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Sato N, Hirakawa S, Marubashi S, Tachimori H, Oshikiri T, Miyata H, Kakeji Y, Kitagawa Y. Predicting surgical outcomes of acute diffuse peritonitis: Updated risk models based on real-world clinical data. Ann Gastroenterol Surg 2024; 8:711-727. [PMID: 38957554 PMCID: PMC11216787 DOI: 10.1002/ags3.12800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/22/2024] [Accepted: 03/17/2024] [Indexed: 07/04/2024] Open
Abstract
Aim The existing predictive risk models for the surgical outcome of acute diffused peritonitis (ADP) need renovation by adding relevant variables such as ADP's definition or causative etiology to pursue outstanding data collection reflecting the real world. We aimed to revise the risk models predicting mortality and morbidities of ADP using the latest Japanese Nationwide Clinical Database (NCD) variable set. Methods Clinical dataset of ADP patients who underwent surgery, and registered in the NCD between 2016 and 2019, were used to develop a risk model for surgical outcomes. The primary outcome was perioperative mortality. Results After data cleanup, 45 379 surgical cases for ADP were derived for analysis. The perioperative and 30-day mortality were 10.6% and 7.2%, respectively. The prediction models have been created for the mortality and 10 morbidities associated with the mortality. The top five relevant predictors for perioperative mortality were age >80, advanced cancer with multiple metastases, platelet count of <50 000/mL, serum albumin of <2.0 g/dL, and unknown ADP site. The C-indices of perioperative and 30-day mortality were 0.859 and 0.857, respectively. The predicted value calculated with the risk models for mortality was highly fitted with the actual probability from the lower to the higher risk groups. Conclusions Risk models for postoperative mortality and morbidities with good predictive performance and reliability were revised and validated using the recent real-world clinical dataset. These models help to predict ADP surgical outcomes accurately and are available for clinical settings.
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Affiliation(s)
- Naoya Sato
- Department of Hepato–Biliary–Pancreatic and Transplant SurgeryFukushima Medical UniversityFukushimaJapan
| | - Shinya Hirakawa
- Endowed Course for Health System InnovationKeio University School of MedicineTokyoJapan
- Department of Healthcare Quality Assessment, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Shigeru Marubashi
- Department of Hepato–Biliary–Pancreatic and Transplant SurgeryFukushima Medical UniversityFukushimaJapan
| | - Hisateru Tachimori
- Endowed Course for Health System InnovationKeio University School of MedicineTokyoJapan
- Department of Healthcare Quality Assessment, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Taro Oshikiri
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of MedicineThe University of TokyoTokyoJapan
- Department of Health Policy and ManagementKeio University School of MedicineTokyoJapan
| | - Yoshihiro Kakeji
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
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2
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Endo I, Takahashi A, Tachimori H, Miyata H, Homma Y, Kumamoto T, Matsuyama R, Kakeji Y, Kitagawa Y, Seto Y. Requirements for hospitals in Japan to have low operative mortality and failure-to-rescue rates. Ann Gastroenterol Surg 2024; 8:342-355. [PMID: 38455494 PMCID: PMC10914696 DOI: 10.1002/ags3.12745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 03/09/2024] Open
Abstract
Aim We explored institutional factors in Japan associated with lower operative mortality and failure-to-rescue (FTR) rates for eight major gastrointestinal procedures. Methods A 22-item online questionnaire was sent to 2119 institutional departments (IDs) to examine the association between institutional factors and operative mortality and FTR rates. IDs were classified according to the number of annual surgeries, board certification status, and locality. In addition, the top 20% and bottom 20% of IDs were identified based on FTR rates and matched with the results of the questionnaire survey. Factors associated with operative mortality were selected by multivariate analysis. Results Of the 1083 IDs that responded to the questionnaire, 568 (213 382 patients) were included in the analysis. Operative morbidity, operative mortality, and FTR rates in the top 20% and bottom 20% of IDs were 13.1% and 8.4% (p < 0.001), 0.52% and 4.3% (p < 0.001), and 4.0% and 51.2% (p < 0.001), respectively. Based on the patients' background characteristics, the top 20% of IDs handled more advanced cases. No significant difference in locality was seen between better or worse hospital FTR rates, but fewer esophagectomies, hepatectomies, and pancreatoduodenectomies were performed in depopulated areas. Six items were found to be associated with operative mortality by multivariate logistic analysis. Only 50 (8.8%) IDs met all five factors related to better FTR rates. Conclusions The present findings indicate that several hospital factors surrounding surgical treatment, characterized by abundant human resources, are closely related to better postoperative recovery from severe complications.
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Affiliation(s)
- Itaru Endo
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
- Department of Gastroenterological SurgeryYokohama City UniversityYokohamaJapan
| | - Arata Takahashi
- Department of Health Policy and Management, School of MedicineKeio UniversityTokyoJapan
| | | | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yuki Homma
- Department of Gastroenterological SurgeryYokohama City UniversityYokohamaJapan
| | - Takafumi Kumamoto
- Department of Gastroenterological SurgeryYokohama City UniversityYokohamaJapan
| | - Ryusei Matsuyama
- Department of Gastroenterological SurgeryYokohama City UniversityYokohamaJapan
| | | | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
- National Clinical DatabaseTokyoJapan
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3
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Kajiwara Y, Takahashi A, Ueno H, Kakeji Y, Hasegawa H, Eguchi S, Goi T, Saiura A, Sasaki A, Takiguchi S, Takeuchi H, Tanaka C, Hashimoto M, Hiki N, Horiguchi A, Matsuda S, Mizushima T, Marubashi S, Gotoh M, Konno H, Yamamoto H, Miyata H, Seto Y, Kitagawa Y. Annual report on National Clinical Database 2020 for gastroenterological surgery in Japan. Ann Gastroenterol Surg 2023; 7:367-406. [PMID: 37152776 PMCID: PMC10154850 DOI: 10.1002/ags3.12662] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 04/04/2023] Open
Abstract
Aim The National Clinical Database (NCD) of Japan is a nationwide data entry system for surgery, and it marked its 10th anniversary in 2020. The aim was to present the 2020 annual report of gastroenterological surgery of the NCD. Methods The data of the surgical procedures stipulated by the training curriculum for board-certified surgeons of the Japanese Society of Gastroenterological Surgery in the NCD from 2011 to 2020 were summarized. Results In total, 5 622 845 cases, including 593 088 cases in 2020, were extracted from the NCD. The total number of gastroenterological surgeries increased gradually in these 10 years, except for the year 2020 due to the COVID-19 pandemic. The annual number of surgeries of each organ, except the pancreas and liver, decreased by 0.4%-13.1% in 2020 compared to 2019. The surgical patients were consistently aging, with more than 20% of all gastroenterological surgeries in 2020 involving patients aged 80 years or older. The participation of board-certified surgeons increased for each organ (75.9%-95.7% in 2020). The rates of endoscopic surgery also increased constantly. Although the incidences of postoperative complications of each organ increased by 0.7%-7.9% in these 10 years, postoperative mortality rates decreased by 0.2%-1.5%. Conclusions We present here the short-term outcomes of each gastroenterological operative procedure in 2020. This review of the 10-years of NCD data of gastroenterological surgery revealed a consistent increase of the number of surgeries (except for in 2020), especially endoscopic procedures, and aging of the Japanese population. The good safety of Japanese gastroenterological surgeries was also indicated.
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Affiliation(s)
| | - Arata Takahashi
- Department of Health Policy and Management, School 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
| | - 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
| | | | - Satoru Matsuda
- 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 Management, School of MedicineKeio UniversityTokyoJapan
- Department of Healthcare Quality Assessment Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroaki Miyata
- Department of Health Policy and Management, School 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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4
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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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5
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Arita J, Yamamoto H, Kokudo T, Hasegawa K, Miyata H, Toh Y, Gotoh M, Kokudo N, Kakeji Y, Seto Y. Impact of board certification system and adherence to the clinical practice guidelines for liver cancer on post-hepatectomy risk-adjusted mortality rate in Japan: A questionnaire survey of departments registered with the National Clinical Database. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:801-811. [PMID: 34043880 PMCID: PMC8597098 DOI: 10.1002/jhbp.1000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/05/2021] [Accepted: 05/19/2021] [Indexed: 12/11/2022]
Abstract
Background It is unclear to what extent a board certification system and implementation of clinical guidelines improves the quality of hepatectomy. Methods A web‐based questionnaire survey was administered to departments registered with the National Clinical Database (NCD) in Japan between 1 October 2014 and 31 January 2015. Quality indicators (QIs), including affiliations with academic societies, numbers of board‐certified doctors affiliated with each institute, and adherence to clinical practice guidelines for hepatocellular carcinoma, were evaluated by calculating risk‐adjusted odds ratios (AORs) for 90‐day postoperative mortality of patients who had undergone hepatectomy in 2013 and 2014. Results Of 1255 departments that had registered at least one hepatectomy in NCD, 592 departments, performing 8601 hepatectomies in total, responded to the questionnaire. AORs were significantly lower in departments that were certified as training hospitals by the Japanese Society of Gastroenterological Society, Japanese Society of Hepato‐Biliary‐Pancreatic Surgery (JSHBPS), and Japan Society of Hepatology than in non‐certified departments. Affiliation of three or more JSHBPS‐certified experts or instructors with an institution also contributed to low AORs. None of the QIs regarding implementation of guidelines significantly impacted on the AOR. Conclusions Quality indicator measurements may improve quality of post‐hepatectomy outcomes in Japan.
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Affiliation(s)
- Junichi Arita
- Liver Cancer Study Group of Japan, Japan Society of Hepatology, Tokyo, Japan.,The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.,Hepato-Biliary and Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Yamamoto
- National Clinical Database, Tokyo, Japan.,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Kokudo
- Liver Cancer Study Group of Japan, Japan Society of Hepatology, Tokyo, Japan.,The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.,Hepato-Biliary and Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Liver Cancer Study Group of Japan, Japan Society of Hepatology, Tokyo, Japan.,The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.,Hepato-Biliary and Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- National Clinical Database, Tokyo, Japan.,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Yasushi Toh
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.,National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.,Osaka General Medical Center, Osaka, Japan
| | - Norihiro Kokudo
- Liver Cancer Study Group of Japan, Japan Society of Hepatology, Tokyo, Japan.,The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.,National Center for Global health and Medicine, Tokyo, Japan
| | - Yoshihiro Kakeji
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.,Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.,National Clinical Database, Tokyo, Japan.,Gastrointestinal Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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6
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Konno H, Kamiya K, Takahashi A, Kumamaru H, Kakeji Y, Marubashi S, Hakamada K, Miyata H, Seto Y. Profiles of institutional departments affect operative outcomes of eight gastroenterological procedures. Ann Gastroenterol Surg 2021; 5:304-313. [PMID: 34095720 PMCID: PMC8164461 DOI: 10.1002/ags3.12431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/25/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
AIM We evaluated the association of profiles of institutional departments with operative outcomes of eight major gastroenterological procedures. METHODS We administered a 15-item online survey to 2634 institutional departments in 2016 to investigate the association of questionnaire responses with operative mortality for the procedures. The proportions of conditions met were listed according to institutional volume and classified according to annual operative cases in 1464 departments. Group A included departments with annual performance of <40 cases of the eight procedures, B 40-79 cases, C 80-199 cases, D 200-499 cases, and E ≥ 500 cases. We evaluated the number of conditions met for 10 of 15 items that could be improved by efforts of institutional departments, to assess whether the profiles of institutional departments had impacts on operative mortality. We built a multivariable logistic regression model for operative mortality with facilities categorized based on the number of conditions met and procedure-specific predicted mortality as explanatory variables using generalized estimating equation to account for facility-level clustering. We also examined how operative outcomes differed between facilities meeting nine or more conditions and those that did not. RESULTS We recognized meeting nine out of the 10 conditions as being a good indicator for having appropriate structural and process measures for gastroenterological surgery. The facilities meeting nine or more of the conditions had better operative mortality for all eight procedures. CONCLUSIONS Our findings reveal that the profiles of institutional departments can reflect the outcomes of gastroenterological surgery in Japan.
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Affiliation(s)
- Hiroyuki Konno
- The Japanese Society of Gastroenterological SurgeryDatabase CommitteeTokyoJapan
- Hamamatsu University School of MedicineHamamatsuJapan
| | - Kinji Kamiya
- Second Department of SurgeryHamamatsu University School of MedicineHamamatsuJapan
| | - Arata Takahashi
- Department of Health Policy and ManagementSchool of MedicineKeio UniversityTokyoJapan
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiraku Kumamaru
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yoshihiro Kakeji
- The Japanese Society of Gastroenterological SurgeryDatabase CommitteeTokyoJapan
| | - Shigeru Marubashi
- The Japanese Society of Gastroenterological SurgeryDatabase CommitteeTokyoJapan
| | | | - Hiroaki Miyata
- Department of Health Policy and ManagementSchool of MedicineKeio UniversityTokyoJapan
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
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7
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Hasegawa H, Takahashi A, Kanaji S, Kakeji Y, Marubashi S, Konno H, Gotoh M, Miyata H, Kitagawa Y, Seto Y. Validation of data quality in a nationwide gastroenterological surgical database: The National Clinical Database site-visit and remote audits, 2016-2018. Ann Gastroenterol Surg 2021; 5:296-303. [PMID: 34095719 PMCID: PMC8164453 DOI: 10.1002/ags3.12419] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND AIM In 2015, the Japanese Society of Gastroenterological Surgery (JSGS) initiated data verification in the gastroenterological section of the National Clinical Database (NCD) and reported high accuracy of data entry. Remote audits were introduced for data validation on a trial basis in 2016 and formally accepted into use in 2017-2018. The aim of this study was to audit the data quality of the NCD gastroenterological section for 2016-2018 and to confirm the high accuracy of data in remote audits. METHODS Each year, 45-46 hospitals were selected for audit. Twenty cases were randomly selected in each hospital, and the accuracy of patient demographic and surgical outcome data (46 items) was compared with the corresponding medical records obtained by visiting the hospital (site-visit audit) or by mailing data from the hospital to the JSGS office (remote audit). RESULTS A total of 136 hospitals were included, of which 88 (64.7%) had a remote audit, and 124 936 items were evaluated with an overall data accuracy of 98.1%. There was no significant difference in terms of data accuracy between site-visit audit and remote audit. Accuracy, sensitivity, and specificity of mortality were 99.7%, 89.7%, 100% for site-visit audits and 99.8%, 97.3%, 100% for remote audits, respectively. Mean time spent on data verification per case of remote audits was shorter than that of site-visit audits (10.0 minutes vs 13.7 minutes, P < 0.001). CONCLUSION The audits showed that NCD data are reliable and characterized by high accuracy. Remote audits may substitute site-visit audits.
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Affiliation(s)
- Hiroshi Hasegawa
- NCD Data Quality Management SubcommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Arata Takahashi
- NCD Data Quality Management SubcommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
- Department of Health Policy and ManagementSchool of MedicineKeio UniversityTokyoJapan
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Shingo Kanaji
- NCD Data Quality Management SubcommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Yoshihiro Kakeji
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Shigeru Marubashi
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroaki Miyata
- Department of Health Policy and ManagementSchool of MedicineKeio UniversityTokyoJapan
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
- National Clinical DatabaseTokyoJapan
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8
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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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Impact of a board certification system and implementation of clinical practice guidelines for pancreatic cancer on mortality of pancreaticoduodenectomy. Surg Today 2020; 50:1297-1307. [PMID: 32382777 PMCID: PMC7501122 DOI: 10.1007/s00595-020-02017-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/14/2020] [Indexed: 12/19/2022]
Abstract
Purposes The aim of this study was to clarify the impact of a board certification system and the implementation of clinical practice guidelines for pancreatic cancer (PC) on the mortality of pancreaticoduodenectomy in Japan. Methods By a web questionnaire survey via the National Clinical Database (NCD) for departments participating in the NCD, quality indicators (QIs) related to the treatment for PC, namely the board certification systems of various societies and the adherence to clinical practice guidelines for PC, were investigated between October 2014 and January 2015. A multivariable logistic regression analysis was performed to evaluate the relationship between the QIs and mortality of pancreaticoduodenectomy. Results Of 1415 departments that registered at least 1 pancreaticoduodenectomy between 2013 and 2014 in NCD, 631 departments (44.6%), which performed pancreaticoduodenectomy for a total of 11,684 cases, answered the questionnaire. The mortality of pancreaticoduodenectomy was positively affected by the board certification systems of the Japanese Society of Gastroenterological Surgery, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Japanese Society of Gastroenterology, and Japanese Society of Medical Oncology as well as by institutions that used magnetic resonance imaging of ≥ 3 T for the diagnosis of PC in principle. Conclusions The measurement of the appropriate QIs is suggested to help improve the mortality in pancreaticoduodenectomy. Masamichi Mizuma and Hiroyuki Yamamoto equally contributed
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Kobayashi H, Yamamoto H, Miyata H, Gotoh M, Kotake K, Sugihara K, Toh Y, Kakeji Y, Seto Y. Impact of adherence to board-certified surgeon systems and clinical practice guidelines on colon cancer surgical outcomes in Japan: A questionnaire survey of the National Clinical Database. Ann Gastroenterol Surg 2020; 4:283-293. [PMID: 32490342 PMCID: PMC7240142 DOI: 10.1002/ags3.12327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/01/2020] [Accepted: 02/26/2020] [Indexed: 12/12/2022] Open
Abstract
AIM To investigate the effectiveness of the institutional medical structure and of the implemented clinical practice guidelines for improving colon cancer surgical outcomes. METHODS We conducted a web-based questionnaire survey among departments registered at the National Clinical Database in Japan from October 2014 to January 2015 to assess the association between quality indicators (QIs), including structure and process indicators (clinical practice guideline adherence), and the risk-adjusted odds ratio for operative mortality (AOR) after right hemicolectomy for colorectal cancer during the study period. RESULTS Among the 2064 departments registering at least one colorectal surgery during the study period, we obtained responses from 814 departments (39.4%). Our analysis on data from 22 816 patients with right hemicolectomy demonstrated that three structural QIs (certification of training hospitals by the Japanese Society of Gastroenterological Surgery and the presences of board-certified gastroenterological and colorectal surgeons) were associated with significantly lower AOR (P < .001, P = .02, and P = .05, respectively). The "performed at the doctor's discretion" answer was associated with poorer short-term outcomes in six process QIs than other answers. CONCLUSION The board certification system for gastroenterological and colorectal surgeons and the adherence to the clinical guidelines improve the operative mortality after right hemicolectomy. It is desired to clarify the most suitable QIs to reduce the operative mortality after colorectal surgery.
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Affiliation(s)
- Hirotoshi Kobayashi
- The Japanese Society for Cancer of the Colon and Rectum Tokyo Japan
- Department of Surgery Teikyo University Mizonokuchi Hospital Kanagawa Japan
| | - Hiroyuki Yamamoto
- National Clinical Database Tokyo Japan
- 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
- National Clinical Database Tokyo Japan
- 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
| | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
- Osaka General Medical Center Osaka Japan
| | - Kenjiro Kotake
- The Japanese Society for Cancer of the Colon and Rectum Tokyo Japan
- Department of Surgery Sano City Hospital Tochigi Japan
| | - Kenichi Sugihara
- The Japanese Society for Cancer of the Colon and Rectum Tokyo Japan
- Tokyo Medical and Dental University Tokyo Japan
| | - Yasushi Toh
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
- Department of Gastroenterological Surgery National Kyushu Cancer Center Fukuoka Japan
| | - Yoshihiro Kakeji
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
- Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
- Department of Gastrointestinal Surgery Graduate School of Medicine The University of Tokyo 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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Hara T, Hiratsuka T, Etoh T, Itai Y, Kono Y, Shiroshita H, Shiraishi N, Inomata M. Intraperitoneal Phototherapy Suppresses Inflammatory Reactions in a Surgical Model of Peritonitis. J Surg Res 2020; 252:231-239. [PMID: 32299011 DOI: 10.1016/j.jss.2020.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/29/2020] [Accepted: 03/09/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Standard treatment for diffuse peritonitis due to colorectal perforation may be insufficient to suppress inflammatory reaction in sepsis. Thus, developing new treatments is important. This study aimed to examine whether intraperitoneal irradiation by artificial sunlight suppresses inflammatory reaction in a lipopolysaccharide (LPS)-induced peritonitis model after surgical treatments. MATERIALS AND METHODS Mice were divided into naive, nontreatment (NT), and phototherapy (PT) groups. In the latter two groups, LPS was intraperitoneally administered to induce peritonitis and removed by intraperitoneal lavage after laparotomy. The PT group was irradiated with artificial sunlight intraperitoneally. We evaluated the local and systemic inflammatory reactions. Murine macrophages were irradiated with artificial sunlight after stimulation by LPS, and cell viability and expression of tumor necrotizing factor-α (TNF-α) were evaluated. RESULTS As a local inflammatory reaction, the whole cell count, the expression of interleukin-6 and TNF-α in the intra-abdominal fluid, and the peritoneal thickness were significantly lower in the PT group than in the NT group. As a systematic inflammatory reaction, the expression of serum TNF-α, granulocyte macrophage colony-stimulating factor, monocyte chemotactic protein-1, macrophage inflammatory protein (MIP)-1α, and MIP-1β were significantly lower in the PT group than in the NT group. Irradiation by artificial sunlight suppressed the expression of TNF-α in murine macrophages without affecting cell viability. CONCLUSIONS Intraperitoneal irradiation by artificial sunlight could suppress local and systemic inflammatory reactions in the LPS-induced peritonitis murine model. These effects may be associated with macrophage immune responses.
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Affiliation(s)
- Takao Hara
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
| | - Takahiro Hiratsuka
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yusuke Itai
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan; Department of Diagnostic Pathology, Oita University Faculty of Medicine, Oita, Japan
| | - Yohei Kono
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hidefumi Shiroshita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Norio Shiraishi
- Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
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13
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Hasegawa H, Takahashi A, Kakeji Y, Ueno H, Eguchi S, Endo I, Sasaki A, Takiguchi S, Takeuchi H, Hashimoto M, Horiguchi A, Masaki T, Marubashi S, Yoshida K, Konno H, Gotoh M, Miyata H, Seto Y. Surgical outcomes of gastroenterological surgery in Japan: Report of the National Clinical Database 2011-2017. Ann Gastroenterol Surg 2019; 3:426-450. [PMID: 31346582 PMCID: PMC6635689 DOI: 10.1002/ags3.12258] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/16/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The Japanese National Clinical Database (NCD) is a large-scale, nationwide, web-based data entry system that is linked to the surgical board certification system and covers almost all surgical cases carried out in Japan. AIM To evaluate outcomes according to the gastroenterological section of the NCD. METHODS The 115 surgical procedures stipulated by the "Training Curriculum for Board-Certified Surgeons in Gastroenterology" were registered from 2011 to 2017. The number of surgeries, preoperative comorbidities, and short-term outcomes were compared between registration periods. RESULTS In total, 3 818 414 cases have been registered. More than 70% of all surgeries were carried out at certified institutions. The annual number of cases has been increasing year after year, and the aged population has also been increasing. Although the rates of preoperative comorbidities and postoperative complications have been increasing, the postoperative mortality rate has remained relatively low; in 2017, the 30-day mortality rate was 1.0% among those who underwent esophagectomy, 0.7% among those who underwent distal gastrectomy, 1.1% among those who underwent total gastrectomy, 1.3% among those who underwent right hemicolectomy, 0.5% among those who underwent low anterior resection, 1.3% among those who underwent hepatectomy, and 1.3% among those who underwent pancreaticoduodenectomy. The annual rate of endoscopic surgery dramatically increased over 7 years between 2011 and 2017, especially for low anterior resection (29.5%-62.6%) and esophagectomy (31.0%-56.1%). CONCLUSION This database is expected to ensure the quality of the board-certification system and surgical outcomes in gastroenterological surgery.
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Affiliation(s)
| | - Arata Takahashi
- Department of Health Policy and ManagementSchool of MedicineKeio UniversityTokyoJapan
| | | | - Hideki Ueno
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Susumu Eguchi
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Itaru Endo
- 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
| | | | | | - Tadahiko Masaki
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | | | | | - Hiroyuki Konno
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroaki Miyata
- Department of Health Policy and ManagementSchool of MedicineKeio UniversityTokyoJapan
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
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Jalbani IK, Khurrum M, Aziz W. Spontaneous rupture of pyonephrosis leading to pyoperitoneum. Urol Case Rep 2019; 26:100928. [PMID: 31275807 PMCID: PMC6586947 DOI: 10.1016/j.eucr.2019.100928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/29/2019] [Indexed: 11/28/2022] Open
Abstract
Forniceal rupture after pyonephrosis can lead to retroperitoneal abscess but extension into peritoneal cavity is unusual. We present a case of 50 year old lady who presented with acute abdomen, CT scan of abdomen showed features suggestive of left pyelonephritis and large intraperitoneal collection. Laparotomy was planned on suspicion of intraperitoneal source of sepsis. Peroperatively no intraperitoneal source of sepsis was found. Retrograde pyelography showed forniceal rupture at lower pole of kidney extending to peritoneal cavity without any obstructing stone or lesion. This case highlights an unusual presentation of pyonephrosis with peritonitis and pyoperitoneum.
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15
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Toh Y, Yamamoto H, Miyata H, Gotoh M, Watanabe M, Matsubara H, Kakeji Y, Seto Y. Significance of the board-certified surgeon systems and clinical practice guideline adherence to surgical treatment of esophageal cancer in Japan: a questionnaire survey of departments registered in the National Clinical Database. Esophagus 2019; 16:362-370. [PMID: 30980202 PMCID: PMC6744385 DOI: 10.1007/s10388-019-00672-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/07/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND It remains unknown how much institutional medical structure and process of implementation of clinical practice guidelines for esophageal cancers can improve quality of surgical outcome in Japan. METHODS A web-based questionnaire survey was performed for departments registered in the National Clinical Database in Japan from October 2014 to January 2015. Quality indicators (QIs) including structure and process indicators (clinical practice guideline adherence) were evaluated on the risk-adjusted odds ratio for operative mortality (AOR) of the patients using registered cases in the database who underwent esophagectomy and reconstruction in 2013 and 2014. RESULTS Among 916 departments which registered at least one esophagectomy case during the study period, 454 departments (49.6%) responded to the questionnaire. Analyses of 6661 cases revealed that two structure QIs (certification of training hospitals by Japan Esophageal Society and presence of board-certified esophageal surgeons) were associated with significantly lower AOR (p < 0.001 and p = 0.005, respectively). One highly recommended process QI regarding preoperative chemotherapy had strong tendency to associate with lower AOR (p = 0.053). In two process QIs, the answer "performed at the doctor's discretion" showed a significant negative impact on prognosis, suggesting importance of institutional uniformity. CONCLUSIONS The medical institutional structure of board-certified training sites for esophageal surgeons and of participation of board-certified esophageal surgeons improves surgical outcome in Japan. Establishment of appropriate QIs and their uniform implementation would be crucial for future quality improvement of medical care in esophagectomy.
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Affiliation(s)
| | | | | | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological Surgery, 3-1-17 Axior Mita 6F, Minato-ku, Tokyo, 108-0073 Japan
| | | | | | - Yoshihiro Kakeji
- The Japanese Society of Gastroenterological Surgery, 3-1-17 Axior Mita 6F, Minato-ku, Tokyo, 108-0073 Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery, 3-1-17 Axior Mita 6F, Minato-ku, Tokyo, 108-0073 Japan
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16
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Kanaji S, Takahashi A, Miyata H, Marubashi S, Kakeji Y, Konno H, Gotoh M, Seto Y. Initial verification of data from a clinical database of gastroenterological surgery in Japan. Surg Today 2018; 49:328-333. [DOI: 10.1007/s00595-018-1733-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/15/2018] [Indexed: 01/22/2023]
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17
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Baba H. Editorial. Ann Gastroenterol Surg 2018; 2:4-5. [PMID: 29863112 DOI: 10.1002/ags3.12053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hideo Baba
- Department of Gastroenterological Surgery Graduate School of Medical Science Kumamoto University Kumamoto Japan
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18
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Miyata H, Mori M, Kokudo N, Gotoh M, Konno H, Wakabayashi G, Matsubara H, Watanabe T, Ono M, Hashimoto H, Yamamoto H, Kumamaru H, Kohsaka S, Iwanaka T. Association between institutional procedural preference and in-hospital outcomes in laparoscopic surgeries; Insights from a retrospective cohort analysis of a nationwide surgical database in Japan. PLoS One 2018; 13:e0193186. [PMID: 29505561 PMCID: PMC5837082 DOI: 10.1371/journal.pone.0193186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/06/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To assess the use of laparoscopic surgeries (LS) and the association between its performance and hospitals' preference for LS over open surgeries. SUMMARY BACKGROUND DATA LS is increasingly used in many abdominal surgeries, albeit both with and without solid guideline recommendations. To date, the hospitals' preference (LS vs. open surgeries) and its association with in-hospital outcomes has not been evaluated. METHODS We enrolled patients undergoing 8 types of gastrointestinal surgeries in 2011-2013 in the Japanese National Clinical Database. We assessed the use of LS and the occurrences of surgery-related morbidity and mortality during the study period. Further, for 4 typical LS procedures, we assessed the hospitals' preference for LS by modeling the propensity to perform LS (over open surgeries) from patient-level factors, and estimating each institution's observed/expected (O/E) ratio for LS use. Institutions with O/E>2 were defined as LS-dominant. Using hierarchical logistic regression models, we assessed the association between LS preference and in-hospital outcomes. RESULTS Among 1,377,118 patients undergoing gastrointestinal procedures in 2,336 participating hospitals, use of LS increased in all 8 procedures (35.1% to 44.7% for distal gastrectomy (DG), and 27.5% to 43.2% for right hemi colectomy (RHC)). Those operated at LS-dominant hospitals were at an increased risk of operative death (OR 1.83 [95%CI, 1.37-2.45] for DG, 1.79 [95%CI, 1.43-2.25] for RHC) compared to standard O/E level hospitals (0.5≤O/E<2.0). CONCLUSIONS LS use widely increased during 2011-2013 in Japan. Facilities with higher than expected LS use had higher mortality compared to other hospitals, suggesting a need for careful patient selection and dissemination of the procedure.
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Affiliation(s)
- Hiroaki Miyata
- National Clinical Database, Tokyo, Japan
- Department of Health Policy and Management, Keio University, Tokyo, Japan
| | - Masaki Mori
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
- Japan Surgical Society, Tokyo, Japan
| | - Norihiro Kokudo
- Japan Surgical Society, Tokyo, Japan
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
- Osaka General Medical Center, Osaka, Japan
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
- Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Wakabayashi
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Hisahiro Matsubara
- Japan Surgical Society, Tokyo, Japan
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshiaki Watanabe
- Japan Surgical Society, Tokyo, Japan
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Minoru Ono
- National Clinical Database, Tokyo, Japan
- Department of Cardiac Surgery, The University of Tokyo, Tokyo, Japan
| | - Hideki Hashimoto
- National Clinical Database, Tokyo, Japan
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Yamamoto
- National Clinical Database, Tokyo, Japan
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiraku Kumamaru
- National Clinical Database, Tokyo, Japan
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shun Kohsaka
- National Clinical Database, Tokyo, Japan
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tadashi Iwanaka
- National Clinical Database, Tokyo, Japan
- Bureau of Saitama Prefectural Hospitals, Saitama, Japan
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19
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Kakeji Y, Takahashi A, Udagawa H, Unno M, Endo I, Kunisaki C, Taketomi A, Tangoku A, Masaki T, Marubashi S, Yoshida K, Gotoh M, Konno H, Miyata H, Seto Y. Surgical outcomes in gastroenterological surgery in Japan: Report of National Clinical database 2011-2016. Ann Gastroenterol Surg 2018; 2:37-54. [PMID: 29863148 PMCID: PMC5881362 DOI: 10.1002/ags3.12052] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/21/2017] [Indexed: 12/19/2022] Open
Abstract
The National Clinical Database (NCD) of Japan started its registration in 2011 and over 9 000 000 cases from more than 5000 facilities were registered over a 6‐year period. This is the report of NCD based upon gastrointestinal surgery information in excess of 3 200 000 cases from 2011 to 2016 adding data of complications. About 70% of all gastrointestinal surgeries were carried out at certified institutions, and the percentage of surgeries done at certified institutions was particularly high for the esophagus (92.4% in 2016), liver (88.4%), pancreas (89.8%), and spleen (86.8%). The percentage of anesthesiologist participation was more than 90% for almost all organs, except 85.7% for the rectum and anus. Approximately, more than two‐thirds of the surgeries were carried out with the participation of a board‐certified surgeon. Although patients have been getting older, mortalities have not been increasing. There were differences in the incidence of complications according to organ site and procedure. Remarkably, mortality rates of low anterior resection were very low, and those of hepatectomy and acute diffuse peritonitis surgery have been gradually decreasing. Although the complication rates were gradually increasing for esophagectomy or pancreaticoduodenectomy, the mortality rates for these procedures were decreasing. Nationwide, this database is expected to ensure the quality of the 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 Kobe Japan
| | - Harushi Udagawa
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Michiaki Unno
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Itaru Endo
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | | | | | - Akira Tangoku
- 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
| | - Hiroaki Miyata
- Department of Health Policy and Management School of Medicine Keio University Kobe 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
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Abstract
PURPOSE The purpose of this study is to identify the current clinical features of neonatal gastrointestinal perforation in Japan. METHODS A questionnaire about cases of neonatal gastrointestinal perforation treated in recent 5 years was sent to participating institutions of the Japanese Society of Pediatric Surgeons (JSPS). RESULTS Five hundred and thirty-six neonates with gastrointestinal perforation were treated. They consisted of 42 patients with gastric rupture/perforation (GR), 33 patients with intestinal atresia/stenosis (IA), 3 patients with malrotation (ML), 118 patients with necrotizing enterocolitis (NEC), 160 patients with focal intestinal perforation (FIP), 46 patients with meconium-related ileus (MRI), 77 patients with meconium peritonitis (MP), and 57 patients with other conditions. The total mortality rate was 20.5 %. The mortality rates of the patients with GR, IA, ML, NEC, FIP, MRI, and MP were 9.5, 9.1, 0, 33.1, 20.6, 28.2, and 9.1 %, respectively. In 263 cases involving extremely low-birth-weight neonates (ELBW), 108 died (mortality rate 41.1 %). The mortality rates for ELBW with GR, NEC, FIP, MRI, MP, and other conditions were 27.3 % (3/11), 58.5 % (48/82), 21.6 % (24/111), 70.6 % (24/34), 57.1 % (4/7), and 27.8 % (5/18), respectively. CONCLUSIONS The mortality rates for ELBW decreased from 62.8 % in the previous survey to 41.1 % by the time of this survey.
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21
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Ohki T, Yamamoto M, Miyata H, Sato Y, Saida Y, Morimoto T, Konno H, Seto Y, Hirata K. A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database. Medicine (Baltimore) 2017; 96:e5818. [PMID: 28079809 PMCID: PMC5266171 DOI: 10.1097/md.0000000000005818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Colorectal perforation has a high rate of mortality. We compared the incidence and fatality rates of colorectal perforation among different hospitals in Japan using data from the nationwide surgical database.Patients were registered in the National Clinical Database (NCD) between January 1st, 2011 and December 31st, 2013. Patients with colorectal perforation were identified from surgery records by examining if acute diffuse peritonitis (ADP) and diseases associated with a high probability of colorectal perforation were noted. The primary outcome measures included the 30-day postsurgery mortality and surgical mortality of colorectal perforation. We analyzed differences in the observed-to-expected mortality (O/E) ratio between the two groups of hospitals, that is, specialized and non-specialized, using the logistic regression analysis forward selection method.There were 10,090 cases of disease-induced colorectal perforation during the study period. The annual average postoperative fatality rate was 11.36%. There were 3884 patients in the specialized hospital group and 6206 in the non-specialized hospital group. The O/E ratio (0.9106) was significantly lower in the specialized hospital group than in the non-specialized hospital group (1.0704). The experience level of hospitals in treating cases of colorectal perforation negatively correlated with the O/E ratio.We conducted the first study investigating differences among hospitals with respect to their fatality rate of colorectal perforation on the basis of data from a nationwide database. Our data suggest that patients with colorectal perforation should choose to be treated at a specialized hospital or a hospital that treats five or more cases of colorectal perforation per year. The results of this study indicate that specialized hospitals may provide higher quality medical care, which in turn proves that government policy on healthcare is effective at improving the medical system in Japan.
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Affiliation(s)
- Takeshi Ohki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University
| | - Hiroaki Miyata
- National Clinical Database
- Department of Health Policy and Management, School of Medicine, Keio University
| | - Yasuto Sato
- Department of Public Health, Tokyo Women's Medical University
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Centre, Tokyo
| | - Tsuyoshi Morimoto
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological Surgery, Tokyo
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery, Tokyo
- Department of Gastrointestinal Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo
| | - Koichi Hirata
- The Japanese Society for Abdominal Emergency Medicine, Tokyo
- First department of surgery of Sapporo Medical university school of Medicine, Sapporo
- Department of Surgery, JR Sapporo Hospital, Sapporo, Japan
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Association between the participation of board-certified surgeons in gastroenterological surgery and operative mortality after eight gastroenterological procedures. Surg Today 2016; 47:611-618. [DOI: 10.1007/s00595-016-1422-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/19/2016] [Indexed: 01/08/2023]
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23
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Development of an annually updated Japanese national clinical database for chest surgery in 2014. Gen Thorac Cardiovasc Surg 2016; 64:569-76. [PMID: 27501695 PMCID: PMC5035318 DOI: 10.1007/s11748-016-0697-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/28/2016] [Indexed: 10/28/2022]
Abstract
OBJECTIVES A national clinical database (NCD) adopted an "Internet-based collection" in 2011. An NCD specializing in chest surgery was launched based on the NCD system in 2014. The system was linked to the board certification as the second level in the hierarchy of the specialty of chest surgery and accreditation of educational institutions for chest surgery. Here, we report the status of the NCD for chest surgery in 2014 and clarified its registration rate and its accuracy. METHODS Chest surgeries undertaken in Japan since January 1st, 2014 until the end of the same year were registered through an Internet-based system until April 8th, 2015. The registration rate was compared with the annual survey conducted by the Japanese Association for Thoracic Surgery (JATS) from 2011 to 2014. The rate of accurate inputting was measured by an Internet-based audit in reference to 563 anonymous operative notes of patients presented by 106 chest surgeons at the time of renewal for board certification for chest surgery. RESULTS A total of 88,112 chest-surgical procedures were registered from 1000 chest surgery units (CSUs). Distribution of procedures by thoracic disease was almost identical to that of the annual survey conducted by JATS. However, the NCD had 4260 more registered procedures compared with the annual survey. The Internet-based audit showed that inter-rater agreement between Internet-based data and operative notes in any item was >94 %. CONCLUSIONS The NCD system can sustainably provide important and up-to-date information relating to preoperative status, oncology, and best practice for chest surgery in Japan.
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Miura F, Yamamoto M, Gotoh M, Konno H, Fujimoto J, Yanaga K, Kokudo N, Yamaue H, Wakabayashi G, Seto Y, Unno M, Miyata H, Hirahara N, Miyazaki M. Validation of the board certification system for expert surgeons (hepato-biliary-pancreatic field) using the data of the National Clinical Database of Japan: part 2 - Pancreatoduodenectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:353-63. [DOI: 10.1002/jhbp.348] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 03/17/2016] [Indexed: 01/30/2023]
Affiliation(s)
- Fumihiko Miura
- Committee of the Board Certification System for Expert Surgeons; Japanese Society of Hepato-Biliary-Pancreatic Surgery; Tokyo Japan
| | - Masakazu Yamamoto
- Committee of the Board Certification System for Expert Surgeons; Japanese Society of Hepato-Biliary-Pancreatic Surgery; Tokyo Japan
| | - Mitsukazu Gotoh
- Database Committee; The Japanese Society of Gastroenterological Surgery; Tokyo Japan
| | - Hiroyuki Konno
- Database Committee; The Japanese Society of Gastroenterological Surgery; Tokyo Japan
| | - Jiro Fujimoto
- Committee of the Board Certification System for Expert Surgeons; Japanese Society of Hepato-Biliary-Pancreatic Surgery; Tokyo Japan
| | - Katsuhiko Yanaga
- Committee of the Board Certification System for Expert Surgeons; Japanese Society of Hepato-Biliary-Pancreatic Surgery; Tokyo Japan
| | - Norihiro Kokudo
- Committee of the Board Certification System for Expert Surgeons; Japanese Society of Hepato-Biliary-Pancreatic Surgery; Tokyo Japan
| | - Hiroki Yamaue
- Committee of the Board Certification System for Expert Surgeons; Japanese Society of Hepato-Biliary-Pancreatic Surgery; Tokyo Japan
| | - Go Wakabayashi
- Committee of the Board Certification System for Expert Surgeons; Japanese Society of Hepato-Biliary-Pancreatic Surgery; Tokyo Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery; Tokyo Japan
| | - Michiaki Unno
- Committee of the Board Certification System for Expert Surgeons; Japanese Society of Hepato-Biliary-Pancreatic Surgery; Tokyo Japan
| | - Hiroaki Miyata
- Database Committee; The Japanese Society of Gastroenterological Surgery; Tokyo Japan
- Department of Health Policy and Management, School of Medicine; Keio University; Tokyo Japan
| | - Norimichi Hirahara
- Department of Health Policy and Management, School of Medicine; Keio University; Tokyo Japan
| | - Masaru Miyazaki
- Japanese Society of Hepato-Biliary-Pancreatic Surgery; Tokyo Japan
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25
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Gotoh M, Miyata H, Hashimoto H, Wakabayashi G, Konno H, Miyakawa S, Sugihara K, Mori M, Satomi S, Kokudo N, Iwanaka T. National Clinical Database feedback implementation for quality improvement of cancer treatment in Japan: from good to great through transparency. Surg Today 2016; 46:38-47. [PMID: 25797948 PMCID: PMC4674525 DOI: 10.1007/s00595-015-1146-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/26/2015] [Indexed: 01/13/2023]
Abstract
The National Clinical Database (NCD) of Japan was established in April, 2010 with ten surgical subspecialty societies on the platform of the Japan Surgical Society. Registrations began in 2011 and over 4,000,000 cases from more than 4100 facilities were registered over a 3-year period. The gastroenterological section of the NCD collaborates with the American College of Surgeons' National Surgical Quality Improvement Program, which shares a similar goal of developing a standardized surgical database for surgical quality improvement, with similar variables for risk adjustment. Risk models of mortality for eight procedures; namely, esophagectomy, partial/total gastrectomy, right hemicolectomy, low anterior resection, hepatectomy, pancreaticoduodenectomy, and surgery for acute diffuse peritonitis, have been established, and feedback reports to participants will be implemented. The outcome measures of this study were 30-day mortality and operative mortality. In this review, we examine the eight risk models, compare the procedural outcomes, outline the feedback reporting, and discuss the future evolution of the NCD.
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Affiliation(s)
- Mitsukazu Gotoh
- National Clinical Database, 1-8-3 Marunouchi, Chiyoda-ku, Tokyo, Japan ,The Japanese Society of Gastroenterological Surgery (JSGS), Database Committee, 1-14-1-501 Shintomi, Chuo-ku, Tokyo, 104-0041 Japan
| | - Hiroaki Miyata
- National Clinical Database, 1-8-3 Marunouchi, Chiyoda-ku, Tokyo, Japan ,The Japanese Society of Gastroenterological Surgery (JSGS), Database Committee, 1-14-1-501 Shintomi, Chuo-ku, Tokyo, 104-0041 Japan
| | - Hideki Hashimoto
- National Clinical Database, 1-8-3 Marunouchi, Chiyoda-ku, Tokyo, Japan ,The Japanese Society of Gastroenterological Surgery (JSGS), Database Committee, 1-14-1-501 Shintomi, Chuo-ku, Tokyo, 104-0041 Japan
| | - Go Wakabayashi
- The Japanese Society of Gastroenterological Surgery (JSGS), Database Committee, 1-14-1-501 Shintomi, Chuo-ku, Tokyo, 104-0041 Japan
| | - Hiroyuki Konno
- National Clinical Database, 1-8-3 Marunouchi, Chiyoda-ku, Tokyo, Japan ,The Japanese Society of Gastroenterological Surgery (JSGS), Database Committee, 1-14-1-501 Shintomi, Chuo-ku, Tokyo, 104-0041 Japan
| | | | - Kenichi Sugihara
- National Clinical Database, 1-8-3 Marunouchi, Chiyoda-ku, Tokyo, Japan
| | - Masaki Mori
- National Clinical Database, 1-8-3 Marunouchi, Chiyoda-ku, Tokyo, Japan
| | - Susumu Satomi
- National Clinical Database, 1-8-3 Marunouchi, Chiyoda-ku, Tokyo, Japan
| | - Norihiro Kokudo
- National Clinical Database, 1-8-3 Marunouchi, Chiyoda-ku, Tokyo, Japan
| | - Tadashi Iwanaka
- National Clinical Database, 1-8-3 Marunouchi, Chiyoda-ku, Tokyo, Japan
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26
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Saze Z, Miyata H, Konno H, Gotoh M, Anazawa T, Tomotaki A, Wakabayashi G, Mori M. Risk Models of Operative Morbidities in 16,930 Critically Ill Surgical Patients Based on a Japanese Nationwide Database. Medicine (Baltimore) 2015; 94:e1224. [PMID: 26222854 PMCID: PMC4554124 DOI: 10.1097/md.0000000000001224] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The aim of the study was to evaluate preoperative variables predictive of lethal morbidities in critically ill surgical patients at a national level.There is no report of risk stratification for morbidities associated with mortality in critically ill patients with acute diffuse peritonitis (ADP).We examined data from 16,930 patients operated during 2011 and 2012 in 1546 different hospitals for ADP identified in the National Clinical Database of Japan. We analyzed morbidities significantly associated with operative mortality. Based on 80% of the population, we calculated independent predictors for these morbidities. The risk factors were validated using the remaining 20%.The operative mortality was 14.1%. Morbidity of any grade occurred in 40.2% of patients. Morbidities correlated with mortality, including septic shock, progressive renal insufficiency, prolonged ventilation >48 hours, systemic sepsis, central nervous system (CNS) morbidities, acute renal failure and pneumonia, and surgical site infection (SSI), were selected for risk models. A total of 18 to 29 preoperative variables were selected per morbidity and yielded excellent C-indices for each (septic shock: 0.851; progressive renal insufficiency: 0.878; prolonged ventilation >48 h: 0.849; systemic sepsis: 0.839; CNS morbidities: 0.848; acute renal failure: 0.868; pneumonia: 0.830; and SSI: 0.688).We report the first risk stratification study on lethal morbidities in critically ill patients with ADP using a nationwide surgical database. These risk models will contribute to patient counseling and help predict which patients require more aggressive surgical and novel pharmacological interventions.
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Affiliation(s)
- Zenichiro Saze
- From the Japanese Society of Gastroenterological Surgery (JSGS) (ZS, TA, MM), JSGS Database Committee (HM, HK, MG, GW), and National Clinical Database (HM, AT), Tokyo, Japan
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27
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Wakabayashi G, Konno H, Udagawa H, Unno M, Endo I, Kunisaki C, Taketomi A, Tangoku A, Hashimoto H, Masaki T, Motomura N, Yoshida K, Watanabe T, Miyata H, Kamiya K, Hirahara N, Gotoh M, Mori M, Clinical Database N. Annual Report of National Clinical Database in Gastroenterological Surgery 2014. ACTA ACUST UNITED AC 2015. [DOI: 10.5833/jjgs.2015.sr002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Go Wakabayashi
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | | | - Harushi Udagawa
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | - Michiaki Unno
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | - Itaru Endo
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | - Chikara Kunisaki
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | - Akinobu Taketomi
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | - Akira Tangoku
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | - Hideki Hashimoto
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | - Tadahiko Masaki
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | - Noboru Motomura
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | - Kazuhiro Yoshida
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | - Toshiaki Watanabe
- Database Committee, The Japanese Society of Gastroenterological Surgery
| | - Hiroaki Miyata
- Database Committee, The Japanese Society of Gastroenterological Surgery
- Department of Healthcare Quality Assessment Graduate School of Medicine, The University of Tokyo
| | - Kinji Kamiya
- The Japanese Society of Gastroenterological Surgery
| | - Norimichi Hirahara
- Department of Healthcare Quality Assessment Graduate School of Medicine, The University of Tokyo
| | | | - Masaki Mori
- The Japanese Society of Gastroenterological Surgery
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Cancer registries in Japan: National Clinical Database and site-specific cancer registries. Int J Clin Oncol 2014; 20:5-10. [PMID: 25376769 DOI: 10.1007/s10147-014-0757-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
The cancer registry is an essential part of any rational program of evidence-based cancer control. The cancer control program is required to strategize in a systematic and impartial manner and efficiently utilize limited resources. In Japan, the National Clinical Database (NCD) was launched in 2010. It is a nationwide prospective registry linked to various types of board certification systems regarding surgery. The NCD is a nationally validated database using web-based data collection software; it is risk adjusted and outcome based to improve the quality of surgical care. The NCD generalizes site-specific cancer registries by taking advantage of their excellent organizing ability. Some site-specific cancer registries, including pancreatic, breast, and liver cancer registries have already been combined with the NCD. Cooperation between the NCD and site-specific cancer registries can establish a valuable platform to develop a cancer care plan in Japan. Furthermore, the prognosis information of cancer patients arranged using population-based and hospital-based cancer registries can help in efficient data accumulation on the NCD. International collaboration between Japan and the USA has recently started and is expected to provide global benchmarking and to allow a valuable comparison of cancer treatment practices between countries using nationwide cancer registries in the future. Clinical research and evidence-based policy recommendation based on accurate data from the nationwide database may positively impact the public.
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