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Predictors of 30-day morbidity after hysterectomy for benign disease
( Meari Dong ),( Seung-hyuk Shim ),( Jung Hwa Suh ),( Sun Joo Lee ),( Ji Young Lee ),( Soo-nyung Kim ),( Soon-beom Kang ) 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-
목적: To determine factors associated with 30-day postoperative morbidity among women who underwent hysterectomy for benign indications. 방법: We retrospectively reviewed the medical records of patients who underwent hysterectomy for benign indications at Konkuk University Hospital during 2011 and 2015. Primary outcome measure was 30-day morbidity after hysterectomy. Bivariate analyses were performed using Pearson χ2 and independent t tests for categorical and continuous variables, respectively. Multivariable regression analysis was performed to identify factors independently associated with 30-day morbidity. 결과: In total, 1,616 hysterectomies were identified during the study period. The median age was 48 (range, 31-82) years. 30-day morbidity rates were 4.2% (68/1616); 8.5% for abdominal hysterectomy, 2.7% for laparoscopic-assisted vaginal hysterectomy, and 2.9% for vaginal hysterectomy. The most common 30-day morbidities were urinary tract injury (26.5%), blood transfusion> 4 unit (20.6%) and surgical site infections (17.6%). 30-day morbidity was associated with increased time to resumption of normal diet, postoperative hospital stay, and readmission rates. Variables that were independently associated with 30-day morbidity after multivariable regression analysis included age [odds ratio (OR) 0.936, 95% CI 0.894-0.980; p=0.005], Charlson comorbidity index ≥3 (OR 4.680, 95% CI 2.050- 10.686; p<0.001), operating time (OR 1.007, 95% CI 1.004-1.010; p<0.001), and estimated blood loss (OR 1.002, 95% CI 1.002-1.003; p<0.001). 결론: We identified several patient-related and procedural risk factors for 30-day morbidity after hysterectomy. 30-day morbidity was associated with significantly prolonged hospital stay and higher rates of readmission. Our findings reinforce the importance of patient selection and optimization of comorbidities before hysterectomy. Future research should aim to further delineate differential risks of morbidity by surgical route as well as modifiable risk factors for morbidity.
( Yihua Jin ),( Meari Dong ),( Seung Woo Yang ),( Kyu-min Lee ),( Sung Won Han ),( Shin Hee Seo ),( Ajin Lee ),( In Sook Sohn ),( Han Sung Kwon ),( Geum Joon Cho ),( Han Sung Hwang ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.4
Objectives The current study aimed to investigate whether pregnancy outcomes are affected by maternal rhesus (Rh) status by comparing the primigravida pregnancy outcomes of Rh-negative women with those of Rh-positive women. Methods The study data were collected from the Korea National Health Insurance Claims Database and the National Health Screening Program for Infants and Children. In total, 1,664,882 primigravida women who gave birth between January 1, 2007 and December 31, 2014, were enrolled in this study. As the risk and severity of sensitization response increases with each subsequent pregnancy, only primigravida women were enrolled. The patients were divided into 2 groups according to Rh status, and the pregnancy outcomes were compared. Results In total, 1,661,320 women in the Rh-positive group and 3,290 in the Rh-negative group were assessed. With regard to adverse pregnancy outcomes, there was no statistically significant difference between the 2 groups in terms of the prevalence of preeclampsia, postpartum hemorrhage, abruptio placenta, placenta previa, and uterine artery embolization. A univariate analysis revealed that none of the adverse pregnancy outcomes were significantly correlated to Rh status (preeclampsia: odds ratio [OR], 1.00, 95% confidence interval [CI], 0.81-1.23; postpartum hemorrhage: OR, 1.10, 95% CI, 0.98-1.24; abruptio placenta: OR, 0.80, 95% CI, 0.46-1.37; and placenta previa: OR, 1.08, 95% CI, 0.78-1.42). The adjusted ORs of postpartum hemorrhage and preterm birth did not significantly differ. Conclusion Maternal Rh status is not associated with adverse outcomes in primigravida women.
( Jung Eun Kim ),( Seung-hyuk Shim ),( Meari Dong ),( Hyojin Lee ),( Han Sung Hwang ),( Han Sung Kwon ),( Sun Joo Lee ),( Ji Young Lee ),( In Sook Sohn ),( Soo-nyung Kim ),( Soon-beom Kang ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.5
Objective To determine whether local bupivacaine injection into the incision site after gynecologic laparoendoscopic single site surgery (LESS) improves postoperative pain. Methods This prospective cohort study included consecutive 158 patients who had LESS for benign adnexal disease from March 2013 to December 2015. Chronologically, 82 patients (March 2013 to August 2014) received no bupivacaine (group 1) and 76 (August 2014 to December 2015) received a bupivacaine block (group 2). For group 2, 10 mL 0.25% bupivacaine was injected into the 20 mm-incision site through all preperitoneal layers after LESS completion. Primary outcome is postoperative pain score using the visual analog scale (VAS). Results There was no difference in clinicopathological characteristics between the groups. Operating time (expressed as median [range], 92 [55-222] vs. 100 [50-185] minutes, P=0.137) and estimated blood loss (50 [30-1,500] vs. 125 [30- 1,000] mL, P=0.482) were similar between the groups. Post-surgical VAS pain scores after 3 hours (3.5 [2-6] vs. 3.5 [2-5], P=0.478), 6 to 8 hours (3.5 [2-6] vs. 3 [1-8], P=0.478), and 16 to 24 hours (3 [2-4] vs. 3 [1-7], P=0.664) did not differ between groups. Conclusion Bupivacaine injection into the trocar site did not improve postoperative pain after LESS. Randomized trials are needed to evaluate the benefits of local bupivacaine anesthetic for postoperative pain reduction.
( Seung Woo Yang ),( Su Hyun Chae ),( So Ra Kim ),( Young Hee Hong ),( Meari Dong ),( Hee Sun Kim ),( Han-sung Kwon ),( In-sook Sohn ),( Han-sung Hwang ) 대한주산의학회 2019 Perinatology Vol.30 No.4
Objective: In Korean population, information is lacking regarding fetal subcutaneous tissue thickness (SCTT) detected during pregnancy in the normal maternal condition. Thus, the aim of this study is to evaluate SCTT in the basic fetal biometry measurement plane, and to identify the clinical significance of SCTT in estimating fetal weight. Methods: In this retrospective observational study, 856 term pregnant women were recruited between 1st January 2013 and 31st December 2015. Estimated fetal weight (EFW) and fetal SCTT were measured routine ultrasonography within one week before delivery. The women were divided in two groups: SCTT group (n=46) and non-SCTT group (n=810). Pregnancy outcomes including birth weight (BW) and EFW were compared between the two groups. Results: The incidence of SCTT was 5.4% and no significant differences in parity, maternal age, maternal pre-pregnancy body mass index or gestational age at delivery were found between the groups. EFW, BW, amniotic fluid index, and cesarean section rate were higher in the SCTT group than in the non-SCTT group. The difference between EFW and BW was only significant in the SCTT group. Moreover, SCTT and EFW were positively correlated with BW (SCTT group: EFW 3,460±472 g vs. BW 3,779±496 g, P=0.013; non-SCTT group: EFW 3,011±436 g vs. BW 3,090±468 g, P=0.324). Conclusion: Fetal SCTT detected during routine biometric ultrasonography evaluation in the third trimester of pregnancy could suggest larger BW than EFW. Therefore, physicians should pay careful attention in such cases during assessments for delivery.