The Longitudinal Trend of Cardiac Surgery in Korea from 2003 to 2013

Abstract

BackgroundThe purpose of this study was to investigate longitudinal changes of the utilization of operational and surgical medical care inside and outside a metropolitan area over 10 years, analyzing the residential areas of patients and the locations of medical facilities for major cardiovascular surgery.MethodsData analysis was conducted by classifying the addresses of patients and the locations of medical care facilities of metropolitan cities and provinces, using data from the National Health Insurance Corporation from January 2003 to December 2013.ResultsThere is serious concentration of major heart surgery to medical facilities in Seoul; this problem has not improved over time. There were differences in percentages of surgical procedures performed in the metropolitan areas according to major diseases. In the case of Busan and Daegu provinces, at least 50% of the patients underwent surgery in medical facilities in the city, but there are other regions where the percentage is less than 50%. In the case of provinces, the percentage of surgical procedures performed in medical facilities in Seoul or nearby metropolitan cities is very high.ConclusionPolicies to strengthen the regional capabilities of heart surgery and to secure human resources are required to mitigate the concentration of patients in the capital area. Many regional multi-centers must be designated to minimize unnecessary competition among regional university hospitals and activate a win-win partnership model for medical services.

Neonatal Patent Ductus Arteriosus Ligation Operations Performed by Adult Cardiac Surgeons

“…In comparison, even in other metropolitan cities, the percentages of patients who underwent the operation in the region of their residence were as low as 14. 8% in some cities [ 8 ]. For complex congenital heart surgery, the percentage of patients who underwent the operation in the region of their residence was as low as 1.5% in some cities in Korea.…”

“…Therefore, the Korean government employed a strategy to designate and run a single regional center in each area to achieve the goal of alleviating the overconcentration of patients in only a few cities. However, this has caused unnecessary competition among comparable university hospitals, resulting in the absence of mutual beneficial cooperation among such centers [ 8 ].…”

“…In South Korea, several reports have shown that the number of newborns has decreased over the last 20 years, but the percentage of newborns with congenital heart disease, including PDA, has remained the same [ 6 , 7 ]. Not all institutions with a NICU have a congenital cardiac surgery program, and pediatric surgical subspecialists show a geographically uneven distribution in South Korea [ 8 ]. Our institution is a training hospital with a NICU, a neonatology department, and a pediatric cardiologist.…”

Hospital Case Volume, Health Care Providers, and Mortality in Patients Undergoing Coronary Artery Bypass Grafting: a Nationwide Cohort Study in South Korea

“…In South Korea, 92.6% of the total CABG surgeries from 2003 to 2013 were performed in Seoul (capital city) alone, which indicates that a majority of the CABG cases were concentrated in hospitals in Seoul. 19) Because CABG cases centralized to specific areas or hospitals might affect the surgical quality, it is speculated that the hospital case volume in South Korea may affect the outcomes after CABG. However, such a relationship has not yet been identified in South Korea.…”

Does Hospital Volume of Coronary Artery Bypass Graft Matter on Mid-Term Mortality?: from the Data of National Health Insurance Service in Korea

“…Annual case number of PCI was 55,074 in 2015, CABG was performed in 3,086 patients older than 20 years in 2013 in Korea. 2) 3) 4) Even though, there are many studies to demonstrate the impact of procedural volume on the level of operator or hospital for PCI or CABG, the result is still non-conclusive. For example, according to the 2014 cohort of the Korean PCI registry, there was no significant difference of major adverse cardiovascular and cerebrovascular events between high (≥400/year) and low (<400/year)-volume PCI hospital for the acute MI including ST-segment elevation MI (STEMI) and non-STEMI after statistical adjustment with various clinical variables including age, diabetes, prior MI, renal failure, cerebrovascular disease, STEMI presentation, cardiogenic shock, cardiac arrest, and left main or proximal left anterior descending disease.…”