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Original Articles
- Usefulness of Bioelectrical Impedance Analysis as a Guidance of Fluid Management in Critically Ill Patients after Major Abdomen Surgery; a Single Center, Prospective Cohort Study
- Yoon Ji Chung, Eun Young Kim
- Surg Metab Nutr 2020;11(2):53-60. Published online December 30, 2020
- DOI: https://doi.org/10.18858/smn.2020.11.2.53
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Abstract
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ePub - Purpose: We evaluated the patterns and changes in bioelectrical impedance analysis parameters of patient who underwent abdominal surgery throughout the early period in surgical intensive care unit stay.
Materials and Methods: From May 2019 to April 2020, patients admitted to surgical intensive care unit for more than 48 hours after surgery were enrolled. Body composition and volume status of patients were measured prospectively using portable bioelectrical impedance analysis device every morning for three days from the day of intensive care unit admission. Overhydration was defined as the case where the value of extracellular water ratio is above 0.390, and the participants were daily classified into overhydration or normohydration group. Relationship between daily volume status measured by bioelectrical impedance analysis and outcomes was assessed.
Results: 107 patients who underwent abdominal surgery and 26 patients who underwent endovascular surgery were reviewed as control group. During the first postoperative 48 hours, most of them showed overhydration status, while the rate of overhydaration was significantly lower in the control group. Overhydration status on day 3 was significant predictors of postoperative morbidities (OR 5.709, 95% CI 2.199~14.819, P<0.001) and in-hospital mortality (OR 4.244, 95% CI 1.398~12.883, P<0.001).
Conclusion: Overhydration status by extracellular water ratio on postoperative day 3 needs careful monitoring and appropriate interventions to improve the postoperative morbidities and in-hospital mortality. Bioelectrical impedance analysis could be a simple, easy and useful tool to monitor the volume status of patients who requiring intensive fluid resuscitation after abdominal surgery.
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- Quality Improvement Activities to Facilitate the Filing of Complexity Payment Claims for Patients with Malnutrition
- Kuk Hwan Kwon, Hyung Soon Lee, Jee Hyoung Yoo, Soo Na Chi, Hyun Hee Park, So Won Kim, Kyung Ran Kim, Nan Hee Yun, Kyoung Taek Ra, Hyun Jung Song
- J Clin Nutr 2018;10(1):20-24. Published online June 30, 2018
- DOI: https://doi.org/10.15747/jcn.2018.10.1.20
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Abstract
PDFePub
Purpose:
The grade of complexity in the diagnosis related group (DRG) payment system is influenced by the secondary diagnosis of specific complication and comorbidity level, in which moderate or severe malnutrition is included. This study examined an existing proportion of patients with malnutrition who were supposed to be qualified for the complexity level and devised quality improvement measures to increase the proportion of qualifying complexity payments.
Methods:
The goal of the activities was to increase the rate of complexity payment claims for patients with malnutrition (%). Cases ineligible for the DRG payment system and cases with no diagnosis of malnutrition were excluded. We established a collaborative system between the nutrition support team and departments related to each improvement factor (
i.e ., patient care, medical records, insurance review, and medical information).Results:
Before implementing the activities, this study investigated the current level of complexity payment claims for malnutrition patients who were discharged within a specific period (June 1, 2015∼August 31, 2015). The results showed that complexity payment claims were filed in 10.00% (2 of the 20 malnutrition cases). After the activities, the rate of complexity payment claims for the patients with malnutrition within the study period (June 1, 2016∼August 31, 2016) was 46.43% (26 out of 56), showing an approximately 364% increase from the pre activity rate. This change was statistically significant according to the chi-square test on Microsoft Excel 2010 (P<0.01).
Conclusion:
Collaborative efforts by the related departments enabled the smooth implementation of each activity. In addition, moderate or severe malnutrition was revealed to be a variable in the complexity-specific payment system. In the future, hospital-wide awareness and effort are crucial to promot the steady practice of these activities and expand their implementation.
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