J Korean Neurosurg Soc.  2018 Jul;61(4):478-484. 10.3340/jkns.2017.0227.

Requirements for Cerebrovascular Surgery in Comprehensive Stroke Centers in South Korea

• Kim T
• Oh CW
• Park HS
• Lee K
• Lee WK
• Lee H

• KMID: 2417324
• DOI: http://doi.org/10.3340/jkns.2017.0227

Abstract

OBJECTIVE
Cerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs).
METHODS
This investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent's opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons.
RESULTS
Most experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery.
CONCLUSION
Raising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.

Keyword

Cerebrovascular disorders; Patient transfer; Health resources

MeSH Terms

Angiography
Cause of Death
Cerebrovascular Disorders
Health Resources
Humans
Korea*
Magnetic Resonance Angiography
Mortality
Operating Rooms
Patient Transfer
Stroke*
Surgeons
Surgical Equipment
Surveys and Questionnaires

Reference

References

1. Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, et al. Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition. Stroke. 36:1597–1616. 2005.

2. Iihara K, Nishimura K, Kada A, Nakagawara J, Ogasawara K, Ono J, et al. Effects of comprehensive stroke care capabilities on in-hospital mortality of patients with ischemic and hemorrhagic stroke: J-ASPECT study. PLoS One. 9:e96819. 2014.

3. Korean Statistical Information Service. Mortality statistics 2014. Available at : http://kosis.kr/eng/statisticsList/statisticsList_01List.jsp?vwcd=MT_ETITLE&parentId=D.

4. Langhorne P, Fearon P, Ronning OM, Kaste M, Palomaki H, Vemmos K, et al. Stroke unit care benefits patients with intracerebral hemorrhage: systematic review and meta-analysis. Stroke. 44:3044–3049. 2013.

5. Ministry of Health and Welfare. National Health Plan 2020. Available at : http://www.mohw.go.kr/front_new/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=0319&CONT_SEQ=257824.

6. Organization for Economic Co-operation and Development. OECD Health Data 2011. Available at : http://dx.doi.org/10.1787/888932523367.

7. Joint Commission launches two new disease-specific care certification programs. Jt Comm Perspect. 26:1–11. 2006.