Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study.

OBJECTIVES: Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival. METHODS: A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed. RESULTS: The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). CONCLUSIONS: Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes.

Hyperglycemia and Hypoglycemia Are Associated with In-Hospital Mortality among Patients with Coronavirus Disease 2019 Supported with Extracorporeal Membrane Oxygenation.

Metabolic abnormalities, such as preexisting diabetes or hyperglycemia or hypoglycemia during hospitalization aggravated the severity of COVID-19. We evaluated whether diabetes history, hyperglycemia before and during extracorporeal membrane oxygenation (ECMO) support, and hypoglycemia were risk factors for mortality in patients with COVID-19. This study included data on 195 patients with COVID-19, who were aged ≥19 years and were treated with ECMO. The proportion of patients with diabetes history among nonsurvivors was higher than that among survivors. Univariate Cox regression analysis showed that in-hospital mortality after ECMO support was associated with diabetes history, renal replacement therapy (RRT), and body mass index (BMI) < 18.5 kg/m2. Glucose at admission >200 mg/dL and glucose levels before ventilator >200 mg/dL were not associated with in-hospital mortality. However, glucose levels before ECMO >200 mg/dL and minimal glucose levels during hospitalization <70 mg/dL were associated with in-hospital mortality. Multivariable Cox regression analysis showed that glucose >200 mg/dL before ECMO and minimal glucose <70 mg/dL during hospitalization remained risk factors for in-hospital mortality after adjustment for age, BMI, and RRT. In conclusion, glucose >200 mg/dL before ECMO and minimal glucose level <70 mg/dL during hospitalization were risk factors for in-hospital mortality among COVID-19 patients who underwent ECMO.

The effect of first- and third-generation prophylactic antibiotics on hospitalization and medical expenditures for cardiac surgery.

BACKGROUND: This study investigated the efficacy of first-generation (cefazolin) and third-generation (ceftizoxime) prophylactic antibiotics in patients undergoing cardiac surgery and the incidence of surgical site infections, hospitalizations, and medical costs. METHODS: All adult patients (≥ 20 years) undergoing cardiac surgery at one hospital from January 01, 2009, to December 31, 2016, were included in this study. A single prophylactic antibiotic was administered at a dose of 1 g within one hour of the surgical incision and for three days after surgery at eight-hour intervals. After propensity score matching, 194 patients in each antibiotic prophylaxis group (first-generation vs third-generation) were analyzed. Among the 388 patients, the incidence of surgical site infections was compared according to the type of prophylactic antibiotic, and risk factors were evaluated by chi-squared tests followed by multivariate logistic regression analysis. RESULTS: The incidence of deep surgical site infections was significantly lower in the first-generation group (5.7%) than in the third-generation group (16.5%). The pathogens isolated from the surgical infection sites were similarly distributed in both groups. However, the prevalence of highly infectious gram-positive bacteria was more than that of gram-negative bacteria (67% vs 23%). The preoperative hospitalization duration, mean operation time, and ventilator use time were similar in both groups, but the postoperative hospitalization duration was significantly shorter in the first-generation group (25.5 days) than in the third-generation group (29.8 days). In addition, the medical costs were lower in the first-generation group (20,594 USD) than in the third-generation group (26,488 USD). CONCLUSION: In conclusion, the first-generation prophylactic antibiotic was better than the third-generation in reducing surgical site infection rates, hospitalization length, and medical expenditures.

Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019: Expert Recommendations from The Korean Society for Thoracic and Cardiovascular Surgery.

Since the first reported case of coronavirus disease 2019 (COVID-19) in December 2019, the numbers of confirmed cases and deaths have continued to increase exponentially despite multi-factorial efforts. Although various attempts have been made to improve the level of evidence for extracorporeal membrane oxygenation (ECMO) treatment over the past 10 years, most experts still hesitate to take an active position on whether to apply ECMO in COVID-19 patients. Several ECMO management guidelines have been published recently, but they reflect some important differences from the Korean medical system and aspects of real-world medical practice in Korea. We aimed to find evidence on the efficacy of ECMO for COVID-19 patients by reviewing the published literature and to propose expert recommendations by analyzing the Korean COVID-19 ECMO registry data.

Acute Type A Aortic Dissection in a 37-Week Pregnant Patient: An Unusual Clinical Presentation.

BACKGROUND: Aortic dissection in pregnancy is relatively rare, but it is often fatal. The estimated incidence of aortic dissection in the general population is 2.9 per 100,000 person-years. Early recognition and treatment of aortic dissections are crucial for survival. Whereas the majority of patients who present with aortic dissection are older than 50 years of age and have a history of hypertension, younger patients with connective tissue disease, bicuspid aortic valves, or a family history of aortic dissection are also at increased risk for developing this condition. CASE REPORT: We report the successful diagnosis and surgical repair of an acute type A aortic dissection in a 35-year-old woman who presented to the emergency department (ED) at 37 weeks of gestation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be alert to the possibility of aortic dissection in any pregnant woman who presents to the ED with unexplained chest, abdominal, or back pain, even those without risk factors for aortic dissection.