Purpose: This study explores the unique experiences and challenges faced by female surgical faculty members in Korea, particularly the transition from resident to faculty and the challenges that follow. Methods: Fifteen female surgeons from diverse surgical specialties, age groups, and medical institutions across Korea were recruited using snowball sampling. In-depth, semi-structured 1:1 interviews were conducted, recorded, and transcribed. Grounded theory was used to analyze the data, identifying recurring themes. Results: Four key themes emerged from the interviews: (1) Sticky floors and broken trail ropes: Female surgeons face a harsh, male-dominated environment with scarce resources for career advancement, often excluded from crucial networks. (2) Strategies: To cope with harsh environments, participants employed various strategies, including silent endurance, mobilizing external resources, exerting ‘feminine’ strength, and learning from the follies of others, or choosing not to use some of them. (3) Triumph and resentment: While participants experienced feelings of self-esteem and selffulfillment as well as insight and flexibility, many also faced pressures of representation and burnout. (4) Building new resources: Participants sought to provide a system with enhanced transparency and fairness, a new network of support, and mentoring for future generations. Conclusion This preliminary research demonstrates that female faculty members have overcome adversity; however, it also reveals that the challenges they face and their responses to them can act as risks that hinder their patient care and overall well-being, jeopardizing sustainability. Both the surgical field and the broader medical community must devote sufficient attention and resources to address this issue.

Purpose: This study explores the unique experiences and challenges faced by female surgical faculty members in Korea, particularly the transition from resident to faculty and the challenges that follow. Methods: Fifteen female surgeons from diverse surgical specialties, age groups, and medical institutions across Korea were recruited using snowball sampling. In-depth, semi-structured 1:1 interviews were conducted, recorded, and transcribed. Grounded theory was used to analyze the data, identifying recurring themes. Results: Four key themes emerged from the interviews: (1) Sticky floors and broken trail ropes: Female surgeons face a harsh, male-dominated environment with scarce resources for career advancement, often excluded from crucial networks. (2) Strategies: To cope with harsh environments, participants employed various strategies, including silent endurance, mobilizing external resources, exerting ‘feminine’ strength, and learning from the follies of others, or choosing not to use some of them. (3) Triumph and resentment: While participants experienced feelings of self-esteem and selffulfillment as well as insight and flexibility, many also faced pressures of representation and burnout. (4) Building new resources: Participants sought to provide a system with enhanced transparency and fairness, a new network of support, and mentoring for future generations. Conclusion This preliminary research demonstrates that female faculty members have overcome adversity; however, it also reveals that the challenges they face and their responses to them can act as risks that hinder their patient care and overall well-being, jeopardizing sustainability. Both the surgical field and the broader medical community must devote sufficient attention and resources to address this issue.

Purpose: This study explores the unique experiences and challenges faced by female surgical faculty members in Korea, particularly the transition from resident to faculty and the challenges that follow. Methods: Fifteen female surgeons from diverse surgical specialties, age groups, and medical institutions across Korea were recruited using snowball sampling. In-depth, semi-structured 1:1 interviews were conducted, recorded, and transcribed. Grounded theory was used to analyze the data, identifying recurring themes. Results: Four key themes emerged from the interviews: (1) Sticky floors and broken trail ropes: Female surgeons face a harsh, male-dominated environment with scarce resources for career advancement, often excluded from crucial networks. (2) Strategies: To cope with harsh environments, participants employed various strategies, including silent endurance, mobilizing external resources, exerting ‘feminine’ strength, and learning from the follies of others, or choosing not to use some of them. (3) Triumph and resentment: While participants experienced feelings of self-esteem and selffulfillment as well as insight and flexibility, many also faced pressures of representation and burnout. (4) Building new resources: Participants sought to provide a system with enhanced transparency and fairness, a new network of support, and mentoring for future generations. Conclusion This preliminary research demonstrates that female faculty members have overcome adversity; however, it also reveals that the challenges they face and their responses to them can act as risks that hinder their patient care and overall well-being, jeopardizing sustainability. Both the surgical field and the broader medical community must devote sufficient attention and resources to address this issue.

The decision to discontinue intensive care unit (ICU) treatment during the end-oflife stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization. Methods: We retrospectively reviewed medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not. Results: Among 54,699 hospital admissions, LST was withdrawn in 550 cases (1%). Cancer was the most common diagnosis, followed by pneumonia and cerebral infarction. Among ICU inpatients, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.002), had longer total hospital stays (16 vs. 11 days, P<0.001), and higher ICU readmission rates than the control group. There were no significant differences in the healthcare costs of ICU stay between the two groups. Most LST decisions (86%) were made by family. Conclusions: The decisions to withdraw LST of ICU inpatients were influenced by age, readmission, and disease category. ICU costs were similar between the withdrawal and control groups. Further research is needed to tailor LST decisions in the ICU.

The decision to discontinue intensive care unit (ICU) treatment during the end-oflife stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization. Methods: We retrospectively reviewed medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not. Results: Among 54,699 hospital admissions, LST was withdrawn in 550 cases (1%). Cancer was the most common diagnosis, followed by pneumonia and cerebral infarction. Among ICU inpatients, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.002), had longer total hospital stays (16 vs. 11 days, P<0.001), and higher ICU readmission rates than the control group. There were no significant differences in the healthcare costs of ICU stay between the two groups. Most LST decisions (86%) were made by family. Conclusions: The decisions to withdraw LST of ICU inpatients were influenced by age, readmission, and disease category. ICU costs were similar between the withdrawal and control groups. Further research is needed to tailor LST decisions in the ICU.

The decision to discontinue intensive care unit (ICU) treatment during the end-oflife stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization. Methods: We retrospectively reviewed medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not. Results: Among 54,699 hospital admissions, LST was withdrawn in 550 cases (1%). Cancer was the most common diagnosis, followed by pneumonia and cerebral infarction. Among ICU inpatients, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.002), had longer total hospital stays (16 vs. 11 days, P<0.001), and higher ICU readmission rates than the control group. There were no significant differences in the healthcare costs of ICU stay between the two groups. Most LST decisions (86%) were made by family. Conclusions: The decisions to withdraw LST of ICU inpatients were influenced by age, readmission, and disease category. ICU costs were similar between the withdrawal and control groups. Further research is needed to tailor LST decisions in the ICU.

The decision to discontinue intensive care unit (ICU) treatment during the end-oflife stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization. Methods: We retrospectively reviewed medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not. Results: Among 54,699 hospital admissions, LST was withdrawn in 550 cases (1%). Cancer was the most common diagnosis, followed by pneumonia and cerebral infarction. Among ICU inpatients, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.002), had longer total hospital stays (16 vs. 11 days, P<0.001), and higher ICU readmission rates than the control group. There were no significant differences in the healthcare costs of ICU stay between the two groups. Most LST decisions (86%) were made by family. Conclusions: The decisions to withdraw LST of ICU inpatients were influenced by age, readmission, and disease category. ICU costs were similar between the withdrawal and control groups. Further research is needed to tailor LST decisions in the ICU.

This study measured the impact of the Decisions on Life-Sustaining Treatment Act by analyzing medical cost data from the National Health Insurance Service-National Sample Cohort. After identifying the patients who died in 2018 and 2019, the case and control groups were set using the presence of codes for managing the implementation of life-sustaining treatment with propensity score matching. Regarding medical costs, the case group had higher medical costs for all periods before death. The subdivided items of medical costs with significant differences were as follows: consultation, admission, injection, laboratory tests, imaging and radiation therapy, nursing hospital bundled payment, and special equipment.This study is the first analysis carried out to measure the impact of the Decision on LifeSustaining Treatment Act through a cost analysis and to refute the common expectation that patients who decided to withhold or withdraw life-sustaining treatment would go through fewer unnecessary tests or treatments.