In February 2024, over 90% of trainee doctors in South Korea’s teaching hospitals resigned en masse, severely disrupting healthcare delivery. We evaluated the associations of this mass resignation with hospital admission and length of stay, expenditure, and patients’ health outcomes in a tertiary teaching hospital. We analyzed inpatient claims data from Jeju National University Hospital (August 2022–July 2024), encompassing 40,577 hospital episodes. Using a difference-in-differences method, we compared outcomes 6 months before and after the mass resignation (February–July 2024 vs. August 2023–January 2024) against the same period 1 year earlier (February–July 2023 vs. August 2022–January 2023) to account for seasonal trends. Primary outcomes included daily hospital admissions, length of stay, total medical costs, 30-day readmission rates, and in-hospital mortality. Analyses were stratified by comorbidity burden using the Charlson Comorbidity Index. The mass resignation was associated with reduced daily hospital admissions (−9.45; 95% CI: −16.1 to −2.77; p = 0.01), decreased length of stay (−1.01 days; 95% CI: −1.97 to −0.06; p = 0.04), and lower healthcare expenditure (−40%; 95% CI: −68% to −12%; p = 0.01). No significant changes were observed in 30-day readmission rates or in-hospital mortality in the overall sample. However, among patients with higher comorbidity burden (CCI ≥ 1), 30-day readmission rates decreased significantly (−0.05; 95% CI: −0.14 to 0.04; p = 0.01). Despite no observed short-term mortality increases, reduced utilization among high-comorbidity patients raises concerns about care access during the crisis. The findings suggest that hospitals exhibited short-term adaptive capacity under workforce shortages, while reduced utilization among high-comorbidity patients raises concern for care access. Strengthening contingency planning, flexible staffing, and real-time monitoring systems will be critical to sustaining care quality during future disruptions. Long-term implications of sustained healthcare disruption warrant further investigation.

Traditionally, 6–8 hours of fasting has been recommended before surgery to prevent respiratory complications. However, recent evidence suggests that intake of clear fluids up to 2 hours before general anesthesia may be safe. This study aimed to evaluate the safety and efficacy of reduced fasting time with clear liquid intake in surgical patients under general anesthesia. In this randomized controlled trial, 60 adult patients undergoing elective endoscopic total extraperitoneal plasty under general anesthesia were divided into two groups (n = 30 each). The control group fasted overnight (nothing per oral), while the liquid group was allowed clear fluids until 2 hours before surgery. Gastric content volume and pH were measured after intubation. Thirst and hunger levels were assessed pre- and postoperatively using a visual analogue scale. Postoperative hoarseness, nausea, vomiting, and oxygen saturation were monitored in the recovery room. The liquid group consumed an average of 520 mL of fluid. No serious respiratory complications were observed in either group. Pre- and postoperative thirst and hunger scores were significantly lower in the liquid group (P < 0.001). Gastric content volume and acidity showed no significant differences between groups, with most patients having negligible volumes (<1 mL). Permitting clear liquid intake up to 2 hours before general anesthesia is safe and does not increase the risk of respiratory complications. It effectively reduces thirst and hunger, improving patient comfort without compromising safety.

Jung KU, et al. Ann Surg Treat Res. 2023 Dec;105(6):341-352. https://doi.org/10.4174/astr.2023.105.6.341

Purpose: Various clinical practice guidelines recommend at least 12 regional lymph nodes should be removed for resected colon cancer. According to a recent study, the lymph node yield (LNY) in colon cancer surgery in the last 20 years has tended to increase from 14.91 to 21.30. However, it is unclear whether these guidelines adequately reflect recent findings on the number of harvested lymph nodes in colon cancer surgery. The aim of this study is to assess the impact of an LNY of more than 25 on survival in right-sided colon cancer.Methods: We included 285 patients who underwent a right hemicolectomy during the period from January 2010 through December 2015. Patients were divided into two groups (<25 nodes and ≥25 nodes). Primary endpoints included 5-year and 10-year survival including disease-free and overall.Results: We found that survival outcomes of patients with a harvest of ≥25 nodes were not significantly different compared with a <25 group. Large tumor size (5 cm) is significantly associated with poor 5-year and 10-year overall survival.Conclusion: Survival outcomes of patients with a harvest of ≥25 nodes were not significantly different compared with the <25 group in stage II colon cancer with no risk.

Micronutrient deficiencies are common in inflammatory bowel disease (IBD). The aim of this study was to evaluate micronutrient deficiencies and identify muscular status of patients with IBD. From June 2019 to October 2021, a total of 105 patients with IBD were enrolled prospectively. To obtain objective data, micronutrients were measured in the patients' serum, and body composition analysis was performed using bioelectrical impedance analysis. There were 51 patients with ulcerative colitis (UC) and 54 with Crohn’s disease (CD), while the gender ratio (M: F) was 54:51. The average age was 37 ± 18 years, which was significantly lower in patients with CD than UC (29 ± 16 vs. 45 ± 16, p < 0.001). Iron and magnesium were lower in patients with CD compared to UC, respectively (63.3 ± 42.5 vs. 82.8 ± 44.0 µg/dL, p = 0.024, 2.08 ± 0.15 vs. 2.15 ± 0.19 mg/dL, p = 0.036). Vitamin D levels showed insufficiency in patients with UC and deficiency (below 20 ng/mL) in patients with CD (20.1 ± 10.6 vs. 19.0 ± 9.9 ng/mL, p = 0.567). In the UC and CD patient groups, skeletal muscle index (SMI) and adjusted skeletal muscle mass were lower in patients with CD compared to UC (SMI: 32.8 ± 4.7 vs. 35.8 ± 5.5%, p < 0.004, adjusted skeletal muscle: 7.0 ± 1.5 vs. 8.2 ± 1.9 kg/m², p < 0.001). In conclusion, decreased trace elements, specifically iron, magnesium, and vitamin D, as well as skeletal muscle mass were observed to be prominent in patients with CD as compared to UC.

Introduction: The diagnosis of primary Aspergillus appendicitis can be missed or delayed because of its rarity. We report our experience of a case of Aspergillus appendicitis complicating chemotherapy of leukemia. Presentation of case: A 48-year-old man who was diagnosed with acute myeloid leukemia developed high fever and epigastric pain two weeks after administration of his fourth consolidation chemotherapy. Right lower quadrant tenderness and rebound tenderness were noticed on physical examination, and the abdomen and pelvis computed tomography suggested acute perforated appendicitis with localized peritonitis. Emergency laparoscopy showed an inflamed appendix, which was resected. Pathology reports revealed invasive aspergillosis in the appendix. The patient recovered after high-dose antifungal therapy, although he required prolonged hospitalization. Discussion: Acute appendicitis is very rarely caused by fungi infection with an overall incidence of up to 1.15 %. Differential diagnosis of fungal appendicitis without pathology report is challenging due to low incidence. Conclusion: Isolated Aspergillus appendicitis is a rare disease that can progress without appropriate antifungal therapy even after surgical resection of the appendix. Surgeons should pay attention to pathology reports after appendectomy to avoid missing unusual cases, especially in immunocompromised patients. Highlights: