{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T22:28:51Z","timestamp":1769120931575,"version":"3.49.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"DOI":"10.1186\/s12871-025-03423-1","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T13:08:21Z","timestamp":1762520901000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness and safety of low-dose intraoperative tranexamic acid in cardiac surgery: a retrospective before-and-after study"],"prefix":"10.1186","volume":"25","author":[{"given":"Jaeyeon","family":"Chung","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"In Jung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae-Woo","family":"Ju","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chan-ho","family":"Hong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youn Joung","family":"Cho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunseok","family":"Jeon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karam","family":"Nam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"3423_CR1","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.athoracsur.2024.06.039","volume":"119","author":"R Salenger","year":"2025","unstructured":"Salenger R, Arora RC, Bracey A, D\u2019Oria M, Engelman DT, Evans C, et al. Cardiac surgical bleeding, transfusion, and quality metrics: joint consensus statement by the enhanced recovery after surgery cardiac society and society for the advancement of patient blood management. Ann Thorac Surg. 2025;119:280\u201395. https:\/\/doi.org\/10.1016\/j.athoracsur.2024.06.039.","journal-title":"Ann Thorac Surg"},{"key":"3423_CR2","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1001\/jamasurg.2019.1153","volume":"154","author":"DT Engelman","year":"2019","unstructured":"Engelman DT, Ben Ali W, Williams JB, Perrault LP, Reddy VS, Arora RC, et al. Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA Surg. 2019;154:755\u201366. https:\/\/doi.org\/10.1001\/jamasurg.2019.1153.","journal-title":"JAMA Surg"},{"key":"3423_CR3","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1056\/NEJMoa051379","volume":"354","author":"DT Mangano","year":"2006","unstructured":"Mangano DT, Tudor IC, Dietzel C, Multicenter Study of Perioperative Ischemia Research G, Ischemia R, Education F. The risk associated with aprotinin in cardiac surgery. N Engl J Med. 2006;354:353\u201365. https:\/\/doi.org\/10.1056\/NEJMoa051379.","journal-title":"N Engl J Med"},{"key":"3423_CR4","doi-asserted-by":"publisher","first-page":"2319","DOI":"10.1056\/NEJMoa0802395","volume":"358","author":"DA Fergusson","year":"2008","unstructured":"Fergusson DA, Hebert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, et al. A comparison of Aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med. 2008;358:2319\u201331. https:\/\/doi.org\/10.1056\/NEJMoa0802395.","journal-title":"N Engl J Med"},{"key":"3423_CR5","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1002\/bjs.9193","volume":"100","author":"K Ker","year":"2013","unstructured":"Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. Br J Surg. 2013;100:1271\u20139. https:\/\/doi.org\/10.1002\/bjs.9193.","journal-title":"Br J Surg"},{"key":"3423_CR6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e3054","volume":"344","author":"K Ker","year":"2012","unstructured":"Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054. https:\/\/doi.org\/10.1136\/bmj.e3054.","journal-title":"BMJ"},{"key":"3423_CR7","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1016\/j.athoracsur.2021.03.033","volume":"112","author":"P Tibi","year":"2021","unstructured":"Tibi P, McClure RS, Huang J, Baker RA, Fitzgerald D, Mazer CD, et al. STS\/SCA\/AmSECT\/SABM update to the clinical practice guidelines on patient blood management. Ann Thorac Surg. 2021;112:981\u20131004. https:\/\/doi.org\/10.1016\/j.athoracsur.2021.03.033.","journal-title":"Ann Thorac Surg"},{"key":"3423_CR8","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezae352","author":"FPA Casselman","year":"2024","unstructured":"Casselman FPA, Lance MD, Ahmed A, Ascari A, Blanco-Morillo J, Bolliger D, et al. 2024 EACTS\/EACTAIC guidelines on patient blood management in adult cardiac surgery in collaboration with EBCP. Eur J Cardiothorac Surg. 2024. https:\/\/doi.org\/10.1093\/ejcts\/ezae352.","journal-title":"Eur J Cardiothorac Surg"},{"key":"3423_CR9","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1213\/ANE.0000000000005553","volume":"133","author":"RV Joshi","year":"2021","unstructured":"Joshi RV, Wilkey AL, Blackwell JM, Kwak J, Raphael J, Shore-Lesserson L, et al. Blood conservation and hemostasis in cardiac surgery: a survey of practice variation and adoption of evidence-based guidelines. Anesth Analg. 2021;133:104\u201314. https:\/\/doi.org\/10.1213\/ANE.0000000000005553.","journal-title":"Anesth Analg"},{"key":"3423_CR10","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","volume":"147","author":"E von Elm","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573\u20137. https:\/\/doi.org\/10.7326\/0003-4819-147-8-200710160-00010.","journal-title":"Ann Intern Med"},{"key":"3423_CR11","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1016\/j.jtcvs.2013.10.070","volume":"147","author":"C Dyke","year":"2014","unstructured":"Dyke C, Aronson S, Dietrich W, Hofmann A, Karkouti K, Levi M, et al. Universal definition of perioperative bleeding in adult cardiac surgery. J Thorac Cardiovasc Surg. 2014;147:1458\u2013e631. https:\/\/doi.org\/10.1016\/j.jtcvs.2013.10.070.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"3423_CR12","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1213\/ANE.0000000000002920","volume":"127","author":"PJ Schulte","year":"2018","unstructured":"Schulte PJ, Mascha EJ. Propensity score methods: theory and practice for anesthesia research. Anesth Analg. 2018;127:1074\u201384. https:\/\/doi.org\/10.1213\/ANE.0000000000002920.","journal-title":"Anesth Analg"},{"key":"3423_CR13","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004017","author":"SJ Staffa","year":"2019","unstructured":"Staffa SJ, Kohane DS, Zurakowski D. Quantile regression and its applications: a primer for anesthesiologists. Anesth Analg. 2019. https:\/\/doi.org\/10.1213\/ANE.0000000000004017.","journal-title":"Anesth Analg"},{"key":"3423_CR14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h2750","volume":"350","author":"E Kontopantelis","year":"2015","unstructured":"Kontopantelis E, Doran T, Springate DA, Buchan I, Reeves D. Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis. BMJ. 2015;350:h2750. https:\/\/doi.org\/10.1136\/bmj.h2750.","journal-title":"BMJ"},{"key":"3423_CR15","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/S0022-5223(19)35634-X","volume":"99","author":"JC Horrow","year":"1990","unstructured":"Horrow JC, Hlavacek J, Strong MD, Collier W, Brodsky I, Goldman SM, et al. Prophylactic tranexamic acid decreases bleeding after cardiac operations. J Thorac Cardiovasc Surg. 1990;99:70\u20134. https:\/\/doi.org\/10.1016\/S0022-5223(19)35634-X.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"3423_CR16","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.1161\/01.cir.84.5.2063","volume":"84","author":"JC Horrow","year":"1991","unstructured":"Horrow JC, Van Riper DF, Strong MD, Brodsky I, Parmet JL. Hemostatic effects of tranexamic acid and desmopressin during cardiac surgery. Circulation. 1991;84:2063\u201370. https:\/\/doi.org\/10.1161\/01.cir.84.5.2063.","journal-title":"Circulation"},{"key":"3423_CR17","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1056\/NEJMoa1606424","volume":"376","author":"PS Myles","year":"2017","unstructured":"Myles PS, Smith JA, Forbes A, Silbert B, Jayarajah M, Painter T, et al. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med. 2017;376:136\u201348. https:\/\/doi.org\/10.1056\/NEJMoa1606424.","journal-title":"N Engl J Med"},{"key":"3423_CR18","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/S0140-6736(10)60835-5","volume":"376","author":"H Collaborators, Shakur","year":"2010","unstructured":"CRASH-2, Collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. Effects of Tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376:23\u201332. https:\/\/doi.org\/10.1016\/S0140-6736(10)60835-5.","journal-title":"Lancet"},{"key":"3423_CR19","doi-asserted-by":"publisher","first-page":"2105","DOI":"10.1016\/S0140-6736(17)30638-4","volume":"389","author":"WOMAN Trial Collaborators","year":"2017","unstructured":"WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389:2105\u201316. https:\/\/doi.org\/10.1016\/S0140-6736(17)30638-4.","journal-title":"Lancet"},{"key":"3423_CR20","doi-asserted-by":"publisher","first-page":"1986","DOI":"10.1056\/NEJMoa2201171","volume":"386","author":"PJ Devereaux","year":"2022","unstructured":"Devereaux PJ, Marcucci M, Painter TW, Conen D, Lomivorotov V, Sessler DI, et al. Tranexamic acid in patients undergoing noncardiac surgery. N Engl J Med. 2022;386:1986\u201397. https:\/\/doi.org\/10.1056\/NEJMoa2201171.","journal-title":"N Engl J Med"},{"key":"3423_CR21","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1001\/jama.2022.10725","volume":"328","author":"J Shi","year":"2022","unstructured":"Shi J, Zhou C, Pan W, Sun H, Liu S, Feng W, et al. Effect of high- vs low-dose tranexamic acid infusion on need for red blood cell transfusion and adverse events in patients undergoing cardiac surgery: the OPTIMAL randomized clinical trial. JAMA. 2022;328:336\u201347. https:\/\/doi.org\/10.1001\/jama.2022.10725.","journal-title":"JAMA"},{"key":"3423_CR22","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1097\/ALN.0000000000003633","volume":"134","author":"PJ Zufferey","year":"2021","unstructured":"Zufferey PJ, Lanoiselee J, Graouch B, Vieille B, Delavenne X, Ollier E. Exposure-Response relationship of Tranexamic acid in cardiac surgery. Anesthesiology. 2021;134:165\u201378. https:\/\/doi.org\/10.1097\/ALN.0000000000003633.","journal-title":"Anesthesiology"},{"key":"3423_CR23","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-021-03799-9","volume":"25","author":"S Murao","year":"2021","unstructured":"Murao S, Nakata H, Roberts I, Yamakawa K. Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis. Crit Care. 2021;25:380. https:\/\/doi.org\/10.1186\/s13054-021-03799-9.","journal-title":"Crit Care"},{"key":"3423_CR24","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200105000-00010","author":"BK Fiechtner","year":"2001","unstructured":"Fiechtner BK, Nuttall GA, Johnson ME, Dong Y, Sujirattanawimol N, Oliver WC Jr., et al. Plasma tranexamic acid concentrations during cardiopulmonary bypass. Anesth Analg. 2001. https:\/\/doi.org\/10.1097\/00000539-200105000-00010.","journal-title":"Anesth Analg"},{"issue":"2","key":"3423_CR25","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1053\/j.jvca.2007.12.016","volume":"22","author":"GA Nuttall","year":"2008","unstructured":"Nuttall GA, Gutierrez MC, Dewey JD, Johnson ME, Oyen LJ, Hanson AC, et al. A preliminary study of a new Tranexamic acid dosing schedule for cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22(2):230\u20135. https:\/\/doi.org\/10.1053\/j.jvca.2007.12.016.","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"4","key":"3423_CR26","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1046\/j.1365-2710.2002.00430.x","volume":"27","author":"AK Wagner","year":"2002","unstructured":"Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299\u2013309. https:\/\/doi.org\/10.1046\/j.1365-2710.2002.00430.x.","journal-title":"J Clin Pharm Ther"},{"issue":"1","key":"3423_CR27","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1093\/ije\/dyw098","volume":"46","author":"JL Bernal","year":"2017","unstructured":"Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348\u201355. https:\/\/doi.org\/10.1093\/ije\/dyw098.","journal-title":"Int J Epidemiol"},{"issue":"1","key":"3423_CR28","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.athoracsur.2022.07.037","volume":"115","author":"BL Shou","year":"2023","unstructured":"Shou BL, Aravind P, Ong CS, Alejo D, Canner JK, Etchill EW, et al. Early reexploration for bleeding is associated with improved outcome in cardiac surgery. Ann Thorac Surg. 2023;115(1):232\u20139. https:\/\/doi.org\/10.1016\/j.athoracsur.2022.07.037.","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"3423_CR29","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/j.athoracsur.2023.04.038","volume":"117","author":"BL Shou","year":"2024","unstructured":"Shou BL, Schena S. Early reexploration for postoperative bleeding in cardiac surgery is beneficial regardless of bleeding site, even when undetectable. Ann Thorac Surg. 2024;117(2):484. https:\/\/doi.org\/10.1016\/j.athoracsur.2023.04.038.","journal-title":"Ann Thorac Surg"},{"key":"3423_CR30","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1111\/j.1528-1157.1982.tb05051.x","volume":"23","author":"A Pellegrini","year":"1982","unstructured":"Pellegrini A, Giaretta D, Chemello R, Zanotto L, Testa G. Feline generalized epilepsy induced by Tranexamic acid (AMCA). Epilepsia. 1982;23:35\u201345. https:\/\/doi.org\/10.1111\/j.1528-1157.1982.tb05051.x.","journal-title":"Epilepsia"},{"key":"3423_CR31","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1124\/jpet.301.1.168","volume":"301","author":"R Furtmuller","year":"2002","unstructured":"Furtmuller R, Schlag MG, Berger M, Hopf R, Huck S, Sieghart W, et al. Tranexamic acid, a widely used antifibrinolytic agent, causes convulsions by a gamma-aminobutyric acid(A) receptor antagonistic effect. J Pharmacol Exp Ther. 2002;301:168\u201373. https:\/\/doi.org\/10.1124\/jpet.301.1.168.","journal-title":"J Pharmacol Exp Ther"},{"key":"3423_CR32","doi-asserted-by":"publisher","first-page":"4654","DOI":"10.1172\/JCI63375","volume":"122","author":"I Lecker","year":"2012","unstructured":"Lecker I, Wang DS, Romaschin AD, Peterson M, Mazer CD, Orser BA. Tranexamic acid concentrations associated with human seizures inhibit Glycine receptors. J Clin Invest. 2012;122:4654\u201366. https:\/\/doi.org\/10.1172\/JCI63375.","journal-title":"J Clin Invest"},{"key":"3423_CR33","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1053\/j.jvca.2010.10.007","volume":"25","author":"K Martin","year":"2011","unstructured":"Martin K, Knorr J, Breuer T, Gertler R, Macguill M, Lange R, et al. Seizures after open heart surgery: comparison of epsilon-aminocaproic acid and Tranexamic acid. J Cardiothorac Vasc Anesth. 2011;25:20\u20135. https:\/\/doi.org\/10.1053\/j.jvca.2010.10.007.","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"3423_CR34","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1213\/ane.0b013e318184bc20","volume":"107","author":"K Martin","year":"2008","unstructured":"Martin K, Wiesner G, Breuer T, Lange R, Tassani P. The risks of aprotinin and tranexamic acid in cardiac surgery: a one-year follow-up of 1188 consecutive patients. Anesth Analg. 2008;107:1783\u201390. https:\/\/doi.org\/10.1213\/ane.0b013e318184bc20.","journal-title":"Anesth Analg"},{"key":"3423_CR35","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1093\/bja\/aes310","volume":"110","author":"A Koster","year":"2013","unstructured":"Koster A, Borgermann J, Zittermann A, Lueth JU, Gillis-Januszewski T, Schirmer U. Moderate dosage of tranexamic acid during cardiac surgery with cardiopulmonary bypass and convulsive seizures: incidence and clinical outcome. Br J Anaesth. 2013;110:34\u201340. https:\/\/doi.org\/10.1093\/bja\/aes310.","journal-title":"Br J Anaesth"},{"key":"3423_CR36","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1213\/ANE.0b013e3181c92b23","volume":"110","author":"JM Murkin","year":"2010","unstructured":"Murkin JM, Falter F, Granton J, Young B, Burt C, Chu M. High-dose tranexamic acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg. 2010;110:350\u20133. https:\/\/doi.org\/10.1213\/ANE.0b013e3181c92b23.","journal-title":"Anesth Analg"},{"issue":"3","key":"3423_CR37","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1053\/j.jvca.2008.09.018","volume":"23","author":"RJ Taghaddomi","year":"2009","unstructured":"Taghaddomi RJ, Mirzaee A, Attar AS, Shirdel A. Tranexamic acid reduces blood loss in off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2009;23(3):312\u20135. https:\/\/doi.org\/10.1053\/j.jvca.2008.09.018.","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"3423_CR38","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1213\/ANE.0b013e3182264a11","volume":"115","author":"G Wang","year":"2012","unstructured":"Wang G, Xie G, Jiang T, Wang Y, Wang W, Ji H, et al. Tranexamic acid reduces blood loss after off-pump coronary surgery: a prospective, randomized, double-blind, placebo-controlled study. Anesth Analg. 2012;115:239\u201343. https:\/\/doi.org\/10.1213\/ANE.0b013e3182264a11.","journal-title":"Anesth Analg"}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-025-03423-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12871-025-03423-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-025-03423-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T13:08:21Z","timestamp":1762520901000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcanesthesiol.biomedcentral.com\/articles\/10.1186\/s12871-025-03423-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,7]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3423"],"URL":"https:\/\/doi.org\/10.1186\/s12871-025-03423-1","relation":{},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,7]]},"assertion":[{"value":"11 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The protocol for this retrospective before-and-after study was approved by the Institutional Review Board of Seoul National University Hospital (approval no. H-2406-022-1540) on June 10, 2024. The requirement for written informed consent was waived due to the de-identified nature of the study. This study was conducted in accordance with the principles outlined in the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"550"}}