Journal of Preventive Medicine and Public Health

Original Articles

Assessing Hospital Surgical Functions in Korea: A Functional Analysis Using the Disease Control Priorities, 3rd Edition Essential Surgery List (2013-2022): Haibin Bai, Jin-Hwan Kim, Yukyung Park; J Prev Med Public Health. 2025;58(6):635-646. Published online September 23, 2025; DOI: https://doi.org/10.3961/jpmph.25.407

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Abstract Summary PDF Supplementary Material: Objectives
Korea has achieved near-universal health coverage through a predominantly privatized healthcare system. However, this structural fragmentation has created significant ambiguity regarding the roles of different healthcare organizations, particularly in ensuring equitable provision of essential surgical services across geographic and institutional boundaries.
Methods
We conducted a retrospective study using the full national health insurance claims database provided by the Health Insurance Review & Assessment Service (2013-2022). Essential surgical procedures from the Disease Control Priorities, 3rd edition Essential Surgery List were mapped to insurance claims codes, and their provision was analyzed across healthcare facilities and regions. Functional capacity was defined using minimum annual volume thresholds of 12, 24, 60, and 120 procedures.
Results
Essential surgery more than doubled between 2013 and 2022, increasing from 2.79 million to nearly 6 million cases. Superior general hospitals and general hospitals consistently delivered high volumes of essential surgeries, while hospital-level facilities experienced marked functional decline, particularly in obstetric services. We observed increasing centralization of surgical services in higher-tier and metropolitan facilities, alongside selective decentralization for lower-risk procedures such as cataract surgery. Regional disparities were especially pronounced for obstetric care.
Conclusions
Functional capacity for essential surgery remains highly uneven across hospitals and regions, undermining equitable access. Policy efforts should focus on strengthening lower-tier hospitals in underserved areas and implementing minimum functionality standards tailored to local needs. Clarifying institutional roles within Korea’s mixed healthcare system is essential to improving accountability and ensuring equitable distribution of essential surgical services.; Summary

Korean summary
본 연구는 DCP3 Essential Surgery List를 한국의 건강보험 청구자료(2013–2022)에 적용하여 필수수술 제공기관의 기능적 변화를 평가하였다. 전체 필수수술 건수는 크게 증가했음에도 불구하고 이를 제공하는 의료기관 수는 지속적으로 감소하며 지역 간 격차도 확대되고 있었다. 필수수술 접근성을 강화하기 위해서는 우선 의료기관 수준별로 제공해야 할 필수 기능을 명확히 규정하는 정책적 가이드가 필요하며, 이를 기반으로 지역 단위의 종합병원·병원급 기능을 지속적으로 모니터링하고 관리하는 체계를 마련해야 한다.

Key Message
This study applies the DCP3 Essential Surgery List to South Korea’s national health insurance claims data (2013–2022) and shows that, despite a substantial rise in essential surgery volumes, the number of institutions providing these procedures has declined, widening regional disparities. Strengthening access to essential surgery requires first establishing clear guidance on the functions expected at each level of care, followed by systematic monitoring to ensure that general and hospital-level facilities maintain the capacity to deliver these core services. Such a combined approach is critical for securing equitable and regionally sustained surgical access.

Risk of Hemorrhage Attributed to Underlying Chronic Diseases and Uninterrupted Aspirin Therapy of Patients Undergoing Minor Oral Surgical Procedures: A Retrospective Cohort Study: Chanapong Rojanaworarit, Soontaree Limsawan; J Prev Med Public Health. 2017;50(3):165-176. Published online April 7, 2017; DOI: https://doi.org/10.3961/jpmph.16.121

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Objectives
This study aimed to estimate the risk of bleeding following minor oral surgical procedures and uninterrupted aspirin therapy in high-risk patients or patients with existing chronic diseases compared to patients who did not use aspirin during minor oral surgery at a public hospital.
Methods
This retrospective cohort study analyzed the data of 2912 patients, aged 20 years or older, who underwent 5251 minor oral surgical procedures at a district hospital in Thailand. The aspirin group was comprised of patients continuing aspirin therapy during oral surgery. The non-aspirin group (reference) included all those who did not use aspirin during surgery. Immediate and late-onset bleeding was evaluated in each procedure. The risk ratio of bleeding was estimated using a multilevel Poisson regression.
Results
The overall cumulative incidence of immediate bleeding was 1.3% of total procedures. No late-onset bleeding was found. A significantly greater incidence of bleeding was found in the aspirin group (5.8% of procedures, p<0.001). After adjusting for covariates, a multilevel Poisson regression model estimated that the bleeding risk in the aspirin group was 4.5 times higher than that of the non-aspirin group (95% confidence interval, 2.0 to 10.0; p<0.001). However, all bleeding events were controlled by simple hemostatic measures.
Conclusions
High-risk patients or patients with existing chronic diseases who continued aspirin therapy following minor oral surgery were at a higher risk of hemorrhage than general patients who had not used aspirin. Nonetheless, bleeding complications were not life-threatening and could be promptly managed by simple hemostatic measures. The procedures could therefore be provided with an awareness of increased bleeding risk, prepared hemostatic measures, and postoperative monitoring, without the need for discontinuing aspirin, which could lead to more serious complications.

Summary

Citations

Citations to this article as recorded by

Local Hemostasis as the Critical Enabler for Safe Antithrombotic Therapy in Dentistry—Navigating Future Frontiers and Innovative Concepts
Diana Tatarciuc, Mioara Florentina Trandafirescu, Dragos Catalin Ghica, Iolanda Foia, Adina Oana Armencia, Irina Gradinaru, Magda Ecaterina Antohe, Lucian Stefan Burlea, Irina Mihaela Esanu, Roxana-Ionela Vasluianu
Journal of Clinical Medicine.2026; 15(5): 1823. CrossRef
Emergency of oral haemorrhage: Retrospective study over 2 years
M. Pinana, I. Rodriguez‐Perron, G. Lescaille, R. Toledo, M. Mondoloni, J. Rochefort
Oral Diseases.2025; 31(2): 648. CrossRef

Improving the Performance of Risk-adjusted Mortality Modeling for Colorectal Cancer Surgery by Combining Claims Data and Clinical Data: Won Mo Jang, Jae-Hyun Park, Jong-Hyock Park, Jae Hwan Oh, Yoon Kim; J Prev Med Public Health. 2013;46(2):74-81. Published online March 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.2.74

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6 Crossref

Abstract PDF

Objectives

The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery.

Methods

We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration.

Results

The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1.

Conclusions

The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.

Summary

Citations

Citations to this article as recorded by

Estimating postoperative mortality in colorectal surgery- a systematic review of risk prediction models
Alexios Dosis, Jack Helliwell, Aron Syversen, Jim Tiernan, Zhiqiang Zhang, David Jayne
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Modified Tumor Budding as a Better Predictor of Lymph Node Metastasis in Early Gastric Cancer: Possible Real-World Applications
Kwangil Yim, Won Mo Jang, Sung Hak Lee
Cancers.2021; 13(14): 3405. CrossRef
Investigación epidemiológica en cáncer colorrectal: perspectiva, prospectiva y retos bajo la óptica de explotación del Big-Data
J.M. García Torrecillas, M. Ferrer Márquez, Á. Reina Duarte, F. Rubio-Gil
SEMERGEN - Medicina de Familia.2016; 42(8): 509. CrossRef
Variation between Hospitals with Regard to Diagnostic Practice, Coding Accuracy, and Case-Mix. A Retrospective Validation Study of Administrative Data versus Medical Records for Estimating 30-Day Mortality after Hip Fracture
Jon Helgeland, Doris Tove Kristoffersen, Katrine Damgaard Skyrud, Anja Schou Lindman, Alanna M Chamberlain
PLOS ONE.2016; 11(5): e0156075. CrossRef
Model for risk adjustment of postoperative mortality in patients with colorectal cancer
K Walker, P J Finan, J H van der Meulen
Journal of British Surgery.2015; 102(3): 269. CrossRef
Problems With Public Reporting of Cancer Quality Outcomes Data
Paul Goldberg, Rena M. Conti
Journal of Oncology Practice.2014; 10(3): 215. CrossRef

Time Series Observations of Outcome Variables and the Factors Associated with the Improvement in the Patient Outcomes of Cataract Surgery.: Han Joong Kim, Eun Cheol Park, Yoon Jung Choi, Hyung Gon Kang; Korean J Prev Med. 2001;34(2):175-181.

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Abstract PDF: OBJECTIVES
To compare the multiple outcomes of patients with cataract surgery at perioperative time, 3-4 months and 12 months after surgery and to assess patient outcomes associated with visual improvement(visual acuity of operated eye, visual function-14(VF-14), symptom score). METHODS: For this assessment, a prospective study was conducted with 389 patients who had undergone cataract surgery for either one eye or both eyes. The surgery was performed by 20 ophthalmologists who were practicing at university hospitals and general hospitals. Patients were interviewed and clinical data were obtained. Doctors were questioned with self-reported questionnaire forms. Medical records were examined in order to measure variables related to the surgical process such as surgical methods and ocular comorbidity. The survey was conducted at 4 stages : preoperative time(389 cases), perioperative time(344 cases, 88.4%), postoperative 3-4 months (343 cases, 88.2%), and postoperative 12 months (281 cases, 72.2%). After excluding cases with incomplete data, 198 cases were enrolled in the study. Patient outcomes was measured for any improvement in the functional outcomes(visual acuity of operated eye, visual function, symptom score) at postoperative 3-4 months. RESULTS: The visual acuity(operated, weighted average), symptom score, VF-14 score, satisfaction with vision, and subjective health status were shown to be improved at the perioperative time, postoperative 3-4 months and 12 months. An improvement in the Snellen visual acuity score was observed in 190 patients(96.0%), whereas improvements of the VF-14 score and cataract symptom score were observed in 151 patients(76.3%) and 179 patients(90.4%), respectively. All three outcome measures demonstrated improvement in 137 patients(69.2%). The improvement of the three functional outcomes at 3-4 months after receiving surgery was associated with a lower level of visual function and a higher level of cataract symptom score at perioperative time, as well as a greater experience level of the surgeon. CONCLUSIONS: In this study, the estimates of the proportion of patients benefiting from cataract surgery varied with the outcome measure of benefit. Preoperative VF-14 score, a measure of functional impairment related to vision, and symptom score may be better measures of the benefit derived from cataract surgery than the change in visual acuity.; Summary

The Patient Recognition, Acceptability and Evaluation of Feasibility for Day Surgery.: Young Ah Kang, Young Ran Beak, Kyeong Soo Lee, Seok Beom Kim, Pock Soo Kang; Korean J Prev Med. 2000;33(3):334-342.

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Abstract PDF: OBJECTIVES
This study was conducted in order to investigate the degree of recognition, acceptability, and attitude towards day surgery of patients who were hospitalized with diseases that were candidates for day surgery; in order to analyze the average length of stay for treatment of the ailments; and to analyze the percentage of patients who could be discharged on the same day after the surgery using the post-anesthesia discharge scoring system. METHODS: Data was collected between February 1 and March 31, 1999 from 353 patients who received surgery for cataract, adenoid hypertrophy, inguinal hernia, strabismus, ptosis, cholelithiasis, hemorrhoid, or anal fistula, at a general hospital in Daegu city. The patients were interviewed and surveyed by a post-anesthesia discharge scoring system(PADS) in order to collect data on patient condition such as vital signs, activity and mental status, pain, nausea and vomiting, surgical bleeding, intake and output after the surgery. RESULTS: Among the 353 patients, 52.7% were awar of the day surgery and 52.1% were interested in day surgery. Of the respondents, 43.1% said 'my ailment was not serious and the surgery was simple' and 30.4% said 'according to my condition rest at home was desirable' as the reasons for wanting day surgery Alternatively, 56.5% of those declining day surgery said the 'uncertainty of staying home' was the reason. The greatest concern in discharging within 24 hours after surgery was a post-op emergency situation. On the other hand, the shortened hospitalization was the largest advantage of day surgery with 39.1% responding this way, followed by the savings in hospitalization costs (25.8%) and emotional stability (13.7%). The majority of those surveyed (47.6%) believed that discharge should be determined within 1-2 days after the surgery. The average hospital stay was 3.1 days for dischargeable ailments. Pain (45.6%), nausea and vomiting (10.5%), and headache (7.9%) were the common symptoms following surgery. The percentage of patients who were able to be discharged within 24 hours after surgery revealed 95.2% were dischargeable after approximately 3 hours, 99.2% dischargeable after 12 hours, and 100% dischargeable atter 24 hours. CONCLUSIONS: According to the PADS score, the cataract extract and strabismus correction patients were eligible for day surgery and the further evaluation concerning the reason for delayed recovery of the other diseases is needed.; Summary

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