Background: We aimed to examine the association between antihypertensive use and the incidence of hospitalized pneumonia in patients with a history of stroke. Methods: In this case-crossover study, we obtained data from the Korean National Health Insurance Service–National Sample Cohort database. We included the data of patients with history of stroke who were admitted with a disease code of pneumonia. We analyzed the patients’ exposure to antihypertensives in the 30 (single case period), 90–120, and 150–180 days (2 control periods) before the onset of pneumonia using conditional logistic regression analysis. Additionally, sensitivity analysis and subgroup analysis according to diabetes status, age, and documented disability were performed. Results: Angiotensin II receptor blocker (ARB) use was associated with a reduced risk of hospitalized pneumonia (adjusted odds ratio [OR] [95% confidence interval; 95% CI]: 0.718 [0.576–0.894]). However, the use of angiotensin converting enzyme inhibitors and other antihypertensives were not associated with a change in hospitalized pneumonia incidence (adjusted OR [95% CI]: 0.902, [0.603–1.350] and 0.788 [0609–1.018], respectively). Subgroup analysis revealed that ARB use was associated with a reduced incidence of hospitalized pneumonia in patients with a history of stroke who were older than 65 years, but not in younger (≤ 65 years) group (adjusted OR [95% CI]: 0.687 [0.536–0.880]). Conclusion ARB use is associated with a reduced incidence of hospitalized pneumonia in patients with a history of stroke, especially in older adults.

Background and Objectives: Preoperative assessment is one of the most important fields in surgery and anesthesia as it can reduce morbidity and mortality from surgery and detect abnormal findings not clinically observed through preoperative examination. However, excessive non-vital preoperative routine tests have been criticized. The aim of the study is to investigate the current use of elective preoperative evaluations using otorhinolaryngologic surgery covering patients of all ages with various levels of difficulty.Subjects and Method Using the Korean National Health Insurance Service National Sample Cohort data, we investigated 98890 subjects who underwent otorhinolaryngologic surgery during the year 2018. We evaluated sociodemographic characteristics, clinical characteristics, medical institutions, and operation characteristics of the subjects and analyzed in detail their routine blood and urine test items, sonographic exams and pulmonary function tests. Results: There were differences in the implementation of preoperative blood and urine tests, sonographic exams and pulmonary function tests according to sociodemographic characteristics, types and locations of medical institutions. Old age, low socioeconomic status, comorbid condition, high Charlson’s Comorbidity Index, tertiary hospital were the factors that increased preoperative evaluation tests. Conclusion Appropriate preoperative evaluation is needed for predicting and preparing for the possibility of treatment complications as well as improving treatment quality while reducing costs for perioperative management.

Background: Previous studies have reported an association between pneumonia risk and the use of certain drugs. We investigated the relationship between antihypertensive drugs and pneumonia in the general population. Methods: This case-crossover study utilized the nationwide data of South Korea. We included participants who were hospitalized for pneumonia. A single case period was defined as 30 days before pneumonia onset, and two control periods were established (90–120 and 150–180 days before pneumonia onset). Further, we performed sensitivity and subgroup analyses (according to the presence of diabetes, documented disability, and whether participants were aged ≥ 70 years). We used conditional logistic regression models adjusted for covariates, such as angiotensin-converting-enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), other antihypertensives, statins, antipsychotics, benzodiazepine, and the number of outpatient visits. Results: In total, 15,463 subjects were included in this study. ACE inhibitors (adjusted odds ratio [aOR], 0.660; 95% confidence interval [CI], 0.558–0.781), ARBs (aOR, 0.702; 95% CI, 0.640–0.770), and other antihypertensive drugs (aOR, 0.737; 95% CI, 0.665–0.816) were significantly associated with reduced pneumonia risk. Subgroup analyses according to the presence of diabetes mellitus, documented disability, and whether participants were aged ≥ 70 years consistently showed the association of antihypertensives with a reduced risk of hospitalization for pneumonia. Conclusion All antihypertensive drug types were related to a lower risk of hospitalization for pneumonia in the general population. Our results implied that frequent medical service usage and protective immunity were primarily related to a reduced risk of pneumonia in the general population of South Korea.