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사공필용,이진석,이은정,고광필,김철환,김윤,김용익,SaKong, Pil-Yong,Lee, Jin-Seok,Lee, Eun-Jung,Ko, Kwang-Pil,Kim, Cheol-Hwan,Kim, Yoon,Kim, Yong-Ik 대한예방의학회 2009 예방의학회지 Vol.42 No.1
Objectives : The purpose of this study was to analyze the association between the pattern of prophylactic antibiotic use(PAU) and the surgical site infection(SSI) rate for major surgeries in Korea. Methods : We retrospectively reviewed the medical records of patients who underwent cardiac, colon and gastric surgery, hysterectomies and hip/knee replacements at 20 hospitals, and inclusive of over 500 beds. We randomly sampled 60 cases per surgery type for patients discharged between September and November, 2006. A total fo 2,924 cases were included in our analysis. Cox's proportional hazard analysis was conducted to evaluate the association between the pattern of PAU and SSI rate. Results : The proportion of patients who received their first prophylactic antibiotics(PA) 1 hour before incision was 65.5%, who received inappropriate PAs was 80.8%, and the proportion of patients whose PA was discontinued within 24 hours of surgery was 0.5%. The average duration of PAU after surgery was 9 days. The relative risk(RR) of SSI in patients who received their first PA more than 1 hour before incision was significantly higher than for those who received it within 1 hour prior to incision(RR=8.20, 95% CI=4.81-13.99). Inappropriate PA selection increased SSI rate, albeit with marginal significance(RR=1.97, 95% CI=0.96-4.03). Also, prolonged PAU following surgery had no effect on SSI rate. Conclusions : These results suggest that the pattern of PAU in the surgeries examined was not appropriate. Errors in the timing of PAU and of PA selection increase SSI rate. SSI rate remained unaltered following prolonged PAU after surgery.
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사공필용,김은경,김윤,김용익,이진석 한국모자보건학회 2009 한국모자보건학회지 Vol.13 No.1
Objectives : The purpose of this study is to analyze the factors affecting breastfeeding initiation by time sequences after delivery. Methods : We retrospectively reviewed medical records of the mothers and neonates in 22 hospitals with over 500 beds selected by proportional stratified random sampling according to location and bed size. We randomly sampled 60 cases per each delivery type (vaginal delivery and C-section) from each hospital, from the patients who had discharged between September 1st and November 30th, 2006. If there were no enough sample size in one hospital, we reviewed all cases during discharged 3 months period. A total of 1,506 medical records were selected but 281 were excluded because of breastfeeding contraindication (54 cases), refusal of breastfeeding(187 cases), and no breastfeeding initiation time record (40 cases). Total number of subjects included for analysis was 1,225. We reviewed breastfeeding initiation time after delivery and conducted Chi-square test and multiple logistic regression analysis. Seven variables (maternal age, delivery type, gestational age, birth weight, 5 minutes APGAR score, mother's hospital duration, and Baby-friendly Hospital Initiative) were used in multiple logistic regression analysis. Multiple logistic regression was carried out using SPSS WIN 12.0 program to identify the factors affecting initiation time of breast feeding. Results : The proportion of mothers who breastfed within 30 minutes after delivery was 12.3% in vaginal delivery and 0% in C-section. Adjusted odds ratios associated with no breastfeeding within 120 minutes after delivery were 0.04(95% CI:0.01-0.19) for C-section with local anesthesia, 0.21 (95% CI: 0.09~0.48) for C-section with general anesthesia compared with vaginal delivery. Adjusted odds ratios associated with no breastfeeding within 180 minutes after delivery were 0.14 (95% CI: 0.06~ 0.31) for C-section with local anesthesia, 0.24 (95% CI: 0.12~0.48) for C-section with general anesthesia compared with vaginal delivery. Adjusted odds ratios associated with no breastfeeding within 24 hours after delivery were 0.19 (95% CI: 0.10~0.37) for C-section with local anesthesia, 0.05 (95% CI: 0.02~0.10) for C- section with general anesthesia compared with vaginal delivery. Conclusion : The results of this study suggest that delivery type, anesthesia type, and Baby-friendly Hospital Initiative are significant factors affecting breastfeeding initiation time after delivery. Because early breastfeeding after delivery is associated with higher breastfeeding rate, policymakers should establish appropriate policies to promote breastfeeding initiation time after delivery.
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고관절 부분 치환술 시술정보 공개에 따른 재입원율, 입원일수 및 진료비의 변화
장원모,은상준,사공필용,이채은,오무경,오주환,김윤,Jang, Won-Mo,Eun, Sang-Jun,SaGong, Pil-Young,Lee, Chae-Eun,Oh, Moo-Kyung,Oh, Ju-Hwan,Kim, Yoon 대한예방의학회 2010 Journal of Preventive Medicine and Public Health Vol.43 No.6
Objectives: We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. Methods: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume (over 16 operations in a year) and low volume institutions, after performance reporting (December 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. Results: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p = 0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25 - 0.95) and 10% (${\beta}$=-0.102, p<0.01) and cost was not changed (${\beta}$=-0.01, p=0.27). The high volume institutions were more decreased than low volume in length of stay. Conclusions: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginally shifted from low volume institutions to high volume institutions.
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