ABSTRACT
Purpose@#Accumulated evidence indicates laparoscopic surgery (LS) has the advantages of less wound pain, less blood loss, shorter hospitalization, and faster functional recovery than open surgery (OS). Previous studies have analyzed the advantages of LS based on hospital data. This study is the first to compare surgical outcomes and health economic data using nationwide administrative claims datasets for gastric cancer. @*Methods@#The claims datasets of the Health Insurance Review and Assessment Service for patients that underwent gastrectomy from May 2012 to April 2017 were analyzed. A total of 76,445 cases (LS, 42,395 and OS, 34,050) were included.Postoperative complications and medical costs were included in the analysis. @*Results@#We analyzed 76,445 cases of gastrectomy. Analysis showed LS was associated with fewer surgical wound infections (2,114 [6.21%] vs. 1,057 [2.49%], p < 0.001), minor abdominal infections and abscesses (826 [2.43%] vs. 390 [0.92%], p < 0.001), cases of surgery-related peritonitis (50 [0.15%] vs. 31 [0.07%], p = 0.0019), repair surgeries (28 [0.08%] vs. 3 [0.01%], p < 0.001), reoperations (504 [1.48%] vs. 343 [0.81%], p < 0.001), less antibiotic use (1,717 [5.04%] vs. 1,268 [2.99%], p < 0.001), and shorter hospital stays (13.61 days vs. 9.97 days, p < 0.001). However, average medical cost was 510,734 Korean Won (444 US dollar) higher for LS than OS. @*Conclusion@#The study confirms the clinical benefits of LS over OS for gastrectomy in terms of fewer postoperative complications and shorter hospital stays. However, the average medical cost of LS was higher than that of OS.
ABSTRACT
PURPOSE: The purpose of this study was to evaluate the clinical results of fixation of the unstable osteochondral dissecans (OCD) lesion with autologous osteochondral plugs. MATERIALS AND METHODS: This study was conducted in 19 patients who were relevant to the International Cartilage Repair Society 2, 3, or 4 who were treated with autologous osteochondral plugs and followed-up for more than 2 years from January 2004 to January 2012. Clinical evaluation was performed by comparing the preoperative and last follow-up scores of Lysholm score and subjective International Knee Documentation Committee (IKDC) score. RESULTS: All patients were male and the average age was 19.1 years. Of the 19 cases, there were 16 cases of medial femoral condyle lateral side lesion, 2 cases of lateral femoral condyle articular surface, and 1 case of femoral intercondylar notch lesions. The average size of the lesion was 5.68 mm2, and average use of osteochodral plugs were 4.3. Average follow-up period was 38 months. Preoperative Lysholm score, IKDC subjective score showed significant improvement. CONCLUSION: Fixation with autologous osteochondral plugs for unstable OCD uses the remnant tissues therefore conserving it, which is thought to be the positive aspect of this type of operation.
Subject(s)
Humans , Male , Cartilage , Follow-Up Studies , Knee Joint , KneeABSTRACT
PURPOSE: Posterior malleolus fractures of the ankle involve the articular surface of the distal tibia, and are related to the axis of weight bearing, which often causes difficulty in reduction and fixation. It was assumed that patients with ankle fractures combined with posterior malleolus fractures would be more prone to arthritis than those without such fractures. The main aim of this article was to define the relationship between early arthritis and an ankle fracture with a concomitant trimalleolar fracture or bimalleolar fracture. MATERIALS AND METHODS: Among the patients who had undergone an open reduction and internal fixation of the ankle joint between Nov. 2000 and Sep. 2005, 52 patients had a bimalleolar fracture or a trimalleolar fracture, and underwent metal removal. A retrospective clinical and radiological analysis was performed on the 52 patients. The mean follow up period was 25 months. Thirty-six patients had a bimalleolar fracture without a posterior malleolus fracture, and 16 patients had a trimalleolar fracture with internal fixation. The mean ages of the two groups were 36 and 43 years of age, and there were no significant differences in the gender distribution, route of trauma, and smoking between the two groups. The post operational rehabilitation treatment was applied equally to both groups. RESULTS: The VAS score of thebimalleolar fracture and trimalleolar fracture was 8.8 and 8.6, respectively. The AOFAS score of the bimalleolar fracture and trimalleolar fracture was 84.0 and 83.5, respectively, showing no significant difference. Only the patients who underwent metal removal were included because of the radiological analysis. The Kellgren-Lawrence scale of the bimalleolar fracture and trimalleolar fracture was 1.00 and 1.31, respectively, showing no significant difference. CONCLUSION: This study showed that patients with ankle fractures concomitant with posterior malleolus fractures had equally favorable outcomes to those patients with ankle fractures without a concomitant posterior malleolus fracture. Studies with more cases, a longer follow up, and prospective approaches will be needed to confirm these results.