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Objective: In Korea, the Value Incentive Program (VIP) was first applied to selected clinical conditions in 2007 to evaluate the performance of medical institutes. We examined whether the condition-specific performance of the VIP resulted in measurable improvement in quality of care and in reduced medical costs.Design: Population-based retrospective observational study.Setting: We used two data set including the results of quality assessment and hospitalization data from National Health Claim data from 2011 to 2014.Participants: Participants who were admitted to the hospital for obstetrics and gynecology were included. A total of 535 289 hospitalizations were included in our analysis.Methods: We used a generalized estimating equation (GEE) model to identify associations between the quality assessment and length of stay (LOS). A GEE model based on a gamma distribution was used to evaluate medical cost. The Poisson regression analysis was used to evaluate readmission.Main Outcome Measures: The outcome variables included LOS, medical costs and readmission within 30 days.Results: Higher condition-specific performance by VIP participants was associated with shorter LOSs, decreases in medical cost, and lower within 30-day readmission rates for target and non-target surgeries. LOS and readmission within 30 days were different by change in quality assessment at each medical institute.Conclusions: Our findings contribute to the body of evidence used by policy-makers for expansion and development of the VIP. The study revealed the positive effects of quality assessment on quality of care. To reduce the between-institute quality gap, alternative strategies are needed for medical institutes that had low performance. [ABSTRACT FROM AUTHOR]

We aimed to compare the effects of ramosetron and palonosetron in the prevention of postoperative nausea and vomiting (PONV) in patients that received opioid-based intravenous patient-controlled analgesia (IV-PCA) after gynecological laparoscopy. We reviewed the electronic medical records of 755 adults. Patients were classified into two groups, ramosetron (group R, n=589) versus palonosetron (group P, n=166). Based on their confounding factors, 152 subjects in each group were selected after the implementation of propensity score matching. The overall incidence of PONV at postoperative day (POD) 0 was lower in group R compared to group P (26.9% versus 36.8%; P=0.043). The severity of nausea was lower in group R than in group P on postoperative day (POD) 0 (P=0.012). Also, the complete responder proportion of patients was significantly higher in group R compared to that in group P on POD 0 (P=0.043). In conclusion, ramosetron showed a greater efficacy in the prevention of postoperative nausea at POD 0 compared to palonosetron in patients after gynecological laparoscopy. [ABSTRACT FROM AUTHOR]

Objective: To compare surgical outcomes of laparoendoscopic single-site myomectomy (LESS-M) vs. conventional laparoscopic myomectomy (LM).Design: Multicenter, noninferiority, randomized, controlled trial.Setting: University hospitals.Patient(s): A total of 100 subjects with symptomatic uterine myomas were randomly assigned to either LESS-M or conventional LM. Surgical outcomes were comparatively assessed between the groups on the basis of the intention-to-treat principle.Intervention(s): Laparoscopic myomectomy.Main Outcome Measure(s): The time required for uterine defect suturing.Result(s): There were no differences in baseline demographics (age, body mass index, surgical indication, number of myomas, and size and location of the largest myoma) between the two groups. The suturing time (mean ± SD) was 21.9 ± 10.7 minutes (95% confidence interval 18.8-24.9 min) for the LESS-M group and 23.3 ± 12.4 minutes (95% confidence interval 19.8-26.9 min) for the conventional LM group, with no significant difference between the two groups. The other surgical outcomes, such as total operative time, operative blood loss, postoperative hemoglobin change, degree of surgical difficulty, postoperative pain scores, operative complication, and length of hospital stay, were similar between the two groups. Three subjects (6%) assigned to the LESS-M group underwent conventional LM because of difficulty in myoma enucleation and suturing, whereas no failure to intended procedure occurred in the conventional LM group (6% vs. 0).Conclusion(s): Laparoendoscopic single-site surgery is a feasible and safe treatment option for myomectomy that offers surgical outcomes comparable to those with conventional LM.Clinical Trial Registration Number: NCT01984632. [ABSTRACT FROM AUTHOR]

Background: Our objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy.Methods: We analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysis.Results: During the study period, 38,402 women with diagnosed myoma(s), 9890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1-1.16 and aOR 7.46, 95% CI 6.97-7.98, respectively) and placenta previa (aOR 1.41, 95% CI 1.29-1.54 and aOR 1.58, 95% CI 1.35-1.83, respectively), compared to women without a diagnosed myoma. And the risk of uterine rupture was significantly higher in women with previous myomectomy (aOR 12.78, 95% CI 6.5-25.13), compared to women without a diagnosed myoma, which was much increased (aOR 41.35, 95% CI 16.18-105.69) in nulliparous women. The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy.Conclusions: Women with a history of myomectomy had significantly higher risks of cesarean section and placenta previa compared to women without a diagnosed myoma. [ABSTRACT FROM AUTHOR]