Advantages of laparoscopy in gynecologic surgery in elderly patients

Jaewon Na,Young Eun Chung,Il-Yeo Jang,Yoo-Young Lee,Tae-Joong Kim,Jeong-Won Lee,Byoung-Gie Kim,Chi-Son Chang,Chel Hun Choi 대한산부인과학회 2024 Obstetrics & Gynecology Science Vol.67 No.2

Objective Geriatric patients requiring gynecological surgery is increasing worldwide. However, older patients are at higher risk of postoperative morbidity and mortality, particularly cardiopulmonary complications. Laparoscopic surgery is widely used as a minimally invasive method for reducing postoperative morbidities. We compared the outcomes of open and laparoscopic gynecologic surgeries in patients older than 55 years.Methods We included patients aged >55 years who underwent gynecological surgery at a single tertiary center between 2010 and 2020, excluding vaginal or ovarian cancer surgeries were excluded. Surgical outcomes were compared between the open surgery and laparoscopic groups, with age cutoff was set at 65 years for optimal discriminative power. We performed linear or logistic regression analyses to compare the surgical outcomes according to age and operation type.Results Among 2,983 patients, 28.6% underwent open surgery and 71.4% underwent laparoscopic surgery. Perioperative outcomes of laparoscopic surgery were better than those of open surgery in all groups. In both the open and laparoscopic surgery groups, the older patients showed worse overall surgical outcomes. However, age-related differences in perioperative outcomes were less severe in the laparoscopic group. In the linear regression analysis, the differences in estimated blood loss, transfusion, and hospital stay between the age groups were smaller in the laparoscopy group. Similar results were observed in cancer-only and benign-only cohorts.Conclusion Although the surgical outcomes were worse in the older patients, the difference between age groups was smaller for laparoscopic surgery. Laparoscopic surgery offers more advantages and safety in patients aged >65 years. Objective Geriatric patients requiring gynecological surgery is increasing worldwide. However, older patients are at higher risk of postoperative morbidity and mortality, particularly cardiopulmonary complications. Laparoscopic surgery is widely used as a minimally invasive method for reducing postoperative morbidities. We compared the outcomes of open and laparoscopic gynecologic surgeries in patients older than 55 years. Methods We included patients aged >55 years who underwent gynecological surgery at a single tertiary center between 2010 and 2020, excluding vaginal or ovarian cancer surgeries were excluded. Surgical outcomes were compared between the open surgery and laparoscopic groups, with age cutoff was set at 65 years for optimal discriminative power. We performed linear or logistic regression analyses to compare the surgical outcomes according to age and operation type. Results Among 2,983 patients, 28.6% underwent open surgery and 71.4% underwent laparoscopic surgery. Perioperative outcomes of laparoscopic surgery were better than those of open surgery in all groups. In both the open and laparoscopic surgery groups, the older patients showed worse overall surgical outcomes. However, age-related differences in perioperative outcomes were less severe in the laparoscopic group. In the linear regression analysis, the differences in estimated blood loss, transfusion, and hospital stay between the age groups were smaller in the laparoscopy group. Similar results were observed in cancer-only and benign-only cohorts. Conclusion Although the surgical outcomes were worse in the older patients, the difference between age groups was smaller for laparoscopic surgery. Laparoscopic surgery offers more advantages and safety in patients aged >65 years.

Public perception of “scarless” laparoendoscopic singlesite surgery in gynecology

( Doo Haeng Lee ),( Su Hyun Nam ),( Taejong Song ),( Woo Young Kim ),( Kyo Won Lee ),( Kye Hyun Kim ) 대한산부인과학회 2015 Obstetrics & Gynecology Science Vol.58 No.4

Objective: To investigate the public perception of laparoendoscopic single-site surgery (LESS) according to the age group. Methods: An anonymous questionnaire about the desire for cosmesis and the preference for LESS in treatment of benign gynecologic diseases was provided to healthy volunteers (n=102). The survey participants were divided into two age groups (young women ≤40 years and middle-aged women >40 years). The desire for cosmesis was assessed using a validated scale, Body Image Scale. Results: All of the participants completed the questionnaire. The Body Image Scale scores were not different between the two age groups (11.5±3.5 vs. 11.8±4.0, P=0.656). The most common fear of surgery was the risk of complications in both age groups (69% in the young age group and 65% in the middle-aged group). Unless the operative risk increased, most of the participants (61% to 67%) in both age groups preferred LESS. Their choice was influenced by reduced scarring (43% to 61%), more safety (20% to 39%), reduced postoperative pain (8% to 10%), and new technology (4% to 6%). Conclusion: Based on these results, there was no difference in the desire for cosmesis and perception of LESS according to the age. Therefore, physicians should discuss and consider LESS even in middle-aged women.

수술시기에 따른 영아내사시의 임상양상 및 수술결과

배소현,최동규 대한안과학회 2008 대한안과학회지 Vol.49 No.12

Purpose: To evaluate the clinical features, surgical outcome and factors influencing the surgical outcome of infantile esotropia according to the age at surgery. Methods: Seventy patients with infantile esotropia followed for at least 6 months after surgery, were enrolled in a retrospective study. Patients were divided into 2 groups. Group 1 included 25 patients who underwent surgery before the age of 24 months and group 2 included 45 patients who underwent surgery after 24 months of age. The clinical characteristics including age at the initial visit, refractive error, angle of deviation, associated strabismus, success rate and reoperation rate were analyzed according to the age at surgery. Results: The mean angle of esodeviation before surgery was 41.71PD and refractive error was +1.26D. Patients underwent bimedial rectus recessions at the mean age of 67.33 months. The age at the initial visit was significantly older in group 2. Surgical success is defined as the ocular alignment within ±10PD in primary position at the last visit. Fourteen patients (56%) from group 1 and 29 (64.4%) from group 2 obtained surgical success. Reoperation was performed in 8 patients (32%) from group 1 and 8 (17.8%) from group 2, which was not statistically significantly different. Stereopsis better than 3,000 seconds of arc was obtained in 3 patients (50%) from group 1 and 16 (76.2%) from group 2. Conclusions: In group 2, the late-surgery group, the success rate was 64.4% and stereopsis was obtained in 76.2%. Surgical results were not different between the two groups.

중년남성의 젊음추구 및 외모관심이 미용성형에 미치는 영향

전현진(Hyun-Jin Jeon) 한국인체미용예술학회 2019 한국인체미용예술학회지 Vol.20 No.2

Under current social and cultural trends in which appearance becomes more important, this study attempted to investigate the effects of the pursuit of youth and appearance interest on cosmetic surgery among middle-aged men with a goal of analyzing differences in diverse cosmetic surgery experiences after dividing them into two groups: a youth-pursuit group and an appearance-interest group. The results found the following: First, in terms of middle-aged men’s cosmetic surgery practices, ‘semi-permanent makeup’ was the highest, followed by ‘removal of freckles and pigment spots’, ‘double eyelid surgery’, ‘dermal filler and Botox’, ‘wrinkle removal’, ‘nose surgery’, ‘lipofilling’, ‘hair transplant’, ‘liposuction’ and ‘facial bone contouring’. Second, the pursuit of youth was classified into social psychological and physical factors while appearance interest was divided into four categories: interest in trend orientation & imitation of others, interest in cosmetic surgery, interest in personal appearance, and interest in professional training. In addition, it was confirmed that the pursuit of youth has a positive influence on appearance interest with statistical significance. Third, according to analysis of differences in cosmetic surgery practices by the degree of the pursuit of youth, such cosmetic surgery experiences (nose surgery, dermal filler & Botox, facial bone contouring, lipofilling, etc.) were higher in the group in high pursuit of youth. Fourth, in terms of differences in cosmetic surgery practices by the degree of appearance interest, such cosmetic surgery experiences (nose surgery, dermal filler & Botox, facial bone contouring, lipofilling, orthodontic treatment & implant, hair transplant, semi-permanent makeup, removal of freckles and pigment spots, laser epilation, high-frequency therapy, etc.) were higher in the group with high interest in appearance.

미디어관여도, 외모만족이 성형태도, 성형의도에 미치는 영향에 관한 연구 - 성별과 연령을 중심으로 -

박수경 한국패션디자인학회 2014 한국패션디자인학회지 Vol.14 No.4

본 연구의 목적은 성인 남녀의 미디어관여도와 외모만족이 성형태도, 성형의도에 미치는 영향을 파악하고 이러한 변인들의 성별, 연령별 차이가 있는지 알아보고자 하는 것이다. 본 연구는 572명을 대상으로 설문지법을 이용한 실증연구를 하였고 SPSS 20.0을 이용하여 기술통계, 신뢰도검증, 요인분석, t-test, 회귀분석을 실시하였다. 본 연구의 결과는 다음과 같다. 첫째, 미디어관여도는 성별, 연령에 있어 차이를 보여 여성이 남성보다 높게 나타났으며 청년층이 중년보다 미디어관여도가 높았다. 둘째, 성형태도 요인 분석 결과 위험감수요인, 성형욕구 및 가치요인, 비밀유지 요인이 추출되었으며 성별 차이에서 여성이 남성보다 세 요인의 성형태도가 높게 나타났고 연령에 대한 차이는 나타나지 않았다. 셋째, 미디어관여도가 성형태도에 미치는 영향은 여성, 남성, 청년, 중년 모두 미디어관여도가 높을수록 성형욕구 및 가치와 위험감수에 대한 성형태도가 높게 나타났다. 비밀유지요인은 유의한 차이가 나타나지 않았다. 미디어관여도가 성형의도에 미치는 영향은 여성이 남성보다 높았으며 청년이 중년보다 높았다. 미디어관여도는 외모만족에 영향을 주었는데 특히, TV미디어관여도는 외모만족에 부적 영향을 주었으며 여성이 남성보다 높았고 청년이 중년보다 미디어관여도의 영향이 높았다. 잡지미디어관여도는 여성, 청년에서 부적 영향이 나타났다. 넷째, 외모만족은 성형태도 중 위험감수요인에서 여성이 남성보다 높은 것으로 나타났고 중년이 청년보다 더 높게 나타났으며 성형욕구가치요인은 여성, 중년에서 유의한 영향이 나타났다. 외모만족은 성형의도에 영향을 미치지 않아 직접적인 영향은 없었으나 외모만족이 성형태도에 영향을 미치고 성형태도가 성형의도에 유의한 영향을 미쳐 간접적인 영향을 보여주었다. 연구의 의의는 성형태도, 성형의도에 영향을 미치는 미디어관여도, 외모만족의 영향을 확인하고 성별, 연령별 차이를 밝혀 외모관리행동 중 가장 적극적인 성형행동에 미디어관여도의 중요성을 확인하였다는 데 있다. The purpose of this study was to investigate the effect of media involvement and appearance satisfaction on plastic surgery related attitudes and intentions of women and men from their twenties to fifties. A total of 571 cases were used as subjects for this study and the survey method was used. The data were analyzed using reliability analysis, factor analysis, t-test and regression analysis using the SPSS statistical program. The results were as follows. 1) There were differences in media involvement according to gender and age. 2) Three factors (risk tolerance of plastic surgery, need/value of plastic surgery, keeping plastic surgery a secret) were extracted on the attitude toward plastic surgery. The three attitude factors differed according to gender but not according to age. 3) Media involvement had a significant influence on plastic surgery related attitudes and intentions. Media involvement had a significant influence on the need/value factor and risk tolerance factor of attitude toward plastic surgery. The higher the media involvement was, the higher effect it had on the attitudes and intentions. Females showed a higher effect on plastic surgery related attitudes and intentions than males. Those in their forties and fifties showed a higher effect on plastic surgery related attitudes than those in their twenties and thirties. Media involvement had a significant influence on appearance satisfaction. 4) Appearance satisfaction had a partly significant effect on attitude toward plastic surgery. The influence of the risk tolerance factor and need/value factor were higher for those in their forties and fifties than those in their twenties and thirties. Appearance satisfaction had no significant influence on intention, but attitude toward plastic surgery had a significant effect on intention. Appearance satisfaction had an indirect effect on intention toward plastic surgery through attitude toward plastic surgery. The conclusion is drawn that media involvement is a very important variable to understanding plastic surgery related behavior.

Risk factors for postoperative delirium in elderly patients after spinal fusion surgery

최시진,정인영,유병훈,이상석,김문철 대한마취통증의학회 2020 Anesthesia and pain medicine Vol.15 No.3

Background: Postoperative delirium (POD) has an incidence rate of 9% to 41%. It is directly linked to decreasing cognitive function, increasing length of hospitalization and cost, as well as other complications and mortality. We aimed to assess the risk factors for POD among elderly patients by analyzing data from those who underwent spinal surgery.Methods: This study included 446 patients aged 65 years or older who underwent spinal surgery at our institution between March 2013 and May 2018. Data were collected retrospectively from the patients’ electronic medical records, and logistic regression was used to identify the risk factors associated with POD. The diagnosis of POD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and was made through consultation with a psychiatrist during postoperative hospitalization and before discharge.Results: Seventy-eight (78/446, 17.4%) patients were diagnosed with POD. The most relevant risk factor for POD was preoperative cognitive dysfunction (odds ratio [OR], 4.37; 95% confidence interval [CI], 1.60 to 11.93; P = 0.004), followed by emergency surgery (OR, 2.70; 95% CI, 1.27 to 5.74; P = 0.01), age (OR, 1.19; 95% CI, 1.13 to 1.26; P < 0.001), and anesthesia time (OR, 1.01; 95% CI 1.00 to 1.01; P = 0.002).Conclusions: Preoperative cognitive dysfunction, emergency surgery, age, and anesthesia time were factors that affected POD occurrence after spinal surgery. Patients with such associated factors may be at a higher risk for POD when undergoing spinal surgery, and hence, careful management may be necessary for these patients.

Risk factor analysis for predicting vertebral body re-collapse after posterior instrumented fusion in thoracolumbar burst fracture

Jang, Hae-Dong,Bang, Chungwon,Lee, Jae Chul,Soh, Jae-Wan,Choi, Sung-Woo,Cho, Hyeung-Kyu,Shin, Byung-Joon Elsevier 2018 SPINE JOURNAL Vol.18 No.2

<P><B>Abstract</B></P> <P><B>Background Context</B></P> <P>In the posterior instrumented fusion surgery for thoracolumbar (T-L) burst fracture, early postoperative re-collapse of well-reduced vertebral body fracture could induce critical complications such as correction loss, posttraumatic kyphosis, and metal failure, often leading to revision surgery. Furthermore, re-collapse is quite difficult to predict because of the variety of risk factors, and no widely accepted accurate prediction systems exist. Although load-sharing classification has been known to help to decide the need for additional anterior column support, this radiographic scoring system has several critical limitations.</P> <P><B>Purpose</B></P> <P>(1) To evaluate risk factors and predictors for postoperative re-collapse in T-L burst fractures. (2) Through the decision-making model, we aimed to predict re-collapse and prevent unnecessary additional anterior spinal surgery.</P> <P><B>Study Design</B></P> <P>Retrospective comparative study.</P> <P><B>Patient Sample</B></P> <P>Two-hundred and eight (104 men and 104 women) consecutive patients with T-L burst fracture who underwent posterior instrumented fusion were reviewed retrospectively. Burst fractures caused by high-energy trauma (fall from a height and motor vehicle accident) with a minimum 1-year follow-up were included. The average age at the time of surgery was 45.9 years (range, 15–79). With respect to the involved spinal level, 95 cases (45.6%) involved L1, 51 involved T12, 54 involved L2, and 8 involved T11. Mean fixation segments were 3.5 (range, 2–5). Pedicle screw instrumentation including fractured vertebra had been performed in 129 patients (62.3%).</P> <P><B>Outcome Measures</B></P> <P>Clinical data using self-report measures (visual analog scale score), radiographic measurements (plain radiograph, computed tomography, and magnetic resonance image), and functional measures using the Oswestry Disability Index were evaluated.</P> <P><B>Methods</B></P> <P>Body height loss of fractured vertebra, body wedge angle, and Cobb angle were measured in serial plain radiographs. We assigned patients to the re-collapse group if their body height loss progressed greater than 20% at any follow-up time compared with immediate postoperative body height loss; we assigned the remaining patients to the well-maintained group. The chi-square test and <I>t</I> test of SPSS were used for comparison of differences between two groups and multiple logistic regression analysis for risk factor evaluation. Through the decision tree analysis of statistical package R, a decision-making model was composed, and a cutoff value of revealed risk factors and re-collapse rate of each subgroup were identified. The present study wassupported by the University College of Medicine Research Fund (university to which authors belong). There was no external funding source for this study. The authors have no conflict of interest to declare.</P> <P><B>Results</B></P> <P>Re-collapse occurred in 31 of 208 patients (14.9%). In this group, age, the proportion of male gender, preoperative height loss, and preoperative wedge angle were significantly greater than the well-maintained group. Multivariable logistic regression analysis identified two independent risk factors: age (adjusted odds ratio 1.084, p=.002) and body height loss (adjusted odds ratio 1.065, p=.003). According to the decision-making tree, age (>43 years) was the most discriminating variable, andpreoperative body height loss (>54%) was the second. In this model, the re-collapse rate was zero in ages less than 43 years, and among those remaining, nearly 80% patients with greater than 54% of body height loss belonged to the re-collapse group.</P> <P><B>Conclusions</B></P> <P>The independent predictors of re-collapse after posterior instrumented fusion for T-L burst fracture were the age at operation (>43 years old) and preoperative body height loss (>54%). Carefu

Oncologic safety of breast-conserving surgery in breast cancer patients under the age of 35

강인천,김주형,박세호,허호,박형석,김승일,조영업 대한종양외과학회 2017 Korean Journal of Clinical Oncology Vol.13 No.1

Purpose: Breast-conserving surgery (BCS) shows no difference in survival rates compared with total mastectomy. So, BCS is considered standard breast surgery with modified radical mastectomy. But in patients who received BCS, there is a risk of local recurrence in their long term follow up periods. Especially, BCS of young age is controversial regarding oncologic safety because of local recurrence. In this study, we struggle to confirm the oncologic safety of BCS compared with total mastectomy under the age of 35 in South Korea. Methods: All patients who underwent surgery for breast cancer were 5,366 at Severance Hospital, Yonsei University Health System, from January 1981 to April 2008. Of them, patients younger than 35 years old were 547. We excluded patients who received chemotherapy before surgery and included only stage 1 and 2 patients who identified through the pathology after surgery. Finally, we got 367 patients; total mastectomy was performed in 245 and BCS, in 122. We compared clinicopathological characteristics and oncologic outcomes between two groups using SPSS program. Results: In patients received BCS, a local recurrence rate was 7.7% at 5 years and up to 20.3% at 10 years. In patients received total mastectomy, a local recurrence rate was 1.9% over 10 years (P<0.001). However, there was no difference in 5-year and 10-year overall survival rates between two groups (P=0.689). Adjuvant chemotherapy decreased local recurrence rate in BCS patients (P=0.019). Conclusion: So, we concluded that BCS under the age of 35 has oncologic safety with undergoing chemotherapy.

Oncologic safety of breast-conserving surgery in breast cancer patients under the age of 35

Incheon Kang,Joo Heung Kim,Seho Park,Ho Hur,Hyung Seok Park,Seung Il Kim,Young Up Cho 대한종양외과학회 2017 Korean Journal of Clinical Oncology Vol.13 No.1

85세 이상의 초고령자에서 백내장 수술 후 시력예후 평가

지민정(Min Jung Ji),김무상(Moo Sang Kim),이승준(Seung Jun Lee),한상범(Sang Beom Han) 대한안과학회 2016 대한안과학회지 Vol.57 No.2

Purpose: To compare the visual outcome after cataract surgery in patients 85 years of age or older with those in other age groups. Methods: This retrospective study included 313 eyes of 204 patients who underwent cataract surgery from April 2014 to March 2015 at Kangwon National University Hospital and were followed up or 3 months or longer. The patients were divided into groups A (86 eyes of 53 patients between 55 and 69 years of age), B (85 eyes of 53 patients between 70 and 84 years of age), and C (143 eyes of 98 patients 85 years of age or older), and the medical records of the patients were reviewed and analyzed. Results: The postoperative best-corrected visual acuity (BCVA) improved in 95% of group A patients, 87% of group B, and 81% of group C. When compared with the log MAR BCVA before and after surgery, the visual acuity after cataract surgery was improved effectively from 0.40 to 0.06 in group A, from 0.50 to 0.16 in group B, and from 0.75 to 0.31 in group C (p < 0.001). In group C, preoperative and postoperative BCVAs were significantly worse than in other groups (p < 0.001 and < 0.001, respectively) and the ratio of patients with vision improvement and patients with BCVA of 20/40 or better was significantly lower than in the other groups (p = 0.009 and < 0.001, respectively). Conclusions: The ratio of visual acuity improvement was decreased among the patients over 85 years of age. Pre and postoperative visual acuities in group C were observed worse than in other groups. Additionally, the postoperative visual acuity was low. However, average visual acuity improved in 81% of patients. Therefore, cataract surgery should be strongly recommended for very old patients. 목적: 85세 이상의 초고령자에서 백내장 수술 후 시력 예후를 다른 연령군 환자에서의 시력 예후와 비교해 보고자 하였다. 대상과 방법: 2014년 4월부터 2015년 3월까지 강원대학교병원에서 백내장 수술을 시행 받은 환자들 중 수술 후 3개월까지 추적관찰이 가능했던 204명 313안을 대상으로 55세부터 69세까지의 환자 53명 86안을 A군, 70세부터 84세까지의 환자 53명 85안을 B군, 85세이상의 환자 98명 143안을 C군으로 나누어 세 군의 의무기록을 후향적으로 분석하였다. 결과: A군은 백내장 수술 후 95%의 환자가 시력호전을 보였고, B군은 87%, C군은 81%로 나타났다. 수술 전후의 logMAR 시력을 비교해보면, A군은 0.40에서 0.06으로, B군은 0.50에서 0.16으로, C군은 0.75에서 0.31로 수술 후 시력이 유의하게 향상되었다(p<0.001) C군의 경우 수술 전(p<0.001) 및 수술 후 시력(p<0.001) 모두 다른 군에 비해 불량하였으며, 시력호전을 보인 환자의 비율(p=0.009)및 술 후 최대교정시력이 20/40 이상인 환자의 비율(p<0.001) 역시 다른 군보다 유의하게 적었다. 결론: 85세 이상의 고령 환자군에서 수술 전 시력 및 시력 예후 모두 다른 연령군에 비해 유의하게 불량한 것으로 나타났으나, 81%의 환자에서 시력향상이 관찰되었고 평균시력의 유의한 향상이 관찰되었다. 따라서 초고령자의 경우에도 적극적으로 백내장 수술을 시행하는 것이 바람직할 것으로 생각된다.