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J Korean Soc Emerg Med > Volume 31(5); 2020 > Article
Journal of The Korean Society of Emergency Medicine 2020;31(5): 511-517.
Effect of the end-of-life care law on life-sustaining treatment in emergency patients with advanced malignancy: a retrospective before-after study
Eun Gon Song , Kyung Su Kim
Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
Correspondence  Kyung Su Kim ,Tel: 02-2072-4751, Fax: 02-3672-8871, Email: kanesu@gmail.com,
Received: August 14, 2019; Revised: October 31, 2019   Accepted: November 9, 2019.  Published online: October 30, 2020.
ABSTRACT
Objective:
This study examined the effects of the new law on life-sustaining treatment (LST) in emergency patients with advanced malignancy.
Method:
This was a retrospective before-after study performed at a single hospital. The enrollment criteria were as follows: patients who visited the emergency department during the study period, age ≥18 years, Korean Triage and Acuity Scale 1-2 to enroll severely ill patients requiring LST, solid malignancy with metastasis, and admitted to the study hospital. The after group was defined as those enrolled in May 2018, and the before group was defined as those enrolled in May 2017. The primary outcomes were defined as LST, including intensive care unit (ICU) admission, renal replacement therapy, mechanical ventilation, and cardiopulmonary resuscitation. Secondary outcomes were defined as each component of the primary outcomes, hospital length of stay, cost, and mortality.
Results:
Ninety-seven patients were enrolled (before group [n=46], after group [n=51]). LST was provided more frequently in the after group (19.6% vs. 47.1%, P=0.004). The ICU admission rate was higher (19.6% vs. 43.1%, P=0.013), and mechanical ventilation was applied more frequently (6.5% vs. 21.6%, P=0.044) in the after group. Furthermore, the median hospital length of stay (six-day vs. 11-day, P=0.016) was longer, and the median hospital cost was higher (3,777 USD vs. 7,882 USD, P<0.001) in the after group. Hospital mortality did not differ (19.6% vs. 35.3%, P=0.084).
Conclusion:
New end-of-life care law increased the rate of LST in emergency patients with advanced malignancy regardless of the improved survival rate.
Key words: Malignancy; Palliative care; Advance directives; Emergency medicine
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