Thoracic and Cardiovascular Surgeons' Perception of the Concentration of Cardiovascular Operations in Seoul Metropolitan Area's Hospitals

Jeong, Hyo Seon,Lee, Kun Sei,Chee, Hyun Keun,Ahn, Hye Mi,Sim, Sung Bo The Korean Society for Thoracic and Cardiovascular 2016 Journal of Chest Surgery (J Chest Surg) Vol.49 No.sup

Background: The purpose of this study is to evaluate the concentration of cardiovascular surgical procedures in a metropolitan area and investigate the perception of specialists regarding governmental policies to resolve this imbalance. Methods: From March to May 2015, surveys were distributed to members of the Thoracic and Cardiovascular Surgery Association. The final pool of research subjects consisted of 75 respondents. Subjects were queried regarding the concentration of cardiovascular operations in metropolitan areas, alternatives to the imbalance, and governmental policies to resolve the inequalities. Results: Survey participants responded that South Korea needs governmental policies to alleviate the concentration of cardiovascular surgery patients in large metropolitan hospitals. Participants agreed that the freedom to choose medical institutions and improved accessibility to metropolitan hospitals due to advanced transportation systems were some of the causes for the concentration. A majority (98.7%) of respondents thought establishing thoracic and cardiovascular surgery centers in provinces was an appropriate solution to alleviate the concentration. Thoracic and cardiovascular surgery specialists were ranked as the number one group on which to focus development. Conclusion: Developing and carrying out policies to establish thoracic and cardiovascular surgery centers in provinces will alleviate the regional imbalance in available heart surgery services and an overall improvement in cardiovascular disease treatment in South Korea.

Projections of Demand for Cardiovascular Surgery and Supply of Surgeons

Lee, Jung Jeung,Park, Nam Hee,Lee, Kun Sei,Chee, Hyun Keun,Sim, Sung Bo,Kim, Myo Jeong,Choi, Ji Suk,Kim, Myunghwa,Park, Choon Seon The Korean Society for Thoracic and Cardiovascular 2016 The Korean Journal of Thoracic and Cardiovascular Vol.49 No.sup

Background: While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. Methods: After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. Results: The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040-an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309-an increase of -24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. Conclusion: Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time, effort, and resources; therefore, by analyzing the various factors affecting the supply of cardiovascular surgeons, an active intervention of policies can be prescribed for the areas that have failed to meet the appropriate market distributions.

The Longitudinal Trend of Cardiac Surgery in Korea from 2003 to 2013

Lee, Kyeong Soo,Kim, Chang Suk,Park, Jong Heon,Hwang, Tae Yoon,Kim, Sang Won,Sim, Sung Bo,Lee, Kun Sei The Korean Society for Thoracic and Cardiovascular 2016 The Korean Journal of Thoracic and Cardiovascular Vol.49 No.sup

Background: The purpose of this study was to investigate longitudinal changes of the utilization of operational and surgical medical care inside and outside a metropolitan area over 10 years, analyzing the residential areas of patients and the locations of medical facilities for major cardiovascular surgery. Methods: Data analysis was conducted by classifying the addresses of patients and the locations of medical care facilities of metropolitan cities and provinces, using data from the National Health Insurance Corporation from January 2003 to December 2013. Results: There is serious concentration of major heart surgery to medical facilities in Seoul; this problem has not improved over time. There were differences in percentages of surgical procedures performed in the metropolitan areas according to major diseases. In the case of Busan and Daegu provinces, at least 50% of the patients underwent surgery in medical facilities in the city, but there are other regions where the percentage is less than 50%. In the case of provinces, the percentage of surgical procedures performed in medical facilities in Seoul or nearby metropolitan cities is very high. Conclusion: Policies to strengthen the regional capabilities of heart surgery and to secure human resources are required to mitigate the concentration of patients in the capital area. Many regional multi-centers must be designated to minimize unnecessary competition among regional university hospitals and activate a win-win partnership model for medical services.

Imbalance in Cardiovascular Surgery Medical Service Use Between Regions

Kim, Myunghwa,Yoon, Seok-Jun,Choi, Ji Suk,Kim, Myo Jeong,Sim, Sung Bo,Lee, Kun Sei,Chee, Hyun Keun,Park, Nam Hee,Park, Choon Seon The Korean Society for Thoracic and Cardiovascular 2016 Journal of Chest Surgery (J Chest Surg) Vol.49 No.1

Background: This study uses the relevance index to understand the condition of regional medical service use for cardiovascular surgery and to identify the medical service use imbalance between regions. Methods: This study calculated the relevance index of 16 metropolitan cities and provinces using resident registration address data from the Ministry of Government Administration and Home Affairs and the 2010-2014 health insurance, medical care assistance, and medical benefits claims data from the Health Insurance Review and Assessment Service. We identified developments over the 5-year time period and analyzed the level of regional imbalance regarding cardiovascular surgery through the relative comparison of relevance indexes between cardiovascular and other types of surgery. Results: The relevance index was high in large cities such as Seoul, Daegu, and Gwangju, but low in regions that were geographically far from the capital area, such as the Gangwon and Jeju areas. Relevance indexes also fell as the years passed. Cardiovascular surgery has a relatively low relevance index compared to key types of surgery of other fields, such as neurosurgery and colorectal surgery. Conclusion: This study identified medical service use imbalance between regions for cardiovascular surgery. Results of this study demonstrate the need for political intervention to enhance the accessibility of necessary special treatment, such as cardiovascular surgery.

The Association Between Treatment Frequency and Treatment Outcome for Cardiovascular Surgeries

Choi, Ji Suk,Park, Choon Seon,Kim, Myunghwa,Kim, Myo Jeong,Lee, Kun Sei,Sim, Sung Bo,Chee, Hyun Keun,Park, Nam Hee,Park, Sung Min The Korean Society for Thoracic and Cardiovascular 2016 The Korean Journal of Thoracic and Cardiovascular Vol.49 No.sup

Background: This study analyzed the association between the volume of heart surgeries and treatment outcomes for hospitals in the last five years. Methods: Hospitals that perform heart surgeries were chosen throughout Korea as subjects using from the Health Insurance Review and Assessment Service. The treatment outcome of the heart surgeries was defined as the mortality within 30 postoperative days, while the annual volume of the surgeries was categorized. Logistic regression was used as the statistical analysis method, and the impacts of the variables on the heart surgery treatment outcomes were then analyzed. Results: The chance of death of patients who received surgery in a hospital that performed 50 or more surgeries annually was noticeably lower than patients receiving operations from hospitals that performed fewer than 50 surgeries annually, indicating that the chance of death decreases as the annual volume of heart surgeries in the hospital increases. In particular, the mortality rate in hospitals that performed more than 200 surgeries annually was less than half of that in hospitals that performed 49 or fewer surgeries annually. Conclusion: These results indicate that accumulation of a certain level of heart surgery experience is critical in improving or maintaining the quality of heart surgeries. In order to improve the treatment outcomes of small hospitals, a support policy must be implemented that allows for cooperation with experienced professionals.

Primary Pulmonary Amyloidosis with Mediastinal Lymphadenopathy

Kim, Dohun,Lee, Yong-Moon,Kim, Si-Wook,Kim, Jong-Won,Hong, Jong-Myeon The Korean Society for Thoracic and Cardiovascular 2016 The Korean Journal of Thoracic and Cardiovascular Vol.49 No.3

We report a case of inadvertent hoarseness after surgery for primary pulmonary amyloidosis. A 55-year-old male was transferred to our facility due to a lung mass. Chest computed tomography revealed a solitary pulmonary nodule. Positron emission tomography-computed tomography showed fluorodeoxyglucose uptake in the main mass and in the mediastinal lymph nodes. To confirm the pathology of the mass, wedge resection and thorough lymph node dissection were performed via video-assisted thoracic surgery (VATS). No complications except for hoarseness were observed; hoarseness developed soon after surgery and lasted for 3 months. The main mass was diagnosed as amyloidosis, but this was not found in the lymph nodes. In conclusion, VATS wedge resection for peripheral amyloidosis is a feasible and safe procedure. However, mediastinal lymph node dissection is not recommended unless there is evidence of a clear benefit.

Public Perception of the Concentration of Cardiac and Cerebrovascular Surgery to Metropolitan Hospitals

Lee, Young-Hoon,Lee, Kun Sei,Jeong, Hyo Seon,Ahn, Hye Mi,Oh, Gyung-Jae The Korean Society for Thoracic and Cardiovascular 2016 The Korean Journal of Thoracic and Cardiovascular Vol.49 No.sup

Background: This study investigates the perception of the general public regarding the concentration to metropolitan, hospitals of cardiac and cerebrovascular surgeries, and the perceived public need for government policies to resolve this issue. Methods: A total of 800 participants were recruited for our telephone interview survey. Quota sampling was performed, adjusting for age and sex, to select by various geographic regions. Sampling with random digit dialing was performed; we called the randomly generated telephone numbers and made three attempts for non-responders before moving on to a different telephone number. Results: Our sample population was 818 participants, 401 men (49.0%) and 417 women (51.0%). Our data showed that 85.5% of participants thought that cardiac surgery and neurosurgery patients are concentrated in large hospitals in Seoul. The principle reason for regional patients to want to receive surgery at major hospitals in Seoul was because of poor medical standards associated with regional hospitals (87.7%). We found that a vast majority of participants (97.5%) felt that government policies are needed to even out the clustering of cardiac surgery and neurosurgery patients, and that this clustering may be alleviated if policies that can specifically enhance the quality and the capacity of regional hospitals to carry out surgeries are adopted (98.3%). Conclusion: Government policy making must reflect public desiderata, and we suggest that these public health needs may be partially resolved through government-designated cardiac and neurosurgery specialist hospitals in regional areas.

Marlex mesh Support for the Correction of Severe Pectus Excavatum

Lee, Doo-Yun,Kim, Hong-Suk,Cho, Bum-Koo The Korean Society for Thoracic and Cardiovascular 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.3

Pectus excavatum is a congenital anomaly of the anterior chest wall with a sharp concave curvature of the body of the sternum, from above downward and from side to side, especially just before the junction of the glandioloxiphoid. There are two major operative procedures -"Ravitch" or "Wada" operation- for the correction of pectus excavatum. We used the modified Ravitch operation which consists of mobilization of the sternum, transverse osteotomy, and parasternal resection of the costal cartilages followed by placement of Marlex mesh using methyl methacrylate behind the sternum and suturing the edge of the Marlex mesh to the peripheral stump of the resected ribs. This was performed in a patient with severe pectus excavatum with good results at the Department of Thoracic and Cardiovascular Surgery Yonsei University College of Medicine in Seoul, Korea on January 12, 1989.anuary 12, 1989.

Progress in cardiac valve replacement: clinical and hemdynamic results with the St. Jude prosthesis

Lillehei, C.W. The Korean Society for Thoracic and Cardiovascular 1983 Journal of Chest Surgery (J Chest Surg) Vol.16 No.3

Extra-anatomical bypass procedure from ascending to abdominal aorta for the surgery of thoracic and thoraco-abdominal aneurysm

Fujita, Tsuyoshi The Korean Society for Thoracic and Cardiovascular 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.3