Coronary artery calcification (CAC) is highly prevalent in patients with chronic kidney disease (CKD) and is associated with major adverse cardiovascular events and metabolic disturbances. The triglyceride-glucose index (TyGI), a novel surrogate marker of metabolic syndrome and insulin resistance, is associated with CAC in the general population and in patients with diabetes. This study investigated the association between the TyGI and CAC progression in patients with CKD, which is unknown. Methods: A total of 1,154 patients with CKD (grades 1–5; age, 52.8 ± 11.9 years; male, 688 [59.6%]) were enrolled from the KNOWCKD (KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease). The TyGI was calculated as follows: ln (fasting triglycerides × fasting glucose/2). Patients were classified into tertiles (low, intermediate, high) based on the TyGI. The primary outcome was annualized percentage change in CAC score [(percent change in CAC score + 1)12/follow-up months – 1] of ≥15%, defined as CAC progression. Results: During the 4-year follow-up, the percentage of patients with CAC progression increased across TyGI groups (28.6%, 37.5%, and 46.2% in low, intermediate, and high groups, respectively; p < 0.001). A high TyGI was associated with an increased risk of CAC progression (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.14–3.88; p = 0.02) compared to the low group. Moreover, a 1-point increase in the TyGI was related to increased risk of CAC progression (OR, 1.55; 95% CI, 1.06–1.76; p = 0.02) after adjustment. Conclusion: A high TyGI may be a useful predictor of CAC progression in CKD.

Background: We aimed to determine whether propofol-based total intravenous anesthesia (TIVA) is associated with mortality and morbidity following cranial neurosurgery compared with inhalation anesthesia. Methods: This nationwide, retrospective, population-based cohort study included patients who underwent cranial neurosurgery under general anesthesia between January 1, 2016, and December 31, 2021. The two study endpoints were 90-day mortality and postoperative complications. Results: In total, 144,506 adult patients were included: 65,442 patients (45.3%) who received TIVA (TIVA group) and 79,064 (54.7%) who received inhalation anesthesia (inhalation anesthesia group). After propensity score (PS) matching, 97,156 patients (48,578 in each group) were included. The 90-day mortality rates after cranial neurosurgery were 14.0% (6,660/48,578) in the TIVA group and 14.2% (6,779/48,578) in the inhalation anesthesia group. Moreover, the postoperative complication rates following cranial neurosurgery were 47.1% (22,411/48,578) and 50.3% (23,912/48,578) in the TIVA and inhalation anesthesia groups, respectively. Based on the logistic regression analysis, TIVA was not associated with 90-day mortality compared with inhalation anesthesia (odds ratio [OR]: 0.97, 95% CI [0.94, 1.01], P = 0.188) in the PS-matched cohort. Logistic regression analysis revealed that the TIVA group had a 12% (OR: 0.88, 95% CI [0.86, 0.90], P < 0.001) lower postoperative complication rate than the inhalation anesthesia group. Conclusions There was no significant association between the type of anesthesia and postoperative 90-day mortality in patients who underwent cranial neurosurgery in South Korea. However, propofol-based TIVA was associated with a lower incidence of postoperative complications than inhalation anesthesia.

Background: We aimed to determine whether propofol-based total intravenous anesthesia (TIVA) is associated with mortality and morbidity following cranial neurosurgery compared with inhalation anesthesia. Methods: This nationwide, retrospective, population-based cohort study included patients who underwent cranial neurosurgery under general anesthesia between January 1, 2016, and December 31, 2021. The two study endpoints were 90-day mortality and postoperative complications. Results: In total, 144,506 adult patients were included: 65,442 patients (45.3%) who received TIVA (TIVA group) and 79,064 (54.7%) who received inhalation anesthesia (inhalation anesthesia group). After propensity score (PS) matching, 97,156 patients (48,578 in each group) were included. The 90-day mortality rates after cranial neurosurgery were 14.0% (6,660/48,578) in the TIVA group and 14.2% (6,779/48,578) in the inhalation anesthesia group. Moreover, the postoperative complication rates following cranial neurosurgery were 47.1% (22,411/48,578) and 50.3% (23,912/48,578) in the TIVA and inhalation anesthesia groups, respectively. Based on the logistic regression analysis, TIVA was not associated with 90-day mortality compared with inhalation anesthesia (odds ratio [OR]: 0.97, 95% CI [0.94, 1.01], P = 0.188) in the PS-matched cohort. Logistic regression analysis revealed that the TIVA group had a 12% (OR: 0.88, 95% CI [0.86, 0.90], P < 0.001) lower postoperative complication rate than the inhalation anesthesia group. Conclusions There was no significant association between the type of anesthesia and postoperative 90-day mortality in patients who underwent cranial neurosurgery in South Korea. However, propofol-based TIVA was associated with a lower incidence of postoperative complications than inhalation anesthesia.

Purpose: Liver transplantation (LT) in South Korea dates back to 1988. However, Asians may be reluctant to donate their organs because of the influence of their traditional religious and philosophical beliefs. We aimed to investigate the mortality and associated factors among patients admitted after LT in South Korea. Methods: The South Korean National Health Insurance Service database was used as a data source. All adult patients who underwent LT between January 1, 2017 and December 31, 2021 (5 years) were included in the study. Results: A total of 7,316 patients were included in the analysis (living donor LT [LDLT], 5,412; deceased donor LT [DDLT], 1,904). The 1-year mortality rate was 12.8% (LDLT, 8.2%; DDLT, 25.9%; P < 0.001), and the postoperative complication rate was 26.8% (LDLT, 16.7%; DDLT, 55.6%; P < 0.001). The average length of hospital stay was 30.8 days, and that in the intensive care unit was 6.1 days. The total mean cost was 69,954 US dollars, and the self-cost was 6,008 US dollars. After adjusting confounders, DDLT (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.79–5.20; P < 0.001), re-LDLT (HR, 4.82;95% CI, 3.10–7.40; P < 0.001), re-DDLT (HR, 4.65; 95% CI, 3.55–7.12; P < 0.001), and postoperative complications (HR, 1.72;95% CI, 1.39–2.12; P < 0.001) were potential risk factors for higher 1-year mortality after transplantation. Conclusion LDLT was performed at a higher rate in South Korea and was associated with lower mortality and fewer postoperative complications than DDLT. Redo LT led to higher mortality rates.

Purpose: Liver transplantation (LT) in South Korea dates back to 1988. However, Asians may be reluctant to donate their organs because of the influence of their traditional religious and philosophical beliefs. We aimed to investigate the mortality and associated factors among patients admitted after LT in South Korea. Methods: The South Korean National Health Insurance Service database was used as a data source. All adult patients who underwent LT between January 1, 2017 and December 31, 2021 (5 years) were included in the study. Results: A total of 7,316 patients were included in the analysis (living donor LT [LDLT], 5,412; deceased donor LT [DDLT], 1,904). The 1-year mortality rate was 12.8% (LDLT, 8.2%; DDLT, 25.9%; P < 0.001), and the postoperative complication rate was 26.8% (LDLT, 16.7%; DDLT, 55.6%; P < 0.001). The average length of hospital stay was 30.8 days, and that in the intensive care unit was 6.1 days. The total mean cost was 69,954 US dollars, and the self-cost was 6,008 US dollars. After adjusting confounders, DDLT (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.79–5.20; P < 0.001), re-LDLT (HR, 4.82;95% CI, 3.10–7.40; P < 0.001), re-DDLT (HR, 4.65; 95% CI, 3.55–7.12; P < 0.001), and postoperative complications (HR, 1.72;95% CI, 1.39–2.12; P < 0.001) were potential risk factors for higher 1-year mortality after transplantation. Conclusion LDLT was performed at a higher rate in South Korea and was associated with lower mortality and fewer postoperative complications than DDLT. Redo LT led to higher mortality rates.

Background: We aimed to determine whether propofol-based total intravenous anesthesia (TIVA) is associated with mortality and morbidity following cranial neurosurgery compared with inhalation anesthesia. Methods: This nationwide, retrospective, population-based cohort study included patients who underwent cranial neurosurgery under general anesthesia between January 1, 2016, and December 31, 2021. The two study endpoints were 90-day mortality and postoperative complications. Results: In total, 144,506 adult patients were included: 65,442 patients (45.3%) who received TIVA (TIVA group) and 79,064 (54.7%) who received inhalation anesthesia (inhalation anesthesia group). After propensity score (PS) matching, 97,156 patients (48,578 in each group) were included. The 90-day mortality rates after cranial neurosurgery were 14.0% (6,660/48,578) in the TIVA group and 14.2% (6,779/48,578) in the inhalation anesthesia group. Moreover, the postoperative complication rates following cranial neurosurgery were 47.1% (22,411/48,578) and 50.3% (23,912/48,578) in the TIVA and inhalation anesthesia groups, respectively. Based on the logistic regression analysis, TIVA was not associated with 90-day mortality compared with inhalation anesthesia (odds ratio [OR]: 0.97, 95% CI [0.94, 1.01], P = 0.188) in the PS-matched cohort. Logistic regression analysis revealed that the TIVA group had a 12% (OR: 0.88, 95% CI [0.86, 0.90], P < 0.001) lower postoperative complication rate than the inhalation anesthesia group. Conclusions There was no significant association between the type of anesthesia and postoperative 90-day mortality in patients who underwent cranial neurosurgery in South Korea. However, propofol-based TIVA was associated with a lower incidence of postoperative complications than inhalation anesthesia.

Purpose: Many patients who undergo major abdominal surgery experience inadvertent hypothermia during the perioperative period. This study aimed to identify risk factors related to postoperative hypothermia and their association with postoperative complications. Methods: This retrospective cohort study used data from Seoul National University Bundang Hospital, a tertiary university medical center in South Korea, between January 1, 2018 and December 31, 2022. We included patients aged ≥18 years who underwent elective major abdominal surgery for more than 2 hours in the operating room. The patients were categorized into the hypothermia (body temperature <36.5 °C) and non-hypothermia (body temperature ≥36.5 °C) groups. Results: The study sample comprised 30,194 patients, and we classified 21,293 and 8,901 into the hypothermic and nonhypothermic groups, respectively. Some factors associated with the occurrence of postoperative hypothermia included the type of surgery. In the multivariable logistic regression model, the incidence of postoperative complications was 9% higher in the hypothermia group than in the non-hypothermic group (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.01–1.19;P = 0.040). Among postoperative complications, the hypothermic group showed a 14% higher incidence of acute kidney injury (OR, 1.14; 95% CI, 1.04–1.25; P = 0.007) than the non-hypothermic group. Conclusion The appearance of postoperative hypothermia during the first 30 minutes of the recovery period was significantly associated with the appearance of postoperative complications, especially acute kidney injury. However, further studies are required to validate these findings.

Background: We aimed to investigate the association between short- and long-term opioid use and long-term mortality in Korea. Methods: In this population-based retrospective cohort study, data were obtained from the National Health Insurance Service of South Korea. The study included all adult individuals who were prescribed opioids in 2016. The control group comprised adults not prescribed opioids in 2016 selected using a 1:1 stratified random sampling technique. Participants were categorized into three groups: non-user, opioid 1–89 days user (short-term), and opioid ≥ 90 days user (long-term) groups. The primary endpoint in this study was 5-year all-cause mortality, evaluated from January 1, 2017 to December 31, 2021. Results: In total, 4,556,606 adults were included in this study. Of these, 2,070,039 were prescribed opioids at least once. Specifically, 1,592,883 adult individuals were prescribed opioids for 1–89 days, while 477,156 adults were prescribed opioid for ≥ 90 days. In the multivariable Cox regression modelling, the opioid user group had a 28% (hazard ratio [HR], 1.28; 95% confidence interval [95% CI], 1.26–1.29; P < 0.001) higher risk of 5-year all-cause mortality than had the non-user group. Moreover, the opioid 1–89 days and opioid ≥ 90 days user groups had 15% (HR, 1.15; 95% CI, 1.14–1.17; P < 0.001) and 49% (HR, 1.49; 95% CI, 1.47–1.51; P < 0.001) higher risks of 5-year all-cause mortality than had the non-user group, respectively. Conclusion Both short and long-term opioid prescriptions were associated with increased long-term mortality among the Korean adult population.

Background: The association between preoperative opioid or glucocorticoid (GC) use and clinical outcomes, such as postoperative mortality after total joint arthroplasty (TJA), is unclear. Methods: A population-based retrospective cohort study was conducted. Data were obtained from the National Health Insurance Service of South Korea. Patients who underwent TJA (total knee or total hip arthroplasty) between January 1, 2016, and December 31, 2021, were included. We examined whether the patients had been prescribed opioids or oral GC for > 90 days prior to TJA. Results: In total, 664,598 patients who underwent TJA were included, among whom 245,260 (52.4%), 23,076 (3.5%), and 47,777 (7.2%) were classified into the opioid, GC, and opioid and GC groups, respectively. Compared to the non-user group, the opioid and GC user groups showed 53% (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.12–2.30; P = 0.010) higher odds of in-hospital mortality. Compared to non-users, GC users (hazard ratio [HR], 1.24;95% CI, 1.15–1.34; P < 0.001) and opioid and GC users (HR, 1.24; 95% CI, 1.14–1.35; P < 0.001) showed a higher risk of 1-year all-cause mortality. Compared to the non-user group, GC users (OR, 1.09; 95% CI, 1.04–1.15; P < 0.001) and opioid and GC users (OR, 1.06; 95% CI, 1.01–1.11;P = 0.014) showed higher odds of postoperative complications. Conclusion Preoperative GC use and concomitant use of opioid analgesics with GC were associated with increased postoperative mortality and morbidity after TJA. However, preoperative chronic opioid analgesic use alone did not affect postoperative mortality or morbidity.

Objective: : We aimed to examine trends in critically ill neurology-neurosurgery (NNS) patients who were admitted to the intensive care unit (ICU) in South Korea and identify risk factors for in-hospital mortality after ICU admission in NNS patients. Methods: : This nationwide population-based retrospective cohort study enrolled adult NNS adult patients admitted to the ICU from 2010 to 2019 extracted from the National Health Insurance Service in South Korea. The critically ill NNS patients were defined as those whose main admission departments were neurology or neurosurgery at ICU admission. The number of ICU admission, age, and total cost for hospitalization from 2010 to 2019 in critically ill NNS patients were examined as trend information. Moreover, multivariable logistic regression modeling was used to identify risk factors for in-hospital mortality among critically ill NNS patients. Results: : We included 845474 ICU admission cases for 679376 critically ill NNS patients in South Korea between January 1, 2010 to December 31, 2019. The total number of ICU admissions among NNS patients was 79522 in 2010, which increased to 91502 in 2019. The mean age rose from 62.8 years (standard deviation [SD], 15.6) in 2010 to 66.6 years (SD, 15.2) in 2019, and the average total cost for hospitalization per each patient consistently increased from 6206.1 USD (SD, 5218.5) in 2010 to 10745.4 USD (SD, 10917.4) in 2019. In-hospital mortality occurred in 75455 patients (8.9%). Risk factors strongly associated with increased in-hospital mortality were the usage of mechanical ventilator (adjusted odds ratio [aOR], 19.83; 95% confidence interval [CI], 19.42–20.26; p<0.001), extracorporeal membrane oxygenation (aOR, 3.49; 95% CI, 2.42–5.02; p<0.001), and continuous renal replacement therapy (aOR, 6.47; 95% CI, 6.02–6.96; p<0.001). In addition, direct admission to ICU from the emergency room (aOR, 1.38; 95% CI, 1.36–1.41; p<0.001) and brain cancer as the main diagnosis (aOR, 1.30; 95% CI, 1.22–1.39; p<0.001) are also potential risk factors for increased in-hospital mortality. Conclusion : In South Korea, the number of ICU admissions increased among critically ill NNS patients from 2010 to 2019. The average age and total costs for hospitalization also increased. Some potential risk factors are found to increase in-hospital mortality among critically ill NNS patients.