Risk Factors of Injured Patients with Frequent Emergency Department Visits: A Single Center Study in Jeju Island

PURPOSE: For patients who suffer frequent injury, there could be several causes contributing to repeated occurrence of injury. Occupation, alcohol, substance, age, socioeconomic status, etc could be related to recidivism. In order to perform an analysis of preventable causes, we investigated the characteristics of injured patients who visited the emergency department (ED) frequently, compared with patients who visited the ED only once. METHODS: A retrospective cohort study was conducted. Data for this study were obtained from the injury surveillance system of the ED at Jeju National University Hospital. Patients who visited the ED between March 2009 and March 2011 were enrolled, and were observed over a period of 18 months. The Once group (OG) was defined as patients who visited the ED once, and the frequent group (FG) as patients who visited the ED more than twice. The following factors were investigated: demographic data, medical condition, drug misuse and abuse, intention of injury, alcohol use, mechanism of injury, place of occurrence, and activity when injured. Chi square test/t-test and logistic regression analysis were performed for analysis of risk factors of FG patients. RESULTS: A total of 12,520 injured patients included: 11,895(95.01%) patients in the OG and 625(4.99%) patients in the FG. The total number of injuries in the FG was 1,352. The mean age of patients in the FG was younger than that of patients in the OG by approximately six years (27.96 vs 34.61). Patients in the FG suffered a greater number of falls, blunt trauma than those in the OG, and injuries occurred more frequently at home. Risk factors for frequent visits to the ED included a younger age, alcohol associated injury, intentional injury, hypertension, diabetes, liver disease, mental illness, dementia, Parkinson's disease, and epilepsy. CONCLUSION: In order to prevent another injury, patients with medical conditions associated with injury recidivism and young people, and alcohol users should undergo screening and should receive education in the ED. In part, on the basis of our results, emergency medical service associated organizations can plan multidirectional injury prevention programs.

Risk Factors for Postoperative Complications of Gastric Cancer Patients

PURPOSE: The surgical techniques and postoperative care for gastric cancer have significantly improved in recent years. However, the incidence of several complications that can result in relatively increased mortality remains high. The aim of this study was to evaluate the risk factors associated with postoperative morbidity in surgery for gastric cancer. METHODS: Four hundreds and one consecutive patients, who underwent surgery for gastric cancer at National Medical Center between January 1994 and December 2002, were reviewed. RESULTS: The overall morbidity and mortality rates were 10.2 and 1.5%, respectively. A univariate analysis of multiple clinical variables revealed that age, leukocyte counts, albumin, protein, comorbid disease, combined resection, operation time, blood loss, operation type, curability, extent of lymph node dissection and stage were significantly associated with morbidity. However, a multivariate analysis showed that comorbid diseases and low curability were independent factors associated with morbidity (P<0.05). CONCLUSION: In patients with comorbid diseases and a noncurative resection, the complication rate was significantly higher. More attention should be paid to the early diagnosis, preoperative evaluation and intraoperative caution of patients with preoperative risk factors.

Risk Factors Associated with Mortality in Emergency Surgery for Perforated Peptic Ulcer

PURPOSE: Despite modern medication, peptic ulcer, patients often require emergency surgery for complications of peptic ulcer disease, and the mortality due to a perforated peptic ulcer still remains high. This retrospective study was conducted to evaluate the risk factors associated with mortality in patients undergoing surgery for a perforated peptic ulcer. METHODS: Two hundred and four consecutive patients (mean age: 45.8 years; range: 15~0 years) who underwent emergency surgery for a perforated peptic ulcer at the National Medical Center, between January 1991 and December 2000, were reviewed. RESULTS: The overall mortality rate was 5.9%. A univariate analysis of multiple clinical variables revealed old age (> or =65 years), duration of symptoms (> or =24 hours), NSAIDs or steroid use, comorbid disease, shock on admission, low hemoglobin ( or =20 mg%), higher creatinine (> or =1.5 mg%), gastric ulcer and simple closure to be significantly associated with mortality. However, a multivariate analysis showed that shock on admission, comorbid disease and old age (> or =65 years) were independent predictors of mortality. CONCLUSION: Shock on admission, comorbid disease and old age should be considered as significant prognostic factors of emergency surgery for a perforated peptic ulcer, and a comorbid disease and age as non modifiable factors. For that reason, prompt resuscitation is considered as the most effective therapy for reducing the mortality due to peptic ulcer perforation.