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dc.contributor.advisor이정연-
dc.contributor.advisor곽혜선-
dc.contributor.author전민선-
dc.creator전민선-
dc.date.accessioned2020-02-03T16:33:03Z-
dc.date.available2020-02-03T16:33:03Z-
dc.date.issued2020-
dc.identifier.otherOAK-000000163498-
dc.identifier.urihttp://dcollection.ewha.ac.kr/common/orgView/000000163498en_US
dc.identifier.urihttps://dspace.ewha.ac.kr/handle/2015.oak/253226-
dc.description.abstractBackground: This study aimed to determine the association of preoperative antithrombotics with intraoperative transfusion undergoing surgery and preoperative medications with unplanned 30 day-readmission after surgery in elderly cancer patients receiving comprehensive geriatric assessment. Methods: The study subjects were patients aged 65 years or older who were scheduled for cancer surgery and presented for comprehensive geriatric assessment at the Geriatric Center of Seoul National University Bundang Hospital from January 2014 to June 2015. We reviewed the baseline patient characteristics obtained from electronic medical records and the patients’ preoperative medication history. Results: A total of 475 cancer patients were included. Multivariate analysis showed that long-acting anticoagulant therapy before surgery was a significant risk factor for intraoperative transfusion. Long-acting anticoagulants increased the risk of transfusion approximately 15.9-fold (95% CI 1.9-136.2). The attributable risk of long-acting anticoagulants to transfusion was approximately 93.7%. Also, low body mass index (BMI) and hepato-pancreato-biliary (HPB) surgery were significantly associated with intraoperative transfusion. The adjusted odds ratios for low BMI (<18.5 kg/m2) and HPB surgery (reference: lower gastrointestinal surgery) were 5.3 (95% CI 1.8-15.4) and 4.9 (95% CI 1.9-12.5), respectively. In the case of 30-day readmission, a total of 473 patients were included after additionally excluding two patients who died during surgery. Multivariate analysis showed that preoperative discontinuation-requiring medication (PDRMs) and gastrointestinal/ hepato-pancreato-biliary (GI/HPB) cancer were significant factors for 30-day readmission. PDRM increased the risk of readmission by about 2.2-fold. Attributable risk of PDRM to readmission was around 55%. The adjusted odds ratio and attributable risk for GI/HPB surgery was 3.4 (95% CI 1.0-11.5) and 70.8%, respectively. Conclusions: It was found that the perioperative use of medication was associated with an increased risk of intraoperative transfusion and unplanned 30-day readmission in geriatric cancer patients, further highlighting the importance of medication optimization for elderly patients with cancer surgery.;본 연구는 노인약물포괄평가를 받은 노인 암환자에서 수술 전 항응고제의 복용과 수술 중 수혈의 상관관계 및 수술 전 복용 약물과 수술 후 예정되지 않은 30일 이내 재입원률과의 상관관계를 규명하고자 하였다. 2014년 1월부터 2015년 6월까지 분당서울대학교병원 노인의료센터에서 노인약물포괄평가를 받은 65세 이상의 수술 예정인 암환자를 대상으로 하였으며, 전자의무기록 상의 환자 기본 정보와 수술 전 약물복용이력을 확인하였다. 475명의 암환자를 대상으로 다변량분석을 한 결과, 수술 전 장시간 지속하는 항응고제 복용은 수술 중 수혈 발생의 유의한 위험 인자였으며, 수혈의 위험을 약 15.9배 상승시켰고(95% CI 1.9-136.2), 기여위험도는 약 93.7% 였다. 또한, 낮은 BMI (<18.5 kg/m2) 와 간췌담도 수술도 수술 중 수혈 발생에 유의하게 연관이 있었다. 낮은 BMI (<18.5 kg/m2) 군과 간췌담도 수술군(비교군: 하부 위장관 수술)의 보정 승산비는 각각 5.3 (95% CI 1.8-15.4) 과 4.9 (95% CI 1.9-12.5)였다. 30일 이내 재입원의 경우, 수술 중 사망한 환자 2명을 추가로 제외하고 총 473명을 대상으로 하였으며, 다변량분석 결과 수술 전 복용 중지가 필요한 약물을 복용한 군과 위장관/간췌담도암 군이 30일 이내 재입원의 유의한 인자였다. 수술 전 복용 중지가 필요한 약물을 복용한 군은 재입원의 위험을 약 2.2배 상승시켰으며, 기여위험도는 약 55%였다. 위장관/간췌담도암에 대한 보정승산비는 3.4(95% CI 1.0-11.5) 였고, 기여위험도는 약 70.8%였다. 이 연구로 노인 암환자에서 수술 전 약물 사용의 수술 중 수혈 및 예정되지 않은 30일 이내 재입원률과의 연관성과 노인 암환자에서 약물최적화의 중요성을 확인하였다.-
dc.description.tableofcontentsⅠ. Introduction 1 A. Background 1 B. Objectives 4 Ⅱ. Methods 5 A. Study population and data collection 5 B. Statistical analysis 9 Ⅲ. Results 13 A. Association of preoperative use of anti-thrombotic medications with intraoperative transfusion in older patients undergoing cancer surgery 13 B. Association of pre-operative medication use with unplanned 30-day hospital readmission after surgery in oncology patients 15 Ⅳ. Discussion 27 Ⅴ. Conclusions 33 Bibliography 34 Abstract (in Korean) 44-
dc.formatapplication/pdf-
dc.format.extent534183 bytes-
dc.languageeng-
dc.publisher이화여자대학교 대학원-
dc.subject.ddc600-
dc.titleAssociation of preoperative medication use with intraoperative transfusion and unplanned 30-day readmission in elderly patients undergoing cancer surgery-
dc.typeDoctoral Thesis-
dc.creator.othernameJun, Min Sun-
dc.format.pagev, 45 p.-
dc.identifier.thesisdegreeDoctor-
dc.identifier.major대학원 생명·약학부약학전공-
dc.date.awarded2020. 2-
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