Background and Objectives: Primary prevention (PP) implantable cardioverter-defibrillator (ICD) therapy for ischemic cardiomyopathy (ICM) is underused in Asian countries, including South Korea. Both clinical and hospital factors may influence appropriate ICD use. We evaluated whether determinants of PP ICD implantation differ by hospital implantation volume. Methods: In this prospective, multicenter observational registry (blinded for review), patients eligible for PP ICD were enrolled. Factors associated with ICD implantation—clinical characteristics and hospital-level systems—were examined across 4 large-volume hospitals (≥ 15 implants during the study) and 12 small-volume hospitals (< 15). Multivariable logistic regression identified independent predictors. Results: Among 3,083 ICM patients (2,403 men; median age 70 years), PP ICD implantation rates were 10.8% in large-volume and 5.7% in small-volume hospitals. Across groups, male sex and chronic kidney disease independently predicted ICD implantation. Regarding hospital factors, non-monetary incentives for referral were the sole independent predictor in large-volume centers (odds ratio [OR], 3.55; 95% confidence interval [CI], 2.07–6.10;P < 0.001). In small-volume centers, heart failure conferences (OR, 12.73; 95% CI, 1.72–94.37;P = 0.013), structured education systems (OR, 11.72; 95% CI, 2.45–56.12; P = 0.02), and pacemaker clinics (OR, 11.4; 95% CI, 2.24–58.39; P = 0.003) were independently associated with implantation. Conclusions Clinical predictors of PP ICD use were consistent across hospital volumes, but hospital-level determinants differed. Referral incentives characterized large-volume centers, whereas conferences, education systems, and pacemaker clinics were key in smallvolume centers. Tailored institutional strategies by hospital volume may help close the PP ICD underuse gap and improve evidence-based implementation.

Background: Identifying the risks related to the complications of electrical cardioversion (ECV) can alert the determinaton of rhythm control in patients with atrial fibrillation (AF). Methods: We retrospectively reviewed 1,058 patients who underwent ECV for persistent or long-standing persistent AF/atrial flutter (AFL) from multiple centers. Patients were classified into the no-complication (1,023 patients) and complication (35 patients) groups based on the following major complications: stroke and/or systemic embolism (SSE), myocardial infarction, major bleeding, implantation of cardiac implantable electronic devices, ventricular tachycardia/fibrillation, and death at 1 year follow-up after ECV. Results: Compared with the no-complication group, the complication group exhibited a higher proportion of female patients (37% vs. 22%), as well as a higher proportion of patients with older age (67 ± 11 vs. 61 ± 10 years), diabetes mellitus (DM) (49% vs. 24%), heart failure (HF) (49% vs. 30%), SSE (23% vs. 9%), high CHA 2 DS 2 -VASc (CV) score (3.6 ± 1.8 vs.2.2 ± 1.4), low left ventricular ejection fraction (LVEF) (50 ± 16% vs. 58 ± 21%), and high left atrial volume index (LAVI) (51 ± 26 vs. 40 ± 20 mL/m 2 ). Class I and III antiarrhythmics were less prescribed in the complication group than in the no-complication group (57% vs.76%). Univariate analysis for complications revealed age (≥ 65 years), female sex, DM, HF, SSE, LVEF (< 50%), LAVI (≥ 40 mL/m 2 ), CV score (≥ 3), bradycardia on Holter (< 60/min), and no antiarrhythmics as risk factors. Among these, multivariate analysis revealed clinical significance of female sex and SSE. Conclusion Female sex and a history of SSE were the most important risk factors of complications in patients with persistent or long-standing persistent AF/AFL who underwent ECV.

Purpose: This study aimed to analyze nationwide trends and regional disparities in inguinal hernia surgeries in South Korea between 2016 and 2022. Additionally, we aimed to evaluate changes in surgery frequency, including urban concentration and the introduction of robotic surgery. Methods: This retrospective review used nationwide data on inguinal hernia surgeries from the Health Insurance Review and Assessment Service database. Results: From 2016 to 2022, 254,367 inguinal hernia surgeries were performed in South Korea, with males accounting for 88.9% of cases. The annual number of surgeries fluctuated, particularly in 2020, owing to the coronavirus disease 2019 pandemic. Medical costs increased from $1,218.4 to $1,970 on average, whereas patient copayments rose from $180.2 to $293.3. Robotic inguinal hernia surgeries, introduced in 2019, increased to 226 cases in 2022. Pediatric surgeries steadily declined, whereas adult surgeries remained stable, with a slight increase in 2022. The average hospital stay did not change significantly but varied between pediatric and adult patients. Regional disparities were notable, especially in pediatric surgery rates between metropolitan areas, such as Seoul and the surrounding provinces. Conclusion This study highlights stable overall surgery rates, a decline in pediatric cases, and an increase in robotic inguinal hernia surgeries. The persistent concentration of healthcare services in metropolitan areas suggests a need for policy interventions to address regional disparities and ensure equitable healthcare access. The findings underscore the importance of ongoing efforts to improve healthcare distribution and the need for long-term strategies to address changing surgical trends.

Purpose: This study aimed to analyze nationwide trends and regional disparities in inguinal hernia surgeries in South Korea between 2016 and 2022. Additionally, we aimed to evaluate changes in surgery frequency, including urban concentration and the introduction of robotic surgery. Methods: This retrospective review used nationwide data on inguinal hernia surgeries from the Health Insurance Review and Assessment Service database. Results: From 2016 to 2022, 254,367 inguinal hernia surgeries were performed in South Korea, with males accounting for 88.9% of cases. The annual number of surgeries fluctuated, particularly in 2020, owing to the coronavirus disease 2019 pandemic. Medical costs increased from $1,218.4 to $1,970 on average, whereas patient copayments rose from $180.2 to $293.3. Robotic inguinal hernia surgeries, introduced in 2019, increased to 226 cases in 2022. Pediatric surgeries steadily declined, whereas adult surgeries remained stable, with a slight increase in 2022. The average hospital stay did not change significantly but varied between pediatric and adult patients. Regional disparities were notable, especially in pediatric surgery rates between metropolitan areas, such as Seoul and the surrounding provinces. Conclusion This study highlights stable overall surgery rates, a decline in pediatric cases, and an increase in robotic inguinal hernia surgeries. The persistent concentration of healthcare services in metropolitan areas suggests a need for policy interventions to address regional disparities and ensure equitable healthcare access. The findings underscore the importance of ongoing efforts to improve healthcare distribution and the need for long-term strategies to address changing surgical trends.

Purpose: This study aimed to analyze nationwide trends and regional disparities in inguinal hernia surgeries in South Korea between 2016 and 2022. Additionally, we aimed to evaluate changes in surgery frequency, including urban concentration and the introduction of robotic surgery. Methods: This retrospective review used nationwide data on inguinal hernia surgeries from the Health Insurance Review and Assessment Service database. Results: From 2016 to 2022, 254,367 inguinal hernia surgeries were performed in South Korea, with males accounting for 88.9% of cases. The annual number of surgeries fluctuated, particularly in 2020, owing to the coronavirus disease 2019 pandemic. Medical costs increased from $1,218.4 to $1,970 on average, whereas patient copayments rose from $180.2 to $293.3. Robotic inguinal hernia surgeries, introduced in 2019, increased to 226 cases in 2022. Pediatric surgeries steadily declined, whereas adult surgeries remained stable, with a slight increase in 2022. The average hospital stay did not change significantly but varied between pediatric and adult patients. Regional disparities were notable, especially in pediatric surgery rates between metropolitan areas, such as Seoul and the surrounding provinces. Conclusion This study highlights stable overall surgery rates, a decline in pediatric cases, and an increase in robotic inguinal hernia surgeries. The persistent concentration of healthcare services in metropolitan areas suggests a need for policy interventions to address regional disparities and ensure equitable healthcare access. The findings underscore the importance of ongoing efforts to improve healthcare distribution and the need for long-term strategies to address changing surgical trends.

Purpose: To report a nationwide survey on neuroblastoma conducted by the Korean Association of Pediatric Surgeons (KAPS) in 2020. Methods: The clinical data of pediatric patients diagnosed with and treated for neuroblastoma from 2005 to 2019 in 19 hospitals of KAPS members were collected. Survival and prognostic factor analyses were performed using the log rank test and Cox proportional hazard analysis. A p-value <0.05 was considered significant. Results: A total of 669 patients with neuroblastoma were registered for the study. The results were presented and discussed at the 36th annual meeting of the KAPS, which was held in Seoul on August 21, 2020. Conclusion This study provides information on patient demographics, prognostic outcomes, and comprehensive treatment outcomes for neuroblastoma. The study is expected to be an important reference for improving pediatric surgeons’ understanding and treatment of neuroblastoma.

Purpose: To report the findings of a perception survey on intestinal malrotation conducted by the Korean Association of Pediatric Surgeons (KAPS) in 2021. Methods: The perceptions on intestinal malrotation regarding clinical decision making of the KAPS members were collected through web-based survey. Results: A total of 22 surgeons were answered for this study. The results were presented and discussed at the 37th annual meeting of KAPS, which was held in Seoul on June 18, 2021. Conclusion This study provides the clinical decisions of the KAPS members on the intestinal malrotation. The study is expected to be an important reference for improving pediatric surgeons’ understanding and treatment of intestinal malrotation.

Purpose: Biliary atresia (BA) is a rare but progressive cholangiopathy and the leading cause of pediatric liver transplantation worldwide. The Korean Association of Pediatric Surgeons (KAPS) has conducted three national surveys (2001, 2011, and 2023) to assess long-term trends in the diagnosis, treatment, and outcomes of BA. This study provides a comparative analysis of the 2nd and 3rd national surveys, with reference to selected findings from the 1st survey. Methods: This study included 453 patients from the 3rd national survey (2011–2021) and 435 patients from the 2nd survey (2001–2010), all of whom underwent Kasai portoenterostomy. Data were collected via electronic case report forms from pediatric surgical centers nationwide. Comparisons were made regarding demographics, clinical features, diagnostic patterns, operative details, follow-up outcomes, and survival. Kaplan–Meier analysis was used to evaluate long-term survival. Results: The mean number of BA patients per year remained stable between surveys (43.5 in the 2nd, 41.18 in the 3rd), though centralization of care increased, with 61.5% of cases managed by two major institutions in the 3rd survey. The median age at surgery decreased, and the use of preoperative imaging (especially magnetic resonance cholangiopancreatography) increased. The 10-year native liver survival rate declined from 59.8% to 53.7%, while overall 10-year survival improved slightly (92.9% to 93.2%). Postoperative complications, such as cholangitis and liver failure, persisted but were better categorized. The 3rd survey also reported improved mortality (4.9%) and reduced follow-up loss (11.5%) compared to the 2nd survey. Conclusion While overall survival after Kasai operation has remained high and even improved, native liver survival has slightly declined. The findings reflect earlier diagnosis, more consistent diagnostic imaging, and increasing centralization of care. These trends underscore the importance of long-term nationwide data collection in guiding future strategies for BA management in Korea.

Purpose: This study aims to investigate and compare the incidence, demographic characteristics, clinical manifestations, preoperative diagnostic methods, anatomical classifications, associated anomalies, operative treatments, and postoperative outcomes of patients with intestinal atresia treated by the members of the Korean Association of Pediatric Surgeons (KAPS) through three nationwide surveys. Methods: KAPS conducted 3 national surveys in 1998, 2010, and 2024 to examine the patients diagnosed with intestinal atresia. In preparation for the survey, we developed a customized case registration form to obtain data on patient sex, birth weight, gestational age, clinical manifestations, preoperative diagnostic methods, anatomical types, associated anomalies, operative treatments, and postoperative outcomes. Authorized KAPS members completed the case registration form. Results: The first, second, and third national surveys included 218, 222, and 236 individuals diagnosed with intestinal atresia, respectively. The male-to-female ratios were 1.5:1, 1.1:1, and 1.1:1, respectively. The first, second, and third national surveys revealed that 34.3%, 43.3%, and 53.4% of patients were born before 37 weeks of gestation, respectively. Additionally, 28.7%, 32.0%, and 40.7% of patients had a birth weight under 2,500 g. In the third national survey, duodenoduodenostomy was the most common procedure, performed in 70 out of 82 patients diagnosed with duodenal atresia. Resection and anastomosis were the main surgical procedures conducted in 47 out of 54 cases of jejunal atresia and 74 out of 92 cases of ileal atresia. The mortality rates in the first, second, and third national surveys were 13.8%, 3.6%, and 1.3% respectively, with the lowest rate observed in the third national survey. Conclusion These national surveys offer valuable insights into the current state of intestinal atresia, including specific surgical interventions and postoperative outcomes in South Korea. For pediatric surgeons aiming to enhance their understanding of intestinal atresia and its treatment options, these surveys could be an indispensable resource and guide.

Objective: Atrial fibrillation (AF) increases the risk of thromboembolic events, making oral anticoagulants (OACs) essential for high-risk patients. This fact sheet provides nationwide statistics on AF management for stroke prevention in Korea. We aimed to evaluate current anticoagulation treatment trends and strategies in Korea.MethodThe Korean national health claims database from the National Health Insurance Service was used. AF patients aged ≥ 18 years from 2013 to 2022 were included. OAC use, including warfarin and non-vitamin K antagonist OACs (NOACs), was tracked through prescription data. The rates of OAC use were calculated based on continued use, considering prescription dates and amounts. For patients with multiple encounters, the last encounter was used for analysis. Results: During the study, 20.4% of strokes were accompanied by AF, with AF diagnosed within 6 months before or after the stroke. The number of patients diagnosed with AF after a stroke increased from 4893 in 2013 to 6978 in 2022. Among newly diagnosed AF patients requiring OACs, 51% were not prescribed OACs within 6 months. OAC treatment rates for high-risk AF patients increased from 44.6% in 2013 to 77.5% in 2022, with NOAC prescriptions rising significantly after 2015. Regional variations in OAC prescription rates were observed, with lower rates in suburban/rural areas than in urban regions (76.0% vs. 79.6%, p < 0.001). Conclusions Considerable strokes could have been prevented with earlier AF detection and OAC treatment through more intensive electrocardiogram screening.