Background: Hip fractures (HFs) are major osteoporotic injuries associated with morbidity, loss of independence, increased mortality, and an increased socioeconomic burden.The total number of HFs is increasing owing to an aging population. While studies have focused on 30-day or 1-year mortality after HF surgery, studies reporting long-term mortality are lacking. Our study bridges this knowledge gap by exploring the relationship between frailty, postoperative complications, and the 5-year mortality after HF surgery.This study aimed to identify the risk factors associated with 5-year mortality after HF surgery. The impact of the Hip-Multidimensional Frailty Score (Hip-MFS) and postoperative complications on 5-year mortality was compared. Methods: This retrospective study included 536 individuals aged 65 years and older with HFs who underwent surgery between 2009 and 2014. The Hip-MFS was calculated using the comprehensive geriatric assessment. Patients whose Hip-MFS score above 8 considered as frail. Postoperative complications included pneumonia, urinary tract infection, delirium, pulmonary thromboembolism, and unplanned intensive care unit admission after surgery.The primary outcome was 5-year mortality. Univariate and multivariate cox-regression, Kaplan–Meier analysis and log-rank tests were used to assess predictive value of frailty and postoperative complications on 5-year mortality. Results: The mean age was 80.5 ± 7.0 years and 71.3% (n = 382) were women. Overall, 48.3% (n = 259) were diagnosed with femoral neck fractures, and 51.7% (n = 277) were diagnosed with intertrochanteric fractures. A total of 223 (41.6%) patients experienced postoperative complications. The overall mortality rate was 60.4% (n = 324), with 1-year and 5-year mortality rates after HF surgery being 13.8% (n = 74) and 43.8% (n = 235), respectively. In the multivariate regression analysis, after adjusting for clinical and demographic factors, the high-risk Hip-MFS group and the group with postoperative complications had hazard ratios for 5-year survival of 1.513 (95% confidence interval [CI], 1.105–2.017; P = 0.010) and 1.470 (95% CI, 1.117–1.936;P = 0.006), respectively. Patients who had postoperative complications with a low Hip-MFS showed better 5-year survival than those without postoperative complications with a high Hip-MFS in the Kaplan–Meier curve (P = 0.013). Conclusion A high Hip-MFS risk and postoperative complications were associated with an increased 5-year mortality rate. In comparison to the occurrence of postoperative complications, the frailty status evaluated using the Hip-MFS had a more significant impact on long-term mortality after HF surgery.

Background: Hip fractures (HFs) are major osteoporotic injuries associated with morbidity, loss of independence, increased mortality, and an increased socioeconomic burden.The total number of HFs is increasing owing to an aging population. While studies have focused on 30-day or 1-year mortality after HF surgery, studies reporting long-term mortality are lacking. Our study bridges this knowledge gap by exploring the relationship between frailty, postoperative complications, and the 5-year mortality after HF surgery.This study aimed to identify the risk factors associated with 5-year mortality after HF surgery. The impact of the Hip-Multidimensional Frailty Score (Hip-MFS) and postoperative complications on 5-year mortality was compared. Methods: This retrospective study included 536 individuals aged 65 years and older with HFs who underwent surgery between 2009 and 2014. The Hip-MFS was calculated using the comprehensive geriatric assessment. Patients whose Hip-MFS score above 8 considered as frail. Postoperative complications included pneumonia, urinary tract infection, delirium, pulmonary thromboembolism, and unplanned intensive care unit admission after surgery.The primary outcome was 5-year mortality. Univariate and multivariate cox-regression, Kaplan–Meier analysis and log-rank tests were used to assess predictive value of frailty and postoperative complications on 5-year mortality. Results: The mean age was 80.5 ± 7.0 years and 71.3% (n = 382) were women. Overall, 48.3% (n = 259) were diagnosed with femoral neck fractures, and 51.7% (n = 277) were diagnosed with intertrochanteric fractures. A total of 223 (41.6%) patients experienced postoperative complications. The overall mortality rate was 60.4% (n = 324), with 1-year and 5-year mortality rates after HF surgery being 13.8% (n = 74) and 43.8% (n = 235), respectively. In the multivariate regression analysis, after adjusting for clinical and demographic factors, the high-risk Hip-MFS group and the group with postoperative complications had hazard ratios for 5-year survival of 1.513 (95% confidence interval [CI], 1.105–2.017; P = 0.010) and 1.470 (95% CI, 1.117–1.936;P = 0.006), respectively. Patients who had postoperative complications with a low Hip-MFS showed better 5-year survival than those without postoperative complications with a high Hip-MFS in the Kaplan–Meier curve (P = 0.013). Conclusion A high Hip-MFS risk and postoperative complications were associated with an increased 5-year mortality rate. In comparison to the occurrence of postoperative complications, the frailty status evaluated using the Hip-MFS had a more significant impact on long-term mortality after HF surgery.

Background: Hip fractures (HFs) are major osteoporotic injuries associated with morbidity, loss of independence, increased mortality, and an increased socioeconomic burden.The total number of HFs is increasing owing to an aging population. While studies have focused on 30-day or 1-year mortality after HF surgery, studies reporting long-term mortality are lacking. Our study bridges this knowledge gap by exploring the relationship between frailty, postoperative complications, and the 5-year mortality after HF surgery.This study aimed to identify the risk factors associated with 5-year mortality after HF surgery. The impact of the Hip-Multidimensional Frailty Score (Hip-MFS) and postoperative complications on 5-year mortality was compared. Methods: This retrospective study included 536 individuals aged 65 years and older with HFs who underwent surgery between 2009 and 2014. The Hip-MFS was calculated using the comprehensive geriatric assessment. Patients whose Hip-MFS score above 8 considered as frail. Postoperative complications included pneumonia, urinary tract infection, delirium, pulmonary thromboembolism, and unplanned intensive care unit admission after surgery.The primary outcome was 5-year mortality. Univariate and multivariate cox-regression, Kaplan–Meier analysis and log-rank tests were used to assess predictive value of frailty and postoperative complications on 5-year mortality. Results: The mean age was 80.5 ± 7.0 years and 71.3% (n = 382) were women. Overall, 48.3% (n = 259) were diagnosed with femoral neck fractures, and 51.7% (n = 277) were diagnosed with intertrochanteric fractures. A total of 223 (41.6%) patients experienced postoperative complications. The overall mortality rate was 60.4% (n = 324), with 1-year and 5-year mortality rates after HF surgery being 13.8% (n = 74) and 43.8% (n = 235), respectively. In the multivariate regression analysis, after adjusting for clinical and demographic factors, the high-risk Hip-MFS group and the group with postoperative complications had hazard ratios for 5-year survival of 1.513 (95% confidence interval [CI], 1.105–2.017; P = 0.010) and 1.470 (95% CI, 1.117–1.936;P = 0.006), respectively. Patients who had postoperative complications with a low Hip-MFS showed better 5-year survival than those without postoperative complications with a high Hip-MFS in the Kaplan–Meier curve (P = 0.013). Conclusion A high Hip-MFS risk and postoperative complications were associated with an increased 5-year mortality rate. In comparison to the occurrence of postoperative complications, the frailty status evaluated using the Hip-MFS had a more significant impact on long-term mortality after HF surgery.

Background: Hip fractures (HFs) are major osteoporotic injuries associated with morbidity, loss of independence, increased mortality, and an increased socioeconomic burden.The total number of HFs is increasing owing to an aging population. While studies have focused on 30-day or 1-year mortality after HF surgery, studies reporting long-term mortality are lacking. Our study bridges this knowledge gap by exploring the relationship between frailty, postoperative complications, and the 5-year mortality after HF surgery.This study aimed to identify the risk factors associated with 5-year mortality after HF surgery. The impact of the Hip-Multidimensional Frailty Score (Hip-MFS) and postoperative complications on 5-year mortality was compared. Methods: This retrospective study included 536 individuals aged 65 years and older with HFs who underwent surgery between 2009 and 2014. The Hip-MFS was calculated using the comprehensive geriatric assessment. Patients whose Hip-MFS score above 8 considered as frail. Postoperative complications included pneumonia, urinary tract infection, delirium, pulmonary thromboembolism, and unplanned intensive care unit admission after surgery.The primary outcome was 5-year mortality. Univariate and multivariate cox-regression, Kaplan–Meier analysis and log-rank tests were used to assess predictive value of frailty and postoperative complications on 5-year mortality. Results: The mean age was 80.5 ± 7.0 years and 71.3% (n = 382) were women. Overall, 48.3% (n = 259) were diagnosed with femoral neck fractures, and 51.7% (n = 277) were diagnosed with intertrochanteric fractures. A total of 223 (41.6%) patients experienced postoperative complications. The overall mortality rate was 60.4% (n = 324), with 1-year and 5-year mortality rates after HF surgery being 13.8% (n = 74) and 43.8% (n = 235), respectively. In the multivariate regression analysis, after adjusting for clinical and demographic factors, the high-risk Hip-MFS group and the group with postoperative complications had hazard ratios for 5-year survival of 1.513 (95% confidence interval [CI], 1.105–2.017; P = 0.010) and 1.470 (95% CI, 1.117–1.936;P = 0.006), respectively. Patients who had postoperative complications with a low Hip-MFS showed better 5-year survival than those without postoperative complications with a high Hip-MFS in the Kaplan–Meier curve (P = 0.013). Conclusion A high Hip-MFS risk and postoperative complications were associated with an increased 5-year mortality rate. In comparison to the occurrence of postoperative complications, the frailty status evaluated using the Hip-MFS had a more significant impact on long-term mortality after HF surgery.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Hemiarthroplasty is frequently used to treat displaced femoral neck fractures in elderly patients, but it has a higher risk of postoperative dislocation. We introduced the posterior approach and inferior capsulotomy (PAICO) to enhance joint stability after bipolar hemiarthroplasty for femoral neck fracture. We evaluated whether the PAICO would have a lower dislocation rate than the conventional posterior approach with superior capsulotomy. Methods: From January 2021 to December 2021, we prospectively recruited 25 patients (25 hips) aged 50 years or older who underwent bipolar hemiarthroplasty for femoral neck fractures due to low-energy trauma as the PAICO group. We compared the PAICO group with a historical control group who had undergone hemiarthroplasty in 7 institutes between 2010 and 2020. The primary endpoint was dislocation within 1 year after the surgery. We compared data from the PAICO group with the data from the historical control group from the Korean Hip Fracture Registry which was carried out in South Korea. Results: A total of 25 patients (25 hips) were enrolled in the present study; 3,477 patients (3,571 hips) who underwent bipolar hemiarthroplasty were reviewed as the historical control group. In the PAICO group, we observed no dislocation, whereas the dislocation rate in the control group was 1.3%. Conclusions In patients with displaced femoral neck fractures, the PAICO approach demonstrated comparable results in operation time and complication rates when compared to bipolar hemiarthroplasty using superior capsulotomy. Notably, there were no observed cases of dislocation among patients who underwent the PAICO approach. We recommend this PAICO approach to surgeons using the posterior approach, hoping to prevent dislocation in bipolar hemiarthroplasty.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, wellplanned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m 2 ), 4–6 times administered intravenously.The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs.

This report presents the latest statistics on the stroke population in South Korea, sourced from the Clinical Research Collaborations for Stroke in Korea-National Institute for Health (CRCS-K-NIH), a comprehensive, nationwide, multicenter stroke registry. The Korean cohort, unlike western populations, shows a male-to-female ratio of 1.5, attributed to lower risk factors in Korean women. The average ages for men and women are 67 and 73 years, respectively.Hypertension is the most common risk factor (67%), consistent with global trends, but there is a higher prevalence of diabetes (35%) and smoking (21%). The prevalence of atrial fibrillation (19%) is lower than in western populations, suggesting effective prevention strategies in the general population. A high incidence of large artery atherosclerosis (38%) is observed, likely due to prevalent intracranial arterial disease in East Asians and advanced imaging techniques.There has been a decrease in intravenous thrombolysis rates, from 12% in 2017–2019 to 10% in 2021, with no improvements in door-to-needle and door-to-puncture times, worsened by the coronavirus disease 2019 pandemic. While the use of aspirin plus clopidogrel for noncardioembolic stroke and direct oral anticoagulants for atrial fibrillation is well-established, the application of direct oral anticoagulants for non-atrial fibrillation cardioembolic strokes in the acute phase requires further research. The incidence of early neurological deterioration (13%) and the cumulative incidence of recurrent stroke at 3 months (3%) align with global figures. Favorable outcomes at 3 months (63%) are comparable internationally, yet the lack of improvement in dependency at 3 months highlights the need for advancements in acute stroke care.

Background: Increasing longevity has caused the very old population to become the fastest-growing segment. The number of centenarians (over 100 years old) is increasing rapidly. Fractures in the elderly lead to excessive medical costs and decreased quality of life with socioeconomic burdens. However, little research has thoroughly examined the functional outcomes and mortality of hip fractures in centenarians. Methods: This is a retrospective observational study. Sixty-eight centenarian hip fracture patients were admitted to the 10 institutions from February 2004 to December 2019. Fifty-six patients with 1-year follow-up were finally included. The following data were obtained: sex, age, body mass index, Charlson comorbidity index value on the operation day, Koval’s classification for ambulatory ability, type of fracture, the time interval from trauma to surgery, American Society of Anesthesiologists grade, surgery-related complications, and duration of hospital stay. Postoperative Koval’s classification (at 1 year after surgery) and information about death were also collected. Multivariate analysis was performed to analyze the risk factors affecting mortality 1 year after surgery. Results: Mortality rates were 26.8% at 6 months and 39.3% at 1 year. The 90-day mortality was 19.6%, and one of them (2.1%) died in the hospital. The 1-year mortality rates for the community ambulatory and non-community ambulatory groups were 29% and 52%, respectively. Only 9 (16.1%) were able to walk outdoors 1 year after surgery. The remaining 47 patients (83.9%) had to stay indoors after surgery. Multivariate analysis demonstrated that the pre-injury ambulatory level (adjusted hazard ratio, 2.884; p = 0.034) was associated with the risk of mortality. Conclusions We report a 1-year mortality rate of 39.3% in centenarian patients with hip fractures. The risk factor for mortality was the pre-injury ambulatory status. This could be an important consideration in the planning of treatment for centenarian hip fracture patients.