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.

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.

Background: The treatment success rate for tuberculosis (TB) has stagnated at 80–81% in South Korea, indicating unsatisfactory outcomes. Enhancing treatment success rate necessitates the development of individualized treatment approaches for each patient. This study aimed to identify the risk factors associated with unfavorable treatment outcomes to facilitate tailored TB care. Methods: We retrospectively analyzed the data of patients with active TB between January 2019 and December 2020 at a single tertiary referral center. We classified unfavorable treatment outcomes according to the 2021 World Health Organization guidelines as follows:“lost to follow-up” (LTFU), “not evaluated” (NE), “death,” and “treatment failure” (TF).Moreover, we analyzed risk factors for each unfavorable outcome using Cox proportional hazard regression analysis. Results: A total of 659 patients (median age 62 years; male 54.3%) were included in the study.The total unfavorable outcomes were 28.1%: 4.6% LTFU, 9.6% NE, 9.1% deaths, and 4.9% TF. Multivariate analysis showed that a culture-confirmed diagnosis of TB was associated with a lower risk of LTFU (adjusted hazard ratio [aHR], 0.25; 95% confidence interval [CI], 0.10–0.63), whereas the occurrence of adverse drug reactions (ADRs) significantly increased the risk of LTFU (aHR, 6.63; 95% CI, 2.63–16.69). Patients living far from the hospital (aHR, 4.47; 95% CI, 2.50–7.97) and those with chronic kidney disease (aHR, 3.21; 95% CI, 1.33–7.75) were at higher risk of being transferred out to other health institutions (NE). Higher mortality was associated with older age (aHR, 1.06; 95% CI, 1.04–1.09) and comorbidities. The ADRs that occurred during TB treatment were a risk factor for TF (aHR, 6.88; 95% CI, 2.24–21.13). Conclusion Unfavorable outcomes of patients with TB were substantial at a tertiary referral center, and the risk factors for each unfavorable outcome varied. To improve treatment outcomes, close monitoring and the provision of tailored care for patients with TB are necessary.

Background: Coronary artery disease patients undergoing percutaneous coronary intervention (PCI) often exhibit reduced left ventricular ejection fraction (LVEF). However, the impact of LV dysfunction status in conjunction with platelet reactivity on clinical outcomes has not been previously investigated. Methods: From the multicenter PTRG-DES (Platelet function and genoType-Related long-term prognosis in DES-treated patients) consortium, the patients were classified as preserved-EF (PEF: LVEF ≥ 50%) and reduced-EF (REF: LVEF< 5 0%) group by echocardiography. Platelet reactivity was measured using VerifyNow P2Y 12 assay and high platelet reactivity (HPR) was defined as PRU ≥ 252. The major adverse cardiac and cerebrovascular events (MACCEs) were a composite of death, myocardial infarction, stent thrombosis and stroke at 5 years after PCI. Major bleeding was defined as Bleeding Academic Research Consortium bleeding types 3–5. Results: A total of 13,160 patients from PTRG-DES, 9,319 (79.6%) patients with the results of both PRU and LVEF were analyzed. The incidence of MACCE and major bleeding was higher in REF group as compared with PEF group (MACCEs: hazard ratio [HR] 2.17, P < 0.001, 95% confidence interval [CI] 1.85–2.55; major bleeding: HR 1.78, P < 0.001, 95% CI 1.39–2.78).The highest rate of MACCEs was found in patients with REF and HPR, and the difference between the groups was statistically significant (HR 3.14 in REF(+)/HPR(+) vs. PEF(+)/HPR(-) group,P <0.01, 95% CI 2.51–3.91). The frequency of major bleeding was not associated with the HPR in either group. Conclusion LV dysfunction was associated with an increased incidence of MACCEs and major bleeding in patients who underwent PCI. The HPR status further exhibited significant increase of MACCEs in patients with LV dysfunction in a large, real-world registry.Trial Registration: ClinicalTrials.gov Identifier: NCT04734028

Background: Limited data are available on the mortality rates of patients receiving extracorporeal membrane oxygenation (ECMO) support for coronavirus disease 2019 (COVID-19). We aimed to analyze the relationship between COVID-19 and clinical outcomes for patients receiving ECMO. Methods: We retrospectively investigated patients with COVID-19 pneumonia requiring ECMO in 19 hospitals across Korea from January 1, 2020 to August 31, 2021. The primary outcome was the 90-day mortality after ECMO initiation. We performed multivariate analysis using a logistic regression model to estimate the odds ratio (OR) of 90-day mortality. Survival differences were analyzed using the Kaplan–Meier (KM) method. Results: Of 127 patients with COVID-19 pneumonia who received ECMO, 70 patients (55.1%) died within 90 days of ECMO initiation. The median age was 64 years, and 63% of patients were male. The incidence of ECMO was increased with age but was decreased after 70 years of age. However, the survival rate was decreased linearly with age. In multivariate analysis, age (OR, 1.048; 95% confidence interval [CI], 1.010–1.089; P = 0.014) and receipt of continuous renal replacement therapy (CRRT) (OR, 3.069; 95% CI, 1.312–7.180; P = 0.010) were significantly associated with an increased risk of 90-day mortality. KM curves showed significant differences in survival between groups according to age (65 years) (log-rank P = 0.021) and receipt of CRRT (log-rank P = 0.004). Conclusion Older age and receipt of CRRT were associated with higher mortality rates among patients with COVID-19 who received ECMO.

Background: Coinfections with multiple nontuberculous mycobacterial (NTM) species have not been widely studied. We aimed to evaluate the clinical characteristics and treatment outcomes in patients with NTM-pulmonary disease (PD) caused by coinfection with multiple NTM species. Methods: We retrospectively reviewed patients with NTM-PD at a tertiary referral hospital in Korea between March 2012 and December 2018. Coinfection was defined as two or more species of NTM pathogens isolated from the same respiratory specimen or different specimens within three months. Results: Among 1,009 patients with NTM-PD, 147 (14.6%) NTM coinfections were observed (average age 64.7 years, 69.4% women). NTM species were identified more frequently (median 6 vs. 3 times, P < 0.001) in the coinfection group than in the single species group, and follow-up duration was also longer in the coinfection group (median 44.9 vs. 27.1 months, P < 0.001). Mycobacterium avium complex (MAC) and M. abscessus and M. massiliense (MAB) were the dominant combinations (n = 71, 48.3%). For patients treated for over six months in the MAC plus MAB group (n = 31), sputum culture conversion and microbiological cure were achieved in 67.7% and 41.9% of patients, respectively. We divided the MAC plus MAB coinfection group into three subgroups according to the target mycobacteria; however, no statistical differences were found in the treatment outcomes. Conclusion In NTM-PD cases, a significant number of multiple NTM species coinfections occurred. Proper identification of all cultured NTM species through follow-up is necessary to detect multispecies coinfections. Further research is needed to understand the nature of NTM-PD in such cases.

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.

Purpose: To assess the diagnostic potential of whole-exome sequencing (WES) and elucidate the clinical and genetic characteristics of primary ciliary dyskinesia (PCD) in the Korean population. Materials and Methods: Forty-seven patients clinically suspected of having PCD were enrolled at a tertiary medical center. WES was performed in all patients, and seven patients received biopsy of cilia and transmission electron microscopy (TEM). Results: Overall, PCD was diagnosed in 10 (21.3%) patients: eight by WES (8/47, 17%), four by TEM. Among patients diagnosed as PCD based on TEM results, two patients showed consistent results with WES and TEM of PCD (2/4, 50%). In addition, five patients, who were not included in the final PCD diagnosis group, had variants of unknown significance in PCD-related genes (5/47, 10.6%).The most frequent pathogenic (P)/likely pathogenic (LP) variants were detected in DNAH11 (n=4, 21.1%), DRC1 (n=4, 21.1%), and DNAH5 (n=4, 21.1%). Among the detected 17 P/LP variants in PCD-related genes in this study, 8 (47.1%) were identified as novel variants. Regarding the genotype–phenotype correlation in this study, the authors experienced severe PCD cases caused by the LP/P variants in MCIDAS, DRC1, and CCDC39. Conclusion Through this study, we were able to confirm the value of WES as one of the diagnostic tools for PCD, which increases with TEM, rather than single gene tests. These results will prove useful to hospitals with limited access to PCD diagnostic testing but with relatively efficient in-house or outsourced access to genetic testing at a pre-symptomatic or early disease stage.