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Chaudhry H, Ekhtiari S, Ravi B, Wadey V, Tomescu S, Murnaghan J, Mundi R. Sex-specific differences in 30-day outcomes following primary total hip replacement in 86,684 patients. Hip Int 2023; 33:828-832. [PMID: 35836327 DOI: 10.1177/11207000221110786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Although differential outcomes based on sex are widespread in medicine and surgery, evaluation of sex-specific differences in the field of orthopaedic surgery in general - and arthroplasty in particular - are lacking. We hypothesised that morbidly obese male and female patients would have differing risks of surgical complications following primary total hip replacement. METHODS We reviewed data contained within the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database from 2015 through 2018, inclusive. A multivariable binary logistic regression model was used to determine the adjusted odds ratios (OR) of relevant variables on primary and secondary outcomes. RESULTS A total of 86,684 patients undergoing THR were identified, of whom 9972 patients (4095 male and 5877 female) were morbidly obese. Among morbidly obese patients, odds of surgical site infection were higher in females than males within 30 days of surgery (adjusted OR 1.40; 95% CI, 1.10-1.79; p = 0.007). This comprised the odds of both superficial infection (1.8% vs. 1.1%, adjusted OR 1.67; 95% CI, 1.16-2.40; p = 0.006) and deep infection (1.9% vs. 1.4%, adjusted OR 1.22; 95% CI, 0.88-1.68; p = 0.24). Unexpected return to the operating room (i.e., reoperation) within 30 days of the surgical procedure was also higher among females than males (4.2% vs. 3.1%, adjusted OR 1.38, 95% CI, 1.10-1.71, p = 0.005). There were no differences between male and female patients in the non-obese cohort. CONCLUSIONS Among patients with morbid obesity, the risk of surgical site infection and reoperation within the first 30 days is greater in women as compared to men. Future research must address whether this early increased risk among morbidly obese women persists in the longer term, and whether it results in compromised function or quality of life.
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Affiliation(s)
- Harman Chaudhry
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, ON, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, ON, Canada
| | - Veronica Wadey
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, ON, Canada
| | - Sebastian Tomescu
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, ON, Canada
| | - John Murnaghan
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, ON, Canada
| | - Raman Mundi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, ON, Canada
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Kikuchi H, Endo H, Yamamoto H, Ozawa S, Miyata H, Kakeji Y, Matsubara H, Doki Y, Kitagawa Y, Takeuchi H. Impact of Reconstruction Route on Postoperative Morbidity After Esophagectomy: Analysis of Esophagectomies in the Japanese National Clinical Database. Ann Gastroenterol Surg 2022; 6:46-53. [PMID: 35106414 PMCID: PMC8786683 DOI: 10.1002/ags3.12501] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/10/2021] [Accepted: 08/22/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Esophagectomy followed by gastric conduit reconstruction is a standard surgical procedure for esophageal cancer. However, there is no evidence of the superiority or inferiority of the posterior mediastinal (PM) versus the retrosternal (RS) reconstruction route with regard to short-term outcomes after esophagectomy. We aimed to elucidate whether the reconstruction route can affect the short-term outcomes after esophagectomy followed by gastric conduit reconstruction. METHODS We reviewed the clinical data of patients who underwent esophagectomy between 2016 and 2018 from the Japanese National Clinical Database. This study included 9786 patients who underwent gastric conduit reconstruction through the PM or RS route with cervical anastomosis. RESULTS Of the 9786 patients analyzed, 3478 and 6308 underwent gastric conduit reconstruction thorough the PM and RS routes, respectively. The incidence of anastomotic leak and surgical site infection (SSI) was significantly lower in the PM group than in the RS group (11.7% vs 13.8%, P = .005 and 8.4% vs 14.9%, P < .001, respectively), while the incidence of pneumonia was higher in the PM group (13.7% vs 12.2%, P = .040). Generalized estimating equation logistic regression analysis revealed a higher risk of anastomotic leak and SSI (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.15-1.51; P < .001 and OR, 2.06; 95% CI, 1.78-2.38; P < .001, respectively) and a lower risk of pneumonia (OR, 0.86; 95% CI, 0.75-0.98; P = .028) in the RS group than in the PM group. CONCLUSION The findings of this study will help surgeons to design the reconstruction route following esophagectomy.
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Affiliation(s)
- Hirotoshi Kikuchi
- Department of SurgeryHamamatsu University School of MedicineHamamatsuJapan
| | - Hideki Endo
- Department of Healthcare Quality AssessmentThe University of TokyoTokyoJapan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality AssessmentThe University of TokyoTokyoJapan
| | - Soji Ozawa
- Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
| | - Hiroaki Miyata
- Department of Healthcare Quality AssessmentThe University of TokyoTokyoJapan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of MedicineKobe UniversityKobeJapan
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hisahiro Matsubara
- Department of Frontier SurgeryChiba University Graduate School of MedicineChibaJapan
- The Japan Esophageal SocietyTokyoJapan
| | - Yuichiro Doki
- The Japan Esophageal SocietyTokyoJapan
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Yuko Kitagawa
- Department of SurgeryKeio University School of MedicineTokyoJapan
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroya Takeuchi
- Department of SurgeryHamamatsu University School of MedicineHamamatsuJapan
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Liu JY, Sharma J. Application of the ACS NSQIP Surgical Risk Calculator on a global scale. Am J Surg 2021; 222:876. [PMID: 34565517 DOI: 10.1016/j.amjsurg.2021.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Jessica Y Liu
- Department of Surgery, Emory University, Atlanta, GA, USA.
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Marubashi S, Takahashi A, Kakeji Y, Hasegawa H, Ueno H, Eguchi S, Endo I, Goi T, Saiura A, Sasaki A, Takiguchi S, Takeuchi H, Tanaka C, Hashimoto M, Hiki N, Horiguchi A, Masaki T, Yoshida K, Gotoh M, Konno H, Yamamoto H, Miyata H, Seto Y, Kitagawa Y. Surgical outcomes in gastroenterological surgery in Japan: Report of the National Clinical Database 2011-2019. Ann Gastroenterol Surg 2021; 5:639-658. [PMID: 34585049 PMCID: PMC8452469 DOI: 10.1002/ags3.12462] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND We aimed to present the 2019 annual report of the gastroenterological section of the National Clinical Database (NCD). METHODS We reviewed 609,589 cases recorded in 2019 and 5,029,764 cases registered from 2011 to 2019 for the 115 selected gastroenterological surgical procedures. RESULTS The main features of gastroenterological surgery in Japan were similar to those described in the 2018 annual report, namely, that 1) operative numbers gradually increased in all procedures, except gastrectomy and hepatectomy, which decreased in these years; 2) in all eight major gastroenterological surgeries, the age distribution tended toward older patients; 3) the morbidity of esophagectomy, hepatectomy, and pancreaticoduodenectomy increased, but mortality was minimized in all procedures; 4) all eight major gastroenterological procedures have increasingly been performed under laparoscopy; and 5) board-certified surgeons were increasingly involved. These trends in recent years were more prominent in 2019. CONCLUSIONS Thanks to the continuous cooperation and dedication of the surgeons, medical staff, and surgical clinical reviewers who registered the clinical data into the NCD, it is possible to understand the comprehensive landscape of surgery in Japan and to disclose new evidence in this field. The Japanese Society of Gastroenterological Surgery will continue to promote the value of this database and encourage the use of feedback and clinical studies using the NCD, now and in the future. Generating further approaches to surgical quality improvement are important directions for future research.
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Affiliation(s)
| | - Arata Takahashi
- Department of Health Policy and ManagementSchool of MedicineKeio UniversityTokyoJapan
- Department of Healthcare Quality Assessment Graduate School of MedicineThe University of TokyoTokyoJapan
| | | | | | - Hideki Ueno
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Susumu Eguchi
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Itaru Endo
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Takanori Goi
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Akio Saiura
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Akira Sasaki
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Shuji Takiguchi
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroya Takeuchi
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Chie Tanaka
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | | | - Naoki Hiki
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | | | - Tadahiko Masaki
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | | | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroyuki Yamamoto
- Department of Health Policy and ManagementSchool of MedicineKeio UniversityTokyoJapan
- Department of Healthcare Quality Assessment Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroaki Miyata
- Department of Health Policy and ManagementSchool of MedicineKeio UniversityTokyoJapan
- Department of Healthcare Quality Assessment Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
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Takahashi A, Yamamoto H, Kakeji Y, Marubashi S, Gotoh M, Seto Y, Miyata H. Estimates of the effects of centralization policy for surgery in Japan: does centralization affect the quality of healthcare for esophagectomies? Surg Today 2021; 51:1010-1019. [PMID: 33660105 DOI: 10.1007/s00595-021-02245-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/17/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE This study compared the quality of healthcare before and after implementation of a policy restructuring the healthcare delivery system and estimated the impact of centralization. METHODS We used the National Clinical Database to study patients undergoing esophagectomies from 2011 to 2016. We compared the effect of centralization based on the patient background, surgical mortality, and year of surgery. Difference-in-difference methods based on the generalized estimating equation logistic regression model were used for before-and-after comparisons after adjusting for patient-level expected surgical mortality. RESULTS In total, 34,640 cases were identified. More cases with risk factors were noted in ultra-low-volume hospitals, where 38.4% of cases in underpopulated areas were treated, than in higher volume facilities, and the operative mortality, readmission within 30 days and length of stay were worse among patients treated in these hospitals. In centralized prefectures, the number of cases per hospital increased over time (7.2 in 2011 to 9.5 in 2016) while the crude operative mortality tended to decrease (3.4% in 2011 to 1.8% in 2016). The difference-in-difference estimator was 0.856 (95% confidence interval: 0.639-1.147, p = 0.298). CONCLUSION The centralization of ultra-low-volume hospitals did not lead to a deterioration in the quality of care but rather an improving trend.
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Affiliation(s)
- Arata Takahashi
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan.,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Yamamoto
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan.,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Kakeji
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan. .,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Geriatric Risk Prediction Models for Major Gastroenterological Surgery using the National Clinical Database in Japan: A Multicenter Prospective Cohort Study. Ann Surg 2020; 275:1112-1120. [PMID: 33065635 DOI: 10.1097/sla.0000000000004308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the effect of geriatric variables on five newly added outcomes and create risk models for predicting these outcomes. SUMMARY BACKGROUND DATA Because there is a current lack of geriatric research focusing on geriatric outcomes using a national surgical database in Japan, there is a need to investigate outcomes associated with major gastroenterological surgery using these data. METHODS This multicenter prospective cohort study was conducted at 26 surgery departments across 21 institutions in Japan using the National Clinical Database (NCD) surgical registry. In total, 22 new geriatric variables were imported from the ACS NSQIP geriatric pilot study. The following five geriatric outcomes were defined: 1) postoperative delirium, 2) physical function on postoperative day 30, 3) fall risk on discharge, 4) discharge other than home with social service, and 5) functional decline on discharge, and geriatric risk prediction models for major gastroenterological surgery were created. RESULTS Between January 2018 and December 2018, data on 3,981 procedures from seven major gastroenterological surgeries were collected and analyzed. Older age and preoperative geriatric variables (Origin status from home, History of dementia, Use of mobility aid, Fall history, and Not competent on admission) were strongly associated with postoperative outcomes. Geriatric risk prediction models for these outcomes were created, with C-statistic values ranging from 0.74 to 0.90, demonstrating model validity and sufficiency of fit. CONCLUSIONS The risk models for the newly defined five geriatric outcomes that we created can be used in the decision-making process or provision of care in geriatric patients.
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Kakeji Y, Yamamoto H, Ueno H, Eguchi S, Endo I, Sasaki A, Takiguchi S, Takeuchi H, Hashimoto M, Horiguchi A, Masaki T, Marubashi S, Yoshida K, Miyata H, Konno H, Gotoh M, Kitagawa Y, Mori M, Seto Y. Development of gastroenterological surgery over the last decade in Japan: analysis of the National Clinical Database. Surg Today 2020; 51:187-193. [PMID: 32681353 DOI: 10.1007/s00595-020-02075-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022]
Abstract
The National Clinical Database (NCD) of Japan was established in 2010 with the board certification system. A joint committee of 16 gastroenterological surgery database-affiliated organizations has been nurturing this nationwide database and utilizing its data for various analyses. Stepwise board certification systems have been validated by the NCD and are used to improve the surgical outcomes of patients. The use of risk calculators based on risk models can be particularly helpful for establishing appropriate and less invasive surgical treatments for individual patients. Data obtained from the NCD reflect current developments in the surgical approaches used in hospitals, which have progressed from open surgery to endoscopic and robot-assisted procedures. An investigation of the data acquired by the NCD could answer some relevant clinical questions and lead to better surgical management of patients. Furthermore, excellent surgical outcomes can be achieved through international comparisons of the national databases worldwide. This review examines what we have learned from the NCD of gastroenterological surgery and discusses what future developments we can expect.
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Affiliation(s)
- Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan.
- National Clinical Database, Tokyo, Japan.
| | - Hiroyuki Yamamoto
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Hideki Ueno
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Susumu Eguchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Itaru Endo
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Akira Sasaki
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Shuji Takiguchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Hiroya Takeuchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Masaji Hashimoto
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Akihiko Horiguchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Tadahiko Masaki
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Shigeru Marubashi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Kazuhiro Yoshida
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Hiroaki Miyata
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Hiroyuki Konno
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Mitsukazu Gotoh
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Yuko Kitagawa
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
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Kakeji Y, Takahashi A, Hasegawa H, Ueno H, Eguchi S, Endo I, Sasaki A, Takiguchi S, Takeuchi H, Hashimoto M, Horiguchi A, Masaki T, Marubashi S, Yoshida K, Gotoh M, Konno H, Yamamoto H, Miyata H, Seto Y, Kitagawa Y. Surgical outcomes in gastroenterological surgery in Japan: Report of the National Clinical Database 2011-2018. Ann Gastroenterol Surg 2020; 4:250-274. [PMID: 32490340 PMCID: PMC7240139 DOI: 10.1002/ags3.12324] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/24/2020] [Indexed: 12/23/2022] Open
Abstract
The National Clinical Database (NCD) of Japan grew rapidly, harvesting over 11 million cases of data between 2011 and 2018 from more than 5000 facilities. This is the Report of the NCD based upon gastrointestinal surgery information in 4 420 175 cases from 2011 to 2018. More than 70% of all gastrointestinal surgeries were performed at certified institutions, and the percentage of surgeries performed at certified institutions was particularly high for the esophagus (93.8% in 2018), liver (89.4%), pancreas (91.3%), and spleen (86.9%). Also, more than 70% of the surgeries were performed with the participation of the board-certified surgeon. As the patients have been getting older, the morbidities have been increasing. However, the mortalities have been kept at a low level. The rates of endoscopic surgery have been increasing year by year, especially high in low anterior resection (67.0%) and esophagectomy (61.0%). Nationwide, this database is surely expecting to ensure the quality of board certification system and surgical outcomes in gastroenterological surgery.
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Affiliation(s)
| | - Arata Takahashi
- Department of Health Policy and Management School of Medicine Keio University Tokyo Japan
- Department of Healthcare Quality Assessment Graduate School of Medicine The University of Tokyo Tokyo Japan
| | | | - Hideki Ueno
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Susumu Eguchi
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Itaru Endo
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Akira Sasaki
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Shuji Takiguchi
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Hiroya Takeuchi
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | | | | | - Tadahiko Masaki
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | | | | | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Hiroyuki Yamamoto
- Department of Health Policy and Management School of Medicine Keio University Tokyo Japan
- Department of Healthcare Quality Assessment Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management School of Medicine Keio University Tokyo Japan
- Department of Healthcare Quality Assessment Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
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Seto Y. National Clinical Database (NCD) shows the trend for centralization of major surgery: Should it depend on hospital or surgeon volume ? Ann Gastroenterol Surg 2019; 3:340-342. [PMID: 31346571 PMCID: PMC6635685 DOI: 10.1002/ags3.12274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- Yasuyuki Seto
- Department of Gastrointestinal SurgeryThe University of TokyoTokyoJapan
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