, an increased preoperative Charlson Comorbidity Index, moderate or severe liver disease, liver cancer surgery, and small bowel cancer surgery, were associated with an increased likelihood of blood transfusion. In the multivariable Cox regression model, patients who received blood transfusion had a significantly higher risk of 90-day mortality (hazard ratio: 5.68; 95% confidence interval: 5.37, 6.00; P < 0.001) than those who did not. Conclusion: We identified potential risk factors for perioperative blood transfusions. Blood transfusion is associated with an increased 90-day mortality risk after major cancer surgery. [ABSTRACT FROM AUTHOR]

We aimed to examine the prevalence of, and factors associated with, quality of life (QOL) worsening among coronavirus disease 2019 (COVID-19) survivors. This population-based retrospective cohort study used data from the Korea Disease Control and Prevention Agency and the National Health Insurance Service in South Korea. A total of 325,666 COVID-19 survivors were included in this study. Among them, 106,091 (32.6%) survivors experienced worsening QOL after COVID-19. Specifically, 21,223 (6.5%) participants experienced job loss, 94,556 (29.0%) experienced decreased household income, and 559 (0.2%) acquired new disabilities. In the multivariable logistic regression model, living in rural areas (odds ratio [OR]: 1.02; 95% confidence interval [CI]: 1.01, 1.04; p = 0.009), intensive care unit admission (OR: 1.08, 95% CI: 1.02, 1.15; p = 0.028), and increase in self-payment by 100 USD (OR: 1.02, 95% CI: 1.02, 1.02; p < 0.001) were associated with increased QOL worsening after COVID-19. Old age (OR: 0.99, 95% CI: 0.98, 0.99; p < 0.001), first vaccination (OR: 0.89, 95% CI: 0.86, 0.93; p < 0.001), and second vaccination (OR: 0.95, 95% CI: 0.93, 0.96; p < 0.001) were associated with decreased QOL worsening after COVID-19. Approximately one-third of COVID-19 survivors in South Korea who were admitted to hospitals or monitoring centers experienced QOL worsening. [ABSTRACT FROM AUTHOR]

Objective:This study aimed to evaluate the rate of transfusion for cardiovascular surgeries between 2010 and 2019 in Republic of Korea and the association between blood transfusion and postoperative mortality. Methods: Data were extracted from the National Health Insurance Service database in Republic of Korea. This study includes adult patients who underwent cardiovascular surgery between 1 January 2010 and 31 December 2019. The endpoints were in-hospital mortality and the 1-year all-cause mortality. Results: The analysis included 62,794 cases, with transfusions used in 88.8% of cases. Multivariable logistic regression revealed that older age, comorbidities, hospital admission through the emergency room, aortic procedures (versus coronary artery bypass grafting), cardiopulmonary bypass, repeat procedures, and supportive therapies during the intensive care (extracorporeal membrane oxygenation and mechanical ventilation) were risk factors for blood transfusion. Female sex was associated with a lower risk of transfusion. Perioperative blood transfusion was associated with a 6.87-fold increased risk of in-hospital mortality (odds ratio [OR]: 6.87, 95% confidence interval [CI]: 3.95, 11.93; p < 0.001) and a 3.20-fold increased risk of 1-year all-cause mortality (OR: 3.35, 95% CI: 2.75, 3.93; p < 0.001). Conclusions: Blood transfusion is used at a high rate in cardiovascular surgeries, and it was associated with increases in the risk of in-hospital and 1-year all-cause mortality. However, these correlations should be viewed with caution as emergent phenomena rather than causative. Understanding factors associated with the need for blood transfusion can assist surgeons in predicting the outcomes of cardiovascular surgery and in tailoring procedures as needed to optimize outcomes. [ABSTRACT FROM AUTHOR]

Identifying patients at risk for developing side effects secondary to intravenous patient-controlled analgesia (IV PCA) and making the necessary adjustments in pain management are crucial. We investigated the risk factors of discontinuing IV PCA due to side effects following general surgery; adult patients who received IV PCA after general surgery (2020–2022) were included. Data on postoperative pain intensity, PCA pain relief, side effects, continuity of PCA use, and PCA pump settings were collected from the records of the acute pain management team. The primary outcome was identifying the risk factors associated with PCA discontinuation due to side effects. Of the 8745 patients included, 94.95% used opioid-containing PCA, and 5.05% used non-steroidal anti-inflammatory drug (NSAID)-only PCA; 600 patients discontinued PCA due to side effects. Female sex (adjusted odds ratio [aOR] 3.31, 95% confidence interval [CI] 2.74–4.01), hepato-pancreatic-biliary surgery (aOR 1.43, 95% CI 1.06–1.94) and background infusion of PCA (aOR 1.42, 95% CI 1.04, 1.94) were associated with an increased likelihood of PCA discontinuation. Preoperative opioid use (aOR 0.49, 95% CI 0.28–0.85) was linked with a decreased likelihood of PCA discontinuation. These findings highlight the importance of individualized pain management, considering patient characteristics and surgical procedures. [ABSTRACT FROM AUTHOR]

This study aimed to examine the associated factors of oral glucocorticoid (GC) use in patients with chronic non-cancer pain (CNCP) associated with musculoskeletal diseases (MSDs) in South Korea. Moreover, we examined whether oral GC use was associated with long-term mortality in patients with CNCP. This population-based cohort study used data from the national registration database in South Korea. Using a stratified random sampling technique, we extracted the data from 2.5% of adult patients diagnosed with MSDs in 2010. Patients with CNCP-associated MSDs who were prescribed oral GC regularly for ≥30 days were defined as GC users, while the other patients were considered to be non-GC users. A total of 1,804,019 patients with CNCP were included in the final analysis, and 9038 (0.5%) patients were GC users, while 1,794,981 (95.5%) patients were non-GC users. Some factors (old age, comorbid status, pain medication use, and MSD) were associated with GC use among patients with CNCP. Moreover, in the multivariable time-dependent Cox regression model, GC users showed a 1.45-fold higher 10-year all-cause mortality (hazard ratio: 1.45, 95% confidence interval: 1.36–1.54; p < 0.001) than non-GC users. In South Korea, the 10-year all-cause mortality risk increased in the patients with CNCP using GC. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the association of modifiable lifestyle factors with long-term survival outcomes in patients with chronic non-cancer pain (CNCP) in South Korea. Methods: This population-based cohort study used data from the National Health Insurance Service database in South Korea. We considered three lifestyle factors from the standard health examination (smoking status, alcohol consumption, and physical activity). Results: A total of 1,298,314 patients with CNCP were analyzed; moreover, the 5-year all-cause mortality rate was 3.3% (42,875 patients). In the multivariable Cox regression model, in the previous-smoker and current-smoker groups, it was 5% (hazard ratio [HR]:1.05, 95% confidence interval [CI]:1.02–1.08; P = 0.003) and 65% (HR: 1.65, 95% CI: 1.60–1.69; P < 0.001) higher, respectively, than that in the never-smoker group. The 5-year all-cause mortality was 19% (HR: 1.19, 95% CI: 1.14–1.24; P < 0.001) higher in the heavy-alcohol-consumption group than in the non-alcohol-consumption group. Compared with those without mild physical activity, patients who engaged in mild physical activity for 1–3 (HR: 0.89, 95% CI: 0.87–0.92; P < 0.001), 4–5 (HR: 0.88, 95% CI: 0.86–0.91; P < 0.001), and 6–7 (HR: 0.90, 95% CI: 0.88–0.93; P < 0.001) days per week exhibited a significantly decreased 5-year all-cause mortality. The association between moderate/intensive physical activity and 5-year all-cause mortality yielded similar results. Conclusion: Lifestyle factors, including previous/current smoking, heavy alcohol consumption, and physical activity, were associated with a higher 5-year all-cause mortality risk among patients with CNCP in South Korea. [ABSTRACT FROM AUTHOR]

We aimed to examine whether preoperative psychiatric morbidities affect 30-day postoperative mortality. Using a nationwide registration database in South Korea, the study included all patients who underwent curative cancer surgery from 1 January 2002 to 31 December 2019. Patients underwent surgery for breast, laryngeal, lung, thyroid, gastric, colorectal, esophageal, liver, pancreatic, kidney, bladder, testicular, prostate, vulvar, uterine, or brain cancer. Depression, anxiety disorder, substance abuse, and post-traumatic stress disorder were considered preoperative psychiatric morbidities. Among the 944,794 patients in the final analysis, 5490 (0.6%) died within 30 days of the surgery, and 24,370 (2.6%) had preoperative psychiatric morbidities. Multivariable logistic regression analysis showed that preoperative psychiatric morbidities were associated with a higher (adjusted odds ratio [aOR]: 1.23; 95% confidence interval [CI]: 1.09, 1.39; p = 0.001) 30-day mortality rate than the rate noted for patients without preoperative psychiatric morbidities. This association was significant in the breast (aOR: 3.31, 95% CI: 1.36, 8.07; p = 0.009), lung (aOR: 1.54, 95% CI: 1.19, 2.01; p = 0.001), and kidney (aOR: 1.87, 95% CI: 1.06, 3.31; p = 0.03) cancer groups in the subgroup analyses. In South Korea, preoperative psychiatric morbidities are considered to be associated with increased 30-day postoperative mortality. [ABSTRACT FROM AUTHOR]

Background: The difference in survival outcomes between closed and open intensive care unit (ICU) designs with respect to trained intensivist coverage remains unknown. We aimed to investigate whether trained intensivist coverage is associated with mortality in critically ill patients admitted to the ICU in South Korea. Methods: This population-based cohort study used nationwide registration data from South Korea. This study enrolled all adult patients admitted to the ICU between January 1, 2016, and December 31, 2019. Patients, who were admitted ICU in a hospital that employed trained intensivists, were designated as the intensivist group. Results: This study included 1,147,493 critically ill patients admitted to the ICU. The intensivist and non-intensivist groups consisted of 484,004 (42.2%) and 663,489 (57.8%) patients, respectively. Mixed effect logistic regression revealed a 22% lower in-hospital mortality rate (odds ratio: 0.78. 95% confidence interval: 0.74, 0.81; P < 0.001) than that in the non-intensivist group. Mixed effect Cox regression revealed a 15% lower 1-year mortality rate (hazard ratio: 0.85. 95% confidence interval: 0.83, 0.89; P < 0.001) in the intensivist group than that in the non-intensivist group. Moreover, the in-hospital mortality was significantly lower in the intensivist group than that in the non-intensivist group, irrespective of age, Charlson comorbidity index, surgery or non-surgery associated admission, and invasive treatment during ICU stay. Conclusions: A closed ICU design with trained intensivist coverage was associated with lower in-hospital and 1-year mortality rates. Our results suggest that hospitals should employ trained intensivists to improve both short-term and long-term survival outcomes of critically ill patients. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the changes in quality of life (QOL) after in-hospital cardiopulmonary arrest (IHCA) among survivors and examined the association between worsening QOL and 3-year all-cause mortality.Methods: This population-based cohort study used data from the National Health Insurance Service database in South Korea. Adult survivors who experienced IHCA between January 1, 2010, and December 31, 2018, and were alive for over 1 year after IHCA were included. Worsening QOL among IHCA survivors was determined using three criteria: decreased household income, unemployment, and acquired disability.Results: A total of 22,611 IHCA survivors from 903 hospitals were included in the final analysis, and 7,796 (34.5%) experienced worsening QOL. Specifically, 5,595 (24.7%), 1,694 (7.5%), and 1,617 (7.2%) survivors experienced decreased household income, unemployment, and acquired disability, respectively. The proportion of brain lesion disability increased from 6.3% to 10.8% after IHCA. In multivariable Cox regression, worsening QOL was not associated with 3-year all-cause mortality (adjusted hazard ratio [aHR]: 1.03, 95% confidence interval [CI]: 0.96, 1.11; P = 0.372). However, among the QOL factors, acquired disability was associated with a 1.29-fold higher risk of 3-year all-cause mortality among IHCA survivors (aHR: 1.29, 95% CI: 1.15, 1.46; P < 0.001).Conclusion: Approximately one-third of IHCA survivors experienced worsening QOL (decreased household income, unemployment, and acquired disability) at 1-year follow-up after IHCA in South Korea. Although overall worsening of QOL was not associated with 3-year all-cause mortality, acquired disability was associated with increased 3-year all-cause mortality among IHCA survivors. [ABSTRACT FROM AUTHOR]

Background The impact of HIV infection on survival outcomes after in-hospital cardiopulmonary resuscitation (ICPR) remains controversial. This study aimed to investigate the impacts of HIV infection on both short-term and long-term outcomes after ICPR. Methods This nationwide, population-based cohort study used data taken from the South Korean National Health Insurance Service database. All adult (≥18 years old) patients who experienced ICPR between January 1, 2010, and December 31, 2019, were included. Results A total of 298 676 adult patients who underwent ICPR were initially included in the analysis. Among them, 586 (0.2%) patients were assigned to the patients with symptomatic HIV infection (PWH) group, while 298 090 (99.8%) patients were assigned to the control group. After 1:10 propensity score (PS) matching, 586 patients in the PWH group and 5845 patients in the control group were included in the analysis. Logistic regression analysis after PS matching showed that the PWH group had a 20% lower live discharge rate after ICPR compared with the control group (odds ratio, 0.80; 95% CI, 0.65–0.97; P  = .024). However, Cox regression analysis after PS matching showed that the risks of 6-month survival (hazard ratio [HR], 1.01; 95% CI, 0.93–1.11; P  = .768) and 1-year survival (HR, 1.02; 95% CI, 0.93–1.11; P  = .702) were not significantly different between the PWH and control groups. Conclusions Although the PWH group showed lower live discharge rates compared with the control group after ICPR, long-term survival outcomes from 6 months and 1 year were not significantly different. [ABSTRACT FROM AUTHOR]

Purpose: Worsening quality of life (QOL) is an important health issue in acute respiratory distress syndrome (ARDS) survivors. We aimed to investigate the prevalence of worsening QOL among ARDS survivors and their association with mortality. Methods: South Korean National Health Insurance database information for all adults admitted to intensive care units for ARDS from January 1, 2010 to December 31, 2018 who survived ≥ 365 days were included in this study. Results: A total of 4452 ARDS survivors were included in the final analysis. Total QOL had worsened in 1667 (37.4%) of the survivors at the follow-up 1 year after being diagnosed with the syndrome. Specifically, 1298 patients (29.2%) experienced decreased income, 334 (7.5%) lost their jobs, and 327 (7.3%) had newly acquired disabilities. In the multivariable Cox regression analysis, worsening QOL was not associated with 2-year all-cause mortality among survivors (P = 0.140). However, newly acquired disability was associated with 1.74-fold (hazard ratio [HR]: 1.74, 95% confidence interval [CI] 1.31–2.33; P < 0.001) higher 2-year all-cause mortality, while decreased income (P = 0.571) and unemployment (P = 0.952) were not associated with it. In addition, newly acquired respiratory disability was associated with a 6.61-fold higher risk of 2-year respiratory mortality (HR: 6.61, 95% CI 3.14–13.90; P < 0.001). Conclusions: At the 1-year follow-up period, one-third of ARDS survivors experienced worsening QOL in South Korea. Specifically, newly acquired disability was associated with a higher risk of 2-year all-cause and respiratory mortality among patients who survived ARDS. [ABSTRACT FROM AUTHOR]

We aimed to examine recent trends in in-hospital cardiopulmonary resuscitation in South Korea from 2010 to 2019. A population-based sample of all adult patients who experienced in-hospital cardiopulmonary resuscitation between 1 January 2010 and 31 December 2019, was included. In all, 298,676 patients who received in-hospital cardiopulmonary resuscitation were included in the survival analysis. In 2010, 60.7 per 100,000 adults experienced in-hospital cardiopulmonary resuscitation. A similar rate was observed until 2015. The rate increased to 83.5 per 100,000 adults in 2016 and gradually increased to 92.1 per 100,000 adults in 2019. Among all patients, 78,783 (26.2%) were discharged alive after in-hospital cardiopulmonary resuscitation. The 6-month and 1-year survival rates were 9.8% and 8.7%, respectively. In 2010, the mean total cost of hospitalization was USD 5822.80 (United States Dollar) (standard deviation; SD: USD 7493.4), which increased to USD 7886.20 (SD: USD 13,071.6) in 2019. The rate of in-hospital cardiopulmonary resuscitation and cost of care have significantly increased since 2010, while the 6-month and 1-year rates of survival post in-hospital resuscitation remain low. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate the prevalence of quality-of-life deterioration and associated factors in patients who underwent craniotomies for brain tumor removal. Additionally, we examined whether deteriorating quality of life after surgery might affect mortality. Methods: As a national population-based cohort study, data were extracted from the National Health Insurance Service database of South Korea. Adult patients (≥ 18 years old) who underwent craniotomy for excision of brain tumors after diagnosis of malignant brain tumor between January 1, 2011, and December 31, 2017, were included in this study. Results: A total of 4852 patients were included in the analysis. Among them, 2273 patients (46.9%) experienced a deterioration in quality of life after surgery. Specifically, 595 (12.3%) lost their jobs, 1329 (27.4%) experienced decreased income, and 844 (17.4%) patients had newly acquired disabilities. In the multivariable Cox regression model, a lower quality of life was associated with a 1.41-fold higher 2-year all-cause mortality (hazard ratio: 1.41, 95% confidence interval: 1.27–1.57; P < 0.001). Specifically, newly acquired disability was associated with 1.80-fold higher 2-year all-cause mortality (hazard ratio: 1.80, 95% confidence interval: 1.59–2.03; P < 0.001), while loss of job (P = 0.353) and decreased income (P = 0.599) were not significantly associated. Conclusions: At 1-year follow-up, approximately half the patients who participated in this study experienced a deterioration in the quality-of-life measures of unemployment, decreased income, and newly acquired disability after craniotomy for excision of brain tumors. Newly acquired disability was associated with increased 2-year all-cause mortality. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the prevalence and associated factors of newly developed depression in patients who underwent craniotomy for brain tumor removal, as well as its effect on long-term mortality.Methods: Using a nationwide cohort database in South Korea, we included adult patients diagnosed with brain tumors who underwent craniotomy for brain tumor removal from January 1, 2011, to December 31, 2017. We excluded patients with a preoperative history of depression.Results: Among 4,275 patients, 727 (17.0%) patients were newly diagnosed with depression within one year, postoperatively. Two-year all-cause mortality and mortality due to brain cancer occurred in 1,233 (28.8%) and 1,099 (25.7%) patients, respectively. In the multivariable logistic regression model, older age, living in rural areas, newly acquired brain disability, underlying other psychiatric disorders, and longer length of hospital stay were associated with a higher incidence of newly developed depression. In the multivariable Cox regression model, newly acquired depression was associated with a 1.58-fold higher 2-year all-cause mortality compared with that in other patients (hazard ratio: 1.58, 95% confidence interval: 1.38-1.80; P < 0.001).Limitation: Lack of information regarding severity and pathologic tumor type.Conclusion: Within one follow-up year, 17.0% of patients were newly diagnosed with depression after craniotomy for brain tumor removal. Some factors (old age, living in rural areas, newly acquired brain disability, longer length of hospital stay, and underlying other psychiatric illnesses) could be risk factors for newly diagnosed depression. Furthermore, newly developed depression was associated with an increased 2-year all-cause mortality. [ABSTRACT FROM AUTHOR]

Background: The prevalence of delirium, its associated factors, and its impact on long-term mortality among survivors of acute respiratory distress syndrome (ARDS) is unclear.Methods: Since this was a population-based study, data were extracted from the National Health Insurance database in South Korea. All adults who were admitted to intensive care units with a diagnosis of ARDS between January 1, 2010, and December 31, 2019, and who survived for ≥ 60 days were included. The International Statistical Classification of Diseases and Related Health Problems, tenth revision code of delirium (F05) was used to extract delirium cases during hospitalization.Results: A total of 6809 ARDS survivors were included in the analysis, and 319 patients (4.7%) were diagnosed with delirium during hospitalization. In the multivariable logistic regression analysis after covariate adjustment, male sex (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.23, 2.08; P < 0.001), longer duration of hospitalization (OR 1.02, 95% CI 1.01, 1.03; P < 0.001), neuromuscular blockade use (OR 1.50, 95% CI 1.12, 2.01; P = 0.006), benzodiazepine (OR 1.55, 95% CI 1.13, 2.13; P = 0.007) and propofol (OR 1.48, 95% CI 1.01, 2.17; P = 0.046) continuous infusion, and concurrent depression (OR 1.31, 95% CI 1.01, 1.71; P = 0.044) were associated with a higher prevalence of delirium among ARDS survivors. In the multivariable Cox regression analysis after adjustment for covariates, the occurrence of delirium was not significantly associated with 1-year all-cause mortality, when compared to the other survivors who did not develop delirium (hazard ratio: 0.85, 95% CI 1.01, 1.71; P = 0.044).Conclusions: In South Korea, 4.7% of ARDS survivors were diagnosed with delirium during hospitalization in South Korea. Some factors were potential risk factors for the development of delirium, but the occurrence of delirium might not affect 1-year all-cause mortality among ARDS survivors. [ABSTRACT FROM AUTHOR]

Background: Anemia, which is a condition with reduced healthy red blood cells, is reported to be closely related to the development of infectious diseases. We aimed to investigate the association between history of anemia and 12-year mortality rate due to infections, and compare it with that among non-anemic individuals.Methods: Data from the National Health Insurance Service Health Screening Cohort were used in this population-based cohort study. Adults who underwent standardized medical examination between and 2002-2003 were included, and the mortality rate due to infection between 2004 and 2015 was analyzed. Individuals were considered to have a history of anemia if the serum hemoglobin level in 2002-2003 was < 12 g/dL for women and < 13 g/dL for men. The severity of anemia at that time was categorized as mild (12 g/dL > hemoglobin ≥11 g/dL in women and 13 g/dL > hemoglobin ≥11 g/dL in men), moderate (hemoglobin 8-10.9 g/dL), or severe (hemoglobin < 8 g/dL). Propensity score (PS) matching and Cox regression analysis were used as statistical methods.Results: Overall, 512,905 individuals were included in this study. The mean age of the participants was 54.5 years old (range: 40-98), and 49,042 (9.6%) individuals were classified in the anemic group, which comprised of 36,383 (7.1%), 11,787 (2.3%), and 872 (0.2%) participants in the mild, moderate, and severe sub-groups, respectively. After PS matching, 49,039 individuals in each group were included in the analysis. The risk of mortality due to infection in the anemic group was 1.77-fold higher (hazard ratio [HR]: 1.77, 95% confidence interval [CI]: 1.52-2.60; P < 0.001) than that in the non-anemic group. In the subgroup analysis, the mild and moderate anemia groups had 1.38-fold (HR: 1.38, 95% CI: 1.23 to 1.55; P < 0.001) and 2.02-fold (HR: 2.02, 95% CI: 1.62 to 2.50; P < 0.001) risk of mortality due to infection compared to that of the non-anemic group, respectively. The severe anemia group did not have a significantly different risk of mortality due to infection (P = 0.448).Conclusions: History of anemia was associated with increased mortality rate due to infection at 12-year follow-up. [ABSTRACT FROM AUTHOR]

We aimed to investigate the association between sleep disorders and 5-year all-cause and disease-specific mortality. In this population-based cohort study, data from the sample cohort of the National Health Insurance Service, that was developed as a representative of the South Korean population were extracted. Sleep disorder was defined based on the 10th edition of the International Classification of Diseases (ICD-10; codes G47*). Multivariate Cox regression modeling was used for statistical analysis. In the sample cohort of 2010, 822,214 adults (≥ 18 years) were included for analysis. Among them, 27,515 (3.3%) individuals had sleep disorders, of which insomnia was most common (17,864 individuals, 2.2%). Compared with the control group, the sleep disorder group showed a 1.23-fold higher 5-year all-cause mortality (hazard ratio [HR]: 1.23, 95% confidence interval: 1.18–1.28; P < 0.001). On competing risk analysis, compared with the control group, the sleep disorder group demonstrated the highest risk of 5-year injury- and poisoning-related mortality (HR: 1.61) followed by 5-year nervous system disease mortality (HR: 1.35). On subgroup analyses according to age, sleep disorders conferred a 2.05-fold higher risk for all-cause mortality (HR: 2.05) in the group aged 18–40 years; sleep disorders in the 41–60 and > 60 years groups showed 1.58-fold (HR: 1.58) and 1.48-fold (HR: 1.48) higher risk, respectively. Increased 5-year all-cause mortality was associated with sleep disorders, particularly for deaths owing to injury or poisoning, and nervous system disease. This association was more evident in the young adult population (aged 18–40 years). [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate whether weekend admission was associated with a higher risk of 90‐day mortality in patients with sepsis. Methods: This population‐based cohort study was based on health records from the National Health Insurance Service database in South Korea. All adult patients (age ≥ 18 years) admitted for sepsis (A40, A41) or septic shock (R65.2) as diagnosed according to the International Classification of Diseases, 10th revision codes, during 2010‐2018 were screened. Weekend admission was defined as admission for sepsis on weekends. Results: In all, 251 837 patients were enrolled, of which 43 327 (17.2%) were in the weekend admission group and 208 510 (82.8%) in the weekday admission group. After propensity score matching, 86 654 patients with sepsis (43 327 patients with sepsis in each group) were included in the analysis. The 90‐day mortality rates in the weekend admission and weekday admission groups were 44.3% (19 204/43 327) and 41.9% (18 157/43 327), respectively. On Cox regression analysis, the risk of 90‐day mortality in the weekend admission group was 1.09‐times higher than that in the weekday admission group (hazard ratio: 1.09, 95% confidence interval: 1.07‐1.12; P <.001). Conclusion: Using the national health claims database in South Korea, we showed that weekend admission for diagnosed sepsis was associated with an increased risk of 90‐day mortality, compared to that for weekday admission. This might be due to the higher severity of illness in patients with sepsis admitted during the weekend or relatively lesser hospital staff during the weekend. [ABSTRACT FROM AUTHOR]

Background: Postoperative mortality associated with elective coronary artery bypass graft (CABG) surgery may reportedly increase as the weekday of surgery approaches the weekend. We aimed to investigate the potential effect of the weekday of CABG surgery on the 30‐day mortality. Methods: This population‐based cohort study analyzed data obtained from the South Korea national health insurance service database. The cohort included all adult patients diagnosed with ischemic heart disease (International Classification of Diseases‐10 codes I20*–I25*) who underwent isolated and elective CABG surgery from January 2012 to December 2017. Results: Of the 13,556 patients included in the analysis, 595 (4.4%) died within 30 days after CABG surgery. In a multivariable Cox model, the 30‐day mortality of patients who underwent CABG surgery later in the week (Wednesday–Friday) was not significantly associated with the weekday of surgery as similar to those who underwent surgery early in the week (Monday–Tuesday) (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 0.97–1.34; p =.109). Multivariable sensitivity analysis revealed that CABG surgery on Friday was associated with a 1.40‐fold higher hazard of 30‐day mortality (HR: 1.40; 95% CI: 1.09–1.80; p =.008) than CABG surgery on Monday. Conclusions: This South Korean population‐based cohort study revealed that relative to surgery early in the week (Monday–Tuesday), CABG surgery later in the week (Wednesday–Friday) was not associated with higher 30‐day mortality. However, using surgery on Monday as a reference, CABG surgery on Friday was associated with higher 30‐day mortality. Future studies must confirm these findings. [ABSTRACT FROM AUTHOR]

Purpose: There have been no large-scale studies on whether metformin therapy might have a potential benefit for lowering mortality. Thus, this study aimed to investigate the association between prior metformin therapy and the development of sepsis as well as the association between prior metformin therapy and 30-day mortality in sepsis patients. Methods: We evaluated adult diabetes patients registered in the 2010 sample cohort database of the National Health Insurance Service in South Korea. Diabetes was identified according to the International Classification of Disease-10 diagnostic system (E10–E14). The cohorts were divided into the metformin user group (i.e., those who had been prescribed continuous oral metformin over a period of ≥ 90 days) and the control group (i.e., all other individuals). The primary endpoint was the development of sepsis between 2011 and 2015, and the secondary endpoint was 30-day mortality among diabetes patients diagnosed with sepsis. Results: In total, 77,337 patients (34,041 in the metformin user group and 43,296 in the control group) were included in the analysis, among whom 2512 patients (3.2%) were diagnosed with sepsis between 2011 and 2015. After propensity score adjustment, metformin use was not significantly associated with both the risk of sepsis (OR: 0.92, 95%CI 0.82–1.03; P = 0.143) and the risk of 30-day mortality after diagnosis of sepsis (OR: 0.94, 95%CI 0.75–1.17; P = 0.571). Conclusions: Prior metformin therapy was not significantly associated with the risk of sepsis and 30-day mortality after diagnosis of sepsis among diabetes patients. [ABSTRACT FROM AUTHOR]

Background This study aimed to determine whether use of preoperative antihypertensive medication is associated with postoperative 90-day mortality in the hypertensive adult population that underwent elective noncardiac surgery. Methods In this retrospective cohort study, medical records of preoperative hypertensive patients who underwent noncardiac surgery at a single tertiary academic hospital from 2012 to 2018 were reviewed. Among the hypertensive patients, those prescribed to take antihypertensive medication continuously for more than 1 month before admission were defined as the HTN MED group; others were defined as the non-HTN MED group. Multiple imputation, propensity score (PS) matching, and logistic regression analysis were used for statistical analysis. Results Overall, 35,589 preoperative hypertensive adult patients (HTN MED group: 26,154 patients, non-HTN MED group: 9,435 patients) were included in the analysis. After PS matching, each group comprised 6,205 patients; thus, 12,410 patients were included in the final analysis. The odds for 90-day mortality of the HTN MED group in the PS-matched cohort were 41% lower (odds ratio: 0.59, 95% confidence interval: 0.41–0.85; P = 0.005) than those of the non-HTN MED group. Comparable results were obtained in the multivariable logistic regression analysis of the entire cohort (odds ratio: 0.54, 95% confidence interval: 0.41–0.72; P < 0.001). Conclusions This study showed that the use of preoperative antihypertensive medication was associated with lower 90-day mortality among hypertensive patients who underwent noncardiac surgery. Therefore, preoperative screening and treatment with appropriate antihypertensive medication are important for hypertensive patients. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the association of chronic opioid usage with 90-day mortality in critically ill patients after admission to the ICU.Methods: This retrospective cohort study analysed the medical records of adult patients admitted to ICUs in a tertiary academic hospital between January 2012 and December 2017. Patients taking opioids regularly for more than 4 weeks before ICU admission were defined as chronic opioid users, whereas the others were defined as opioid-naïve patients.Results: We selected 18 409 patients for this study, including 757 (4.1%) chronic opioid users. After propensity matching, 2990 patients (chronic opioid users, 757; opioid-naïve, patient: 2233) were included in the analysis. The odds of 90-day mortality were higher in chronic opioid users than in opioid-naïve patients using both the generalised estimating equation model for the propensity-matched cohort (odds ratio=1.90; 95% confidence interval, 1.57-2.31; P<0.001) and the multivariable logistic regression model for the entire cohort (odds ratio=2.20; 95% confidence interval, 1.81-2.66; P<0.001). Additionally, this association was significant in cancer patients and non-chronic kidney disease (CKD) patients and was not significant in non-cancer and CKD patients.Conclusions: Our results suggest that in a cohort of critically ill adult patients, chronic opioid use is associated with an increase in 90-day mortality. This association was more evident in cancer patients and non-CKD patients. [ABSTRACT FROM AUTHOR]

We aimed to investigate whether coronavirus disease (COVID-19) survivors were at a higher risk of dementia diagnosis compared to controls at 6 months follow-up. Data pertaining to the period between 1 January and 4 June 2020, were extracted from the National Health Insurance Service (NHIS)-COVID-19 database in South Korea. Data on adults (≥20 years old) with no history of dementia, obtained from the NHIS-COVID-19 database, were included in the study. The endpoint of this study was the development of dementia, which was evaluated from 1 January to 1 December 2020. A total of 306,577 adults were included in the analysis, comprising 7133 COVID-19 survivors and 299,444 individuals in the control group. Among the subjects, new-onset dementia diagnosed in 2020 was recorded in 1.2% (3546 of 306,577). In the covariate-adjusted multivariable Cox regression model, the incidence of dementia among COVID-19 survivors was 1.39-fold higher (hazard ratio: 1.39, 95% confidence interval: 1.05–1.85; p = 0.023) than that in the control group. At approximately 6 months of follow-up, COVID-19 survivors were at a higher risk of dementia compared to other populations in South Korea. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate whether trained intensivist coverage affects survival outcomes following in-hospital cardiopulmonary resuscitation (ICPR) for in-hospital cardiac arrest (IHCA).Methods: All adult patients who received ICPR for IHCA between January 1, 2016 and December 31, 2019 in South Korea were included. Patients who received ICPR in hospitals with trained intensivist coverage for ICU staffing were defined as the intensivist group, whereas other patients were considered the non-intensivist group.Results: In total 68,286 adult patients (36,025 [52.8%] in the intensivist group and 32,261 [47.2%] in the non-intensivist group) were included in the analysis. After propensity score (PS) matching 40,988 patients (20,494 in each group) were included. In logistic regression after PS matching, the intensivist group showed a 17% (odds ratio: 1.17; 95% confidence interval [CI]: 1.12-1.22; P < 0.001) higher live discharge rate after ICPR than the non-intensivist group. In Cox regression after PS matching, the 6-month and the 1-year mortality rates in the intensivist group after ICPR were 11% (hazard ratio [HR]: 0.89; 95% CI: 0.87-0.91; P < 0.001) and 10% (HR: 0.90; 95% CI: 0.88-0.92; P < 0.001) lower than those in the non-intensivist group, respectively. In Kaplan-Meir estimation the median survival time after ICPR in the intensivist group was 12.0 days (95% CI: 11.6-12.4) while that in the non-intensivist group was 8.0 days (95% CI: 7.7-8.3).Conclusions: Trained intensivist coverage in the ICU was associated with improvements in both short and long-term survival outcomes after ICPR for IHCA. [ABSTRACT FROM AUTHOR]

Background: We aimed to examine the prevalence and associated factors of newly developed psychiatric morbidity among survivors of in-hospital cardiopulmonary resuscitation (ICPR). Additionally, we investigated whether pre-existing and newly developed psychiatric morbidities affect long-term mortality.Methods: We extracted data from the National Health Insurance Service database in South Korea. Adult ICPR survivors who underwent ICPR from January 1, 2010, to December 31, 2018, and who were alive for more than 1 year after ICPR were enrolled. Depression, anxiety, substance abuse, and post-traumatic stress disorder (PTSD) were evaluated as psychiatric morbidity.Results: A total of 22,611 survivors of ICPR from 615 hospitals in South Korea were included in the final analysis. Among them, 7825 (34.6%) had pre-existing psychiatric morbidity before ICPR, while 2524 (11.2%) had newly developed psychiatric morbidity after ICPR. In multivariable Cox regression analysis, compared to the no psychiatric morbidity group, the pre-existing psychiatric morbidity group (adjusted hazard ratio, 1.02; 95% confidence interval, 0.94, 1.11; P = 0.629) and the newly developed psychiatric morbidity group (adjusted hazard ratio, 1.02; 95% confidence interval, 0.90, 1.15; P = 0.798) were not associated with 1-year all-cause mortality among 1-year survivors of ICPR.Limitation: Retrospective cohort design.Conclusions: In South Korea, 11.2% of ICPR survivors had newly developed psychiatric morbidity such as depression, anxiety disorder, substance abuse, and PTSD within 1 year after ICPR. However, both pre-existing and newly developed psychiatric morbidities were not associated with 1-year all-cause mortality among 1-year survivors of ICPR. [ABSTRACT FROM AUTHOR]

We investigated the association between physician turnover and survival outcomes after in-hospital cardiopulmonary resuscitation (ICPR) in South Korea. This population-based cohort study used the South Korean national registration database as the data source. All adult patients admitted to the hospital and who underwent ICPR between 1 January 2010 and 31 December 2019, were included. Patients who underwent ICPR in March were included in the turnover group, while those who underwent ICPR in the other months were included in the non-turnover group. Propensity score (PS) matching was performed. Overall, 298,676 adult patients who underwent ICPR in 2,553 South Korean hospitals were included in the analysis. Among them, 26,342 (8.8%) and 272,334 (91.2%) were included in the turnover and non-turnover groups, respectively. In total, 7,009 (26.6%) and 6,903 (26.2%) of the 26,342 patients each in the turnover and non-turnover groups, respectively, were discharged alive after ICPR. Using logistic regression analysis in the PS-matched cohort, the two groups did not show any significant association in the live discharge rate after ICPR (odds ratio: 1.02, 95% confidence interval: 0.98, 1.06; P = 0.295). This non-significant association was also observed in patients who underwent ICPR in tertiary general hospitals that had cardiopulmonary resuscitation teams for ICPR (P = 0.136). Moreover, the median survival time in the turnover and non-turnover groups was 4.0 days (95% confidence interval: 3.8 days, 4.2 days; log-rank test, P = 0.796). Significant association between physician turnover and survival outcomes was not observed after ICPR in South Korea. [ABSTRACT FROM AUTHOR]

It has been reported that survivors of acute respiratory distress syndrome (ARDS) experience depression. However, the relationship between newly developed depression and mortality among survivors of ARDS has not been elucidated. Thus, the aim of this study was to investigate the prevalence and associated factors of depression among survivors of ARDS and determine whether newly developed depression is associated with long-term mortality among them. The data used for this study were extracted from the national health insurance database of South Korea. All adult patients who were admitted into intensive care units for ARDS between January 1, 2010, and December 31, 2018, and survived for ≥1 year after treatment were defined as ARDS survivors and included in this study. A total of 4,452 ARDS survivors were included in the final analysis. Of these, 581 (13.4%) were newly diagnosed with depression within 1 year after ARDS diagnosis. Multivariable logistic regression showed that underlying anxiety disorder (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.93–2.86; P < 0.001), substance abuse (OR, 2.18; 95% CI, 1.48–3.20; P < 0.001), and post-traumatic stress disorder (OR, 15.52; 95% CI, 2.57–93.51; P = 0.003) were associated with a higher prevalence of post-ARDS depression among survivors. Multivariable Cox regression analysis showed that post-ARDS depression was associated with a 1.49-fold increased risk of 2-year all-cause mortality (hazard ratio, 1.49; 95% CI, 1.18–1.88; P = 0.001). Underlying psychiatric illness is a potential risk factor for the development of depression among ARDS survivors. Post-ARDS depression is associated with an increased risk of 2-year all-cause mortality. [ABSTRACT FROM AUTHOR]

Objectives: The quality of life after extracorporeal membrane oxygenation therapy has emerged as an important issue for extracorporeal membrane oxygenation survival; however, its association with long-term prognosis has not been identified. We investigated the changes in the quality of life after extracorporeal membrane oxygenation among the survivors and examine the association between a worse quality of life and 3-year all-cause mortality.Design: This was a population-based cohort study.Setting: Data were obtained from the National Health Insurance Service database in South Korea.Patients: Adult individuals (≥ 18 yr old) who received extracorporeal membrane oxygenation therapy from 2006 to 2017 were included. Extracorporeal membrane oxygenation survivors were defined as patients who had survived for 1-year after the initiation of extracorporeal membrane oxygenation therapy.Interventions: None.Measurements and Main Results: The income level, employment status, and registered disability were examined before and 1-year after extracorporeal membrane oxygenation therapy. The decreased income level, job loss, and newly acquired disability were considered as change in the quality of life among extracorporeal membrane oxygenation survivors. A total of 5,821 adult extracorporeal membrane oxygenation survivors were included in the final analysis, and 2,959 patients (50.8%) experienced quality of life change. Specifically, 1,782 patients (30.6%) experienced a decrease in income, 682 (11.7%) lost their jobs, and 1,540 (26.5%) had a new disability within 1-year after extracorporeal membrane oxygenation therapy. In the multivariable Cox regression model, newly acquired disability was associated with 2.31-fold higher 3-year all-cause mortality among extracorporeal membrane oxygenation survivors (hazard ratio, 2.31; 95% CI, 1.79-2.97; p < 0.001), while job loss (p = 0.180) and decreased income (p = 0.993) were not associated with the 3-year all-cause mortality.Conclusions: At 12 months after extracorporeal membrane oxygenation therapy, nearly half survivors experienced quality of life worsening such as unemployment, decreased income, and new disability. Additionally, among the three factors, acquiring a new disability might significantly increase the 3-year mortality. This is the first study to report the association between changes in the quality of life and long-term prognosis in extracorporeal membrane oxygenation survivors. [ABSTRACT FROM AUTHOR]