1
|
Kakeji Y, Yamamoto H, Watanabe M, Kono K, Ueno H, Doki Y, Kitagawa Y, Takeuchi H, Shirabe K, Seto Y. Outcome research on esophagectomy analyzed using nationwide databases in Japan: evidences generated from real-world data. Esophagus 2024:10.1007/s10388-024-01080-w. [PMID: 39158676 DOI: 10.1007/s10388-024-01080-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 08/11/2024] [Indexed: 08/20/2024]
Abstract
Esophagectomy for esophageal cancer is a highly invasive gastrointestinal surgical procedure. The National Clinical Database (NCD) of Japan, initiated in 2011, has compiled real-world data on esophagectomy, one of nine major gastroenterological surgeries. This review examines outcomes after esophagectomy analyzed using the Japanese big databases. Certification systems by the Japanese Society of Gastroenterological Surgery (JSGS) and the Japan Esophageal Society (JES) have shown that institutional certification has a greater impact on short-term surgical outcomes than surgeon certification. Minimally invasive esophagectomy has emerged as a viable alternative to open esophagectomy, although careful patient selection is crucial, especially for elderly patients with advanced tumors. The NCD has significantly contributed to the assessment and enhancement of surgical quality and short-term outcomes, while studies based on Comprehensive Registry of Esophageal Cancer in Japan (CRECJ) have provided data on patient characteristics, treatments, and long-term outcomes. The JES has conducted various questionnaire-based retrospective clinical reviews in collaboration with authorized institutions certified by JES. The Diagnosis Procedure Combination (DPC) database provides administrative claims data including itemized prices for surgical, pharmaceutical, laboratory, and other inpatient services. Analyzing these nationwide databases can offer precise insights into surgical quality for esophageal cancer, potentially leading to improved treatment outcomes.
Collapse
Affiliation(s)
- Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku,Kobe, 650-0017, Japan.
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koji Kono
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Yasui T, Kikuchi E, Yamamoto H, Ishii D, Mizuno R, Hatakeyama S, Kobayashi T, Uchida J, Takahashi M, Sakamoto S, Morizane S, Kamoto T, Eto M. Annual record on the number of general urological surgeries registered in the National Clinical Database system between April 2018 and December 2021 in Japan. Int J Urol 2024. [PMID: 39105577 DOI: 10.1111/iju.15551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND The Japanese National Clinical Database (NCD) is a large-scale, nationwide, web-based data entry system that covers the majority of surgical cases performed in Japan. An NCD specializing in urological surgery was launched based on the NCD system in 2018. METHODS All urological surgeries performed at more than 1000 institutions were registered from 2018. We herein report the number of surgeries conducted as stipulated in the "Certified Urology Surgeon Training Curriculum" between April 2018 and December 2021. RESULTS A total of 1 377 677 cases were registered from 1185 facilities nationwide under the initiative of the Japanese Urological Association. We examined the number of procedures performed every year for each of the 10 categories. CONCLUSIONS The NCD system sustainably provides important information relating to the preoperative status, operational outcome, and best practice for urological surgery in Japan.
Collapse
Affiliation(s)
- Takahiro Yasui
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sceinces, Nagoya, Aichi, Japan
| | - Eiji Kikuchi
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroyuki Yamamoto
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Ishii
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ryuichi Mizuno
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shingo Hatakeyama
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takashi Kobayashi
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junji Uchida
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Masayuki Takahashi
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shinichi Sakamoto
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shuichi Morizane
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Toshiyuki Kamoto
- National Clinical Database Steering Committee of Japanese Urological Association, Tokyo, Japan
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masatoshi Eto
- Department of Urology, Kyushu University, Fukuoka, Japan
| |
Collapse
|
3
|
Ozawa H, Takahashi A, Bessho R, Hoshina K, Shukuzawa K, Ohki T. Saccular and Fusiform Abdominal Aortic Aneurysms Treated With Endovascular Repair Differ in Presentation and Treatment Threshold: Analyses Using a National Clinical Database in Japan. J Am Heart Assoc 2024; 13:e032715. [PMID: 38780177 PMCID: PMC11255613 DOI: 10.1161/jaha.123.032715] [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] [Received: 12/01/2023] [Accepted: 03/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Saccular abdominal aortic aneurysms (AAAs) are considered to be at higher risk of rupture than fusiform AAAs, but not much is known about the extent of this risk. Therefore, this study aimed to compare the rupture presentation between fusiform and saccular AAAs. METHODS AND RESULTS This is a retrospective cohort study on 27 290 patients who underwent primary endovascular repair for a degenerative AAA between 2016 and 2019, and who were registered in the National Clinical Database in Japan. At operation for nonruptured case, the aneurysm diameter was significantly smaller in saccular AAAs than in fusiform AAAs (median, 44.0 versus 51.0 mm; P<0.001). Similarly, aneurysm diameter at rupture was significantly smaller in saccular AAAs than in fusiform AAAs (median, 55.6 versus 68.0 mm; P<0.001). The likelihood of repair for rupture was significantly higher in saccular AAAs than in fusiform AAAs in the 40- to 54-mm diameter range, in which saccular morphology was found to be an independent risk factor for rupture against fusiform morphology by adjusting for sex and aneurysm diameter (odds ratio, 2.54 [95% CI, 1.75-3.69]). In addition, receiver-operating characteristic curve analysis revealed that the cutoff diameter to predict rupture was smaller in saccular AAAs than in fusiform AAAs (50.5 and 59.5 mm, respectively) based on the Youden index. CONCLUSIONS Saccular AAAs presented at smaller diameters than fusiform AAAs in patients with ruptured AAAs treated with endovascular aortic repair, which supports the idea that saccular AAAs should be treated at smaller diameters.
Collapse
Affiliation(s)
- Hirotsugu Ozawa
- Division of Vascular Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
- Japanese Society for Vascular SurgeryTokyoJapan
| | - Arata Takahashi
- Department of Health Policy and Management, School of MedicineKeio UniversityTokyoJapan
- Department of Healthcare Quality Assessment, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Ryuzo Bessho
- Department of Cardiovascular SurgeryNippon Medical School, Chiba Hokusoh HospitalChibaJapan
| | - Katsuyuki Hoshina
- Department of Vascular Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
- Japanese Committee for Stentgraft ManagementTokyoJapan
| | - Kota Shukuzawa
- Division of Vascular Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Takao Ohki
- Division of Vascular Surgery, Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| |
Collapse
|
4
|
Hosaka A, Takahashi A, Kumamaru H, Azuma N, Obara H, Miyata T, Obitsu Y, Zempo N, Miyata H, Komori K. Prognostic factors after open and endovascular repair for infected native aneurysms of the abdominal aorta and common iliac artery. J Vasc Surg 2024; 79:1379-1389. [PMID: 38280686 DOI: 10.1016/j.jvs.2024.01.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/13/2024] [Accepted: 01/21/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE Infected native aneurysms (INAs) of the abdominal aorta and iliac arteries are uncommon, but potentially fatal. Endovascular aneurysm repair (EVAR) has recently been introduced as a durable treatment option, with outcomes comparable to those yielded by conventional open repair. However, owing to the rarity of the disease, the strengths and limitations of each treatment remain uncertain. The present study aimed to separately assess post-open repair and post-EVAR outcomes and to clarify factors affecting the short-term and late prognosis after each treatment. METHODS Using a nationwide clinical registry, we investigated 600 patients treated with open repair and 226 patients treated with EVAR for INAs of the abdominal aorta and/or common iliac artery. The relationships between preoperative or operative factors and postoperative outcomes, including 90-day and 3-year mortality and persistent or recurrent aneurysm-related infection, were examined. RESULTS Prosthetic grafts were used in >90% of patients treated with open repair, and in situ and extra-anatomic arterial reconstruction was performed in 539 and 57 patients, respectively. Preoperative anemia and imaging findings suggestive of aneurysm-enteric fistula were independently associated with poor outcomes in terms of both 3-year mortality (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.01-2.62; P = .046, and HR, 2.24; 95% CI, 1.12-4.46; P = .022, respectively) and persistent or recurrent infection (odds ratio [OR], 2.16; 95% CI, 1.04-4.49; P = .039, and OR, 4.96; 95% CI, 1.81-13.55; P = .002, respectively) after open repair, whereas omental wrapping or packing and antibiotic impregnation of the prosthetic graft for in situ reconstruction contributed to improved 3-year survival (HR, 0.60; 95% CI, 0.39-0.92; P = .019, and HR, 0.53; 95% CI, 0.32-0.88; P = .014, respectively). Among patients treated with EVAR, abscess formation adjacent to the aneurysm was significantly associated with the occurrence of persistent or recurrent infection (OR, 2.24; 95% CI, 1.06-4.72; P = .034), whereas an elevated preoperative white blood cell count was predictive of 3-year mortality (HR, 1.77; 95% CI, 1.00-3.13; P = .048). CONCLUSIONS Profiles of prognostic factors differed between open repair and EVAR in the treatment of INAs of the abdominal aorta and common iliac artery. Open repair may be more suitable than EVAR for patients with concurrent abscess formation.
Collapse
Affiliation(s)
- Akihiro Hosaka
- Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
| | - Arata Takahashi
- 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
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuro Miyata
- Office of Medical Education, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Yukio Obitsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Nobuya Zempo
- Division of Vascular Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Hiroaki Miyata
- 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
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| |
Collapse
|
5
|
Hosaka A, Kumamaru H, Usune S, Miyata H, Goto H. Surgical Repair of Abdominal Aorto-Iliac Prosthetic Graft Infections: A Nationwide Japanese Cohort Study. Eur J Vasc Endovasc Surg 2023; 66:407-416. [PMID: 37391011 DOI: 10.1016/j.ejvs.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/23/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE Prosthetic graft infection (PGI) after open abdominal aortic and iliac artery reconstruction is life threatening. However, because it is rare and frequently difficult to diagnose, robust evidence on its treatment and optimal management strategies are lacking. This study aimed to clarify the clinical characteristics and surgical treatment outcomes of this condition and to identify pre-operative and operative factors affecting its prognosis. METHODS This was a nationwide cohort study. Using a nationwide clinical registry system, patients who were treated surgically for PGI after open abdominal aortic and iliac artery reconstruction between 2011 and 2017 were investigated, and their profiles and clinical courses were analysed. The relationships between the pre-operative and operative factors and the post-operative outcomes, including death and persistent or recurrent graft related infection, were evaluated. RESULTS The study included 213 patients. The median duration between the index arterial reconstruction and surgical treatment for PGI was 644 days. Fistula development to the gastrointestinal tract was confirmed during surgery in 53.1% of patients. The cumulative overall survival rates at 30 and 90 days, one, three, and five years were 87.3%, 74.8%, 62.2%, 54.5%, and 48.1%, respectively. Pre-operative shock was the only factor independently associated with 90 day and three year death. Short term and late mortality rates, as well as the rate of persistent or recurrent graft related infection, did not differ significantly between patients treated with total removal of the infected graft and those treated with partial removal of the graft. CONCLUSION Surgery for PGI after open reconstruction of the abdominal aorta and iliac arteries is complex, and the post-operative mortality rate remains high. Partial removal of the infected graft may be an alternative in selected patients with limited extent of infection.
Collapse
Affiliation(s)
- Akihiro Hosaka
- Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Centre, Tokyo, Japan; Japanese Society for Vascular Surgery, Tokyo, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiyori Usune
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hitoshi Goto
- Japanese Society for Vascular Surgery, Tokyo, Japan; Department of Vascular Surgery, South Miyagi Medical Centre, Miyagi, Japan
| |
Collapse
|
6
|
Fujimura N, Obara H, Takahashi A, Miyata H, Hosaka A, Obitsu Y, Zempo N, Miyata T, Azuma N, Komori K. Surgical Treatment for Popliteal Artery Entrapment Syndrome in Japan: a Retrospective, Multicentre Study Using a National Clinical Registry. Eur J Vasc Endovasc Surg 2023; 66:381-388. [PMID: 37220801 DOI: 10.1016/j.ejvs.2023.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/01/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Surgical treatment is an established method for popliteal artery entrapment syndrome (PAES), which, however, mainly derives from single centre experiences where PAES cases are centralised and treated periodically. This study evaluated clinical outcomes of surgical treatment for PAES in a clinical setting where PAES cases were not centralised. METHODS Multicentre, retrospective cohort study using a national clinical registry. From a Japanese nationwide clinical registry, data for patients who underwent surgical treatment for PAES between 2013 and 2018, including 58 limbs from 41 institutes, were retrieved and evaluated. Patency was analysed using Kaplan-Meier curves. RESULTS The mean patient age was 36 ± 19 years, 78% were male, and the incidence of PAES was 0.24 limbs/centre/year, reflecting a clinical setting where PAES cases are not centralised. The most frequent arterial symptom was intermittent claudication (90%). Computed tomography was performed in 57 limbs (98%) for the diagnosis, however active manoeuvres such as dorsiflexion and plantarflexion during the examination was performed in only 13 limbs (22%), and occlusion of the popliteal artery was present in 38 limbs (66%) at diagnosis. Regarding surgical treatment, myotomy alone was performed in only seven limbs (12%), and other limbs were revascularised. Mean follow up was 26 ± 20 months, and surgical treatment was effective as it relieved symptoms in > 96% of limbs, with five year primary and secondary patency of the surgical treatment for PAES of 72% and 93%, respectively. CONCLUSION Results of surgical treatment were acceptable even in a clinical setting where PAES cases were not centralised. However, a low incidence of active manoeuvres performed during the examination and a high incidence of occlusion at diagnosis suggests there may be delayed or underdiagnosis of PAES in Japan, and increased awareness for PAES is warranted.
Collapse
Affiliation(s)
- Naoki Fujimura
- Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan; Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
| | - Arata Takahashi
- 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
| | - Hiroaki Miyata
- 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
| | - Akihiro Hosaka
- Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Centre, Tokyo, Japan
| | - Yukio Obitsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Nobuya Zempo
- Division of Vascular Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Tetsuro Miyata
- Office of Medical Education, School of Medicine, International University of Health and Welfare, Otawara, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
7
|
Hosaka A, Kumamaru H, Usune S, Miyata H, Goto H. Outcomes of Surgery for Endograft Infection in the Abdominal Aorta and Iliac Artery: A Nationwide Cohort Study. Ann Surg 2023; 277:e963-e970. [PMID: 35129489 DOI: 10.1097/sla.0000000000005293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to clarify the clinical features, postoperative outcomes, and prognostic factors in patients with endograft infection in the abdominal aorta and iliac artery. SUMMARY BACKGROUND DATA Endograft infection in the abdominal aorta and iliac artery is a potentially fatal condition. However, due to its rarity, clinical characteristics and optimal treatment strategy remain to be established. METHODS In this nationwide retrospective cohort study, we investigated 112 patients who underwent surgical treatment for endograft infection in the abdominal aorta and/or iliac artery between 2011 and 2017 using a Japanese clinical registry. We examined the relationships between the preoperative and operative factors and the outcomes after surgery including persistent or recurrent infection related to the endograft and 90-day and 3-year mortality. RESULTS The median period between the index endograft placement and surgery for infection was 369.5 days. Persistent or recurrent endograft-related infection occurred in 34 patients (30.4%). The cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years, and 5 years were 90.2%, 76.5%, 66.7%, 50.9%, and 31.5%, respectively. Partial removal or total preservation of the infected endograft was independently associated with short-term and late mortality. Preoperative anemia and imaging findings suggestive of fistula development to the gastrointestinal tract also showed an independent association with late mortality. CONCLUSIONS Surgical intervention for endograft infection in the abdominal aorta and iliac artery was associated with a high risk of postoperative morbidity and mortality. Total removal of the infected endograft should be attempted because partial removal or total preservation can lead to a poor prognosis.
Collapse
Affiliation(s)
- Akihiro Hosaka
- Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Japanese Society for Vascular Surgery, Tokyo, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiyori Usune
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hitoshi Goto
- Japanese Society for Vascular Surgery, Tokyo, Japan
- Department of Vascular Surgery, South Miyagi Medical Center, Miyagi, Japan
| |
Collapse
|
8
|
Mise Y, Hirakawa S, Tachimori H, Kakeji Y, Kitagawa Y, Komatsu S, Nanashima A, Nakamura M, Endo I, Saiura A. Volume- and quality-controlled certification system promotes centralization of complex hepato-pancreatic-biliary surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023. [PMID: 36706938 DOI: 10.1002/jhbp.1307] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/26/2022] [Accepted: 01/19/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Centralization of complex surgeries has made little progress when it only considers the minimum number of surgical procedures. We aim to assess the impact of certification system of Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) on centralization and surgical quality of advanced hepato-pancreatic-biliary (HPB) surgery. METHODS The National Clinical Database was used to review 20 111 patients who underwent pancreatoduodenectomy (PD) and 9666 who underwent advanced hepatectomy defined as hepatectomy of more than one section during 2019 and 2020. JSHPBS certifies hospitals based on the annual number of advanced HPB surgeries and the surgical quality. Minimum numbers of surgeries for board-certified A and B institutions are 50 and 30, respectively. Short-term outcomes were compared among institutions. RESULTS In 2020, 69.4% (7007/10090) and 72.9% (3433/4710) of patients underwent PD and advanced hepatectomy at board-certified institutions. In-hospital mortality rates after PD was 0.9% at certified A institutions, 1.4% at B institutions, and 2.7% at non-certified institutions (p < .001). The odds ratio (OR) of risk-adjusted mortality after PD compared with non-certified institutions was 0.39 (confidence interval [CI]: 0.30-0.50, p < .001) at certified A institutions, and 0.54 at certified B institutions (CI: 0.40-0.73, p < .001). In-hospital mortality rates after advanced hepatectomy was 1.7% at certified A institutions, 2.3% at B institutions, and 3.2% at non-certified institutions (p < .001). The OR of risk-adjusted mortality after advanced hepatectomy compared with non-certified institutions was 0.57 at certified A institutions (CI: 0.41-0.78, p < .001). CONCLUSION The volume- and quality-controlled certification system of JSHBPS reduces surgical mortality after advanced HPB surgeries.
Collapse
Affiliation(s)
- Yoshihiro Mise
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Hospital, Bunkyo-Ku, Japan
| | - Shinya Hirakawa
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
| | - Hisateru Tachimori
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Shohei Komatsu
- Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
| | | | | | - Itaru Endo
- Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Hospital, Bunkyo-Ku, Japan
| |
Collapse
|
9
|
Effects of the
COVID
‐19 pandemic on gastroenterological surgeries in 2020: A study using the National Clinical Database of Japan. Ann Gastroenterol Surg 2022; 7:407-418. [PMID: 37152784 PMCID: PMC10154870 DOI: 10.1002/ags3.12638] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Aim This study aimed to investigate the effect of the coronavirus disease pandemic on the number of surgeries for gastroenterological cancer cases in Japan. Methods The data recorded in the National Clinical Database of Japan between 2018 and 2020 were utilized for this study. Five specific surgeries for primary cancers and surgery for acute diffuse peritonitis were considered the primary endpoints. We divided the study period into the prepandemic and postpandemic (after April 2020) periods and examined the number of surgeries in relation to clinical factors. Results Overall, 228 860 surgeries were analyzed. Among the five primary cancer surgeries, the number of distal gastrectomies for gastric cancer decreased the most (to 81.0% of the monthly number in the prepandemic period), followed by that of low anterior resections for rectal cancer (91.4%). In contrast, the number of pancreaticoduodenectomies for pancreatic cancer increased by 7.1%, while that of surgeries for peritonitis remained stable. This trend was observed nationwide. We also noted a marked reduction in the number of distal gastrectomy (to 72.5%), low anterior resection (84.0%), and esophagectomy (88.8%) procedures for T1 tumors. The noncurative resection rate and mortalities were low despite the increased proportion of T4 tumors and older patients. Conclusion A marked reduction in surgeries for gastric and rectal cancers with early T factors may reflect prioritization of surgeries and reduction in cancer screenings. Although the quality of the surgery was maintained in terms of reduced mortalities and morbidities, the long-term effects of this pandemic should be monitored.
Collapse
|
10
|
Miyata T, Kumamaru H, Mii S, Kinukawa N, Miyata H, Shigematsu K, Azuma N, Ishida A, Izumi Y, Inoue Y, Uchida H, Ohki T, Kuma S, Kurosawa K, Kodama A, Komai H, Komori K, Shibuya T, Shindo S, Sugimoto I, Deguchi J, Hoshina K, Hideaki M, Midorikawa H, Yamaoka T, Yamashita H, Yunoki Y. Prediction Models for Two Year Overall Survival and Amputation Free Survival After Revascularisation for Chronic Limb Threatening Ischaemia. Eur J Vasc Endovasc Surg 2022; 64:367-376. [PMID: 35680042 DOI: 10.1016/j.ejvs.2022.05.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/27/2022] [Accepted: 05/29/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to create prediction models for two year overall survival (OS) and amputation free survival (AFS) after revascularisation in patients with chronic limb threatening ischaemia (CLTI). METHODS This was a retrospective analysis of prospectively collected multicentre registry data (JAPAN Critical Limb Ischaemia Database; JCLIMB). Data from 3 505 unique patients with CLTI who had undergone revascularisation from 2013 to 2017 were extracted from the JCLIMB for the analysis. The cohort was randomly divided into development (2 861 patients) and validation cohorts (644 patients). In the development cohort, multivariable risk models were constructed to predict two year OS and AFS using Cox proportional hazard regression analysis. These models were applied to the validation cohort and their performances were evaluated using Harrell's C index and calibration plots. RESULTS Kaplan-Meier estimates of two year OS and AFS post-revascularisation in the whole cohort were 69% and 62%, respectively. Strong predictors for OS consisted of age, activity, malignant neoplasm, chronic kidney disease (CKD), congestive heart failure (CHF), geriatric nutritional risk index (GNRI), and sex. Strong predictors for AFS included age, activity, malignant neoplasm, CKD, CHF, GNRI, body temperature, white blood cells, urgent revascularisation procedure, and sex. Prediction models for two year OS and AFS showed good discrimination with Harrell's C indexes of 0.73 (95% confidence interval [CI] 0.69 - 0.77) and 0.72 (95% CI 0.68 - 0.76), respectively CONCLUSION: Prediction models for two year OS and AFS post-revascularisation in patients with CLTI were created. They can assist in determining treatment strategies and serve as risk adjustment modalities for quality benchmarking for revascularisation in patients with CLTI at each facility.
Collapse
Affiliation(s)
- Tetsuro Miyata
- Office of Medical Education, School of Medicine, International University of Health and Welfare, Chiba, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinsuke Mii
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, Fukuoka, Japan
| | - Naoko Kinukawa
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Atsuhisa Ishida
- Department of Surgery, Kawasaki Medical School General Medical Centre, Okayama, Japan
| | - Yuichi Izumi
- Department of Cardiovascular Surgery, Nayoro City General Hospital, Hokkaido, Japan
| | | | - Hisashi Uchida
- Department of Cardiovascular Surgery, Sapporo Kousei Hospital, Hokkaido, Japan
| | - Takao Ohki
- Department of Vascular Surgery, The Jikei University Hospital, Tokyo, Japan
| | - Sosei Kuma
- Department of Vascular Surgery, Kyushu Central Hospital, Fukuoka, Japan
| | - Koji Kurosawa
- Department of Vascular Surgery, Atsugi City Hospital, Kanagawa, Japan
| | - Akio Kodama
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hiroyoshi Komai
- Department of Vascular Surgery, Kansai Medical University Medical Centre, Osaka, Japan
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takashi Shibuya
- Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan
| | - Shunya Shindo
- Department of Cardiovascular Surgery, Tokyo Medical University, Hachioji Medical Centre, Tokyo, Japan
| | - Ikuo Sugimoto
- Department of Medical Safety Management, Aichi Medical University, Aichi, Japan
| | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Centre, Saitama Medical University, Saitama, Japan
| | - Katsuyuki Hoshina
- Department of Vascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Maeda Hideaki
- Department of Vascular Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Hirofumi Midorikawa
- Department of Cardiovascular Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Hiroya Yamashita
- Department of Vascular Surgery, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yasuhiro Yunoki
- Department of Cardiovascular Surgery, Kawasaki Medical School Hospital, Okayama, Japan
| |
Collapse
|
11
|
Uemura S, Endo H, Ichihara N, Miyata H, Maeda H, Hasegawa H, Kamiya K, Kakeji Y, Yoshida K, Yasuyuki S, Yamaue H, Yamamoto M, Kitagawa Y, Hanazaki K. Day of surgery and mortality after pancreatoduodenectomy: A retrospective analysis of 29 270 surgical cases of pancreatic head cancer from Japan. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:778-784. [PMID: 34496150 DOI: 10.1002/jhbp.1043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND/PURPOSE The day of the week can impact medical treatment outcomes; however, few large-scale, disease-specific studies have focused on the association between the day of the week and mortality in patients after pancreatoduodenectomy for pancreatic head cancer. METHODS Data were obtained from the National Clinical Database. Twenty-two clinical variables were adopted for hierarchal logistic regression modeling to determine adjusted odds ratios (ORs) for surgical mortality after elective pancreatoduodenectomy. RESULTS The 30-day mortality and surgical mortality rates were 1.0% and 1.7%, respectively (n = 29 720). Surgeries were performed the least on Fridays (13.4%) compared with other weekdays. Crude rates of severe postoperative complications (mean, 14.1%; range, 13.5%-14.8%) and pancreatic fistulas (mean, 10.0%; range, 9.6%-10.3%) remained stable throughout the week. Unadjusted/adjusted ORs did not significantly differ between Friday and Monday (0.868, 95% CI: 0.636-1.173, P = .365, and 0.928, 95% CI: 0.668-1.287, P = .653, respectively), and results were similar for the remaining weekdays. Nineteen independent factors were associated with surgical mortality. CONCLUSIONS The rate of perioperative mortality for elective pancreatoduodenectomy is low in Japan, with no evidence of disparities in surgical mortality rates between weekdays.
Collapse
Affiliation(s)
- Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - Hideki Endo
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | | | - Hiroshi Hasegawa
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Kinji Kamiya
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Seto Yasuyuki
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | |
Collapse
|
12
|
Nishigori T, Ichihara N, Obama K, Uyama I, Miyata H, Inomata M, Kakeji Y, Kitagawa Y, Sakai Y. Prevalence and safety of robotic surgery for gastrointestinal malignant tumors in Japan. Ann Gastroenterol Surg 2022; 6:746-752. [PMID: 36338596 PMCID: PMC9628217 DOI: 10.1002/ags3.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 05/02/2022] [Indexed: 12/15/2022] Open
Abstract
Aim The National Health Insurance system has reimbursed robotic gastrointestinal surgery since April 2018 in Japan. Additionally, strict facility and surgeon standards were established by the government and the academic society. This study aimed to evaluate the prevalence and safety of robotic surgery using a Japanese nationwide web‐based database. Methods Patients who underwent the following robotic surgeries for malignant tumors in 2018 were included: esophagectomy (RE), total gastrectomy (RTG), distal gastrectomy (RDG), proximal gastrectomy (RPG), low anterior resection (RLAR), and rectal resections other than RLAR (RRR). The number of cases and surgical mortality rates each month were calculated to evaluate the prevalence and safety of robotic procedures. Results A total of 3281 patients underwent robotic gastrointestinal surgery. The monthly number of robotic surgeries nearly doubled in April 2018 when they were initially reimbursed by the National Health Insurance system. Operative mortality rates were 0.9%, 0.4%, 0.2%, and 2.8% for RE (n = 330), RTG (n = 239), RDG (n = 1167), and RPG (n = 109), respectively. No mortality was observed in RLAR (n = 1062) or RRR (n = 374). Conclusion Robotic surgery for gastrointestinal malignant tumors was safely introduced into daily clinical practice along with rigorous surgeon and facility standards in Japan.
Collapse
Affiliation(s)
- Tatsuto Nishigori
- Japan Society for Endoscopic SurgeryTokyoJapan
- Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
- Department of Patient SafetyKyoto University HospitalKyotoJapan
| | - Nao Ichihara
- Department of Healthcare Quality AssessmentGraduate School of Medicine, The University of TokyoTokyoJapan
| | - Kazutaka Obama
- Japan Society for Endoscopic SurgeryTokyoJapan
- Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
| | | | - Hiroaki Miyata
- Department of Healthcare Quality AssessmentGraduate School of Medicine, The University of TokyoTokyoJapan
| | | | | | - Yuko Kitagawa
- Japanese Society of Gastroenterological SurgeryTokyoJapan
| | | |
Collapse
|
13
|
Correlation between surgical mortality for perforated peritonitis and days of the week for operations: A retrospective study using the Japanese National Clinical Database. Am J Surg 2022; 224:546-551. [PMID: 35210064 DOI: 10.1016/j.amjsurg.2022.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The association between weekend interventions and poor outcomes is termed the "weekend effect." This retrospective study investigated whether the weekend effect exists in the surgical treatment of acute diffuse peritonitis due to gastrointestinal perforation. METHODS Patients (n = 16,209) who underwent operation for acute diffuse peritonitis during 2016-2017 were included and grouped depending on the perforation site. Using 23 variables, we performed hierarchical logistic regression analysis and calculated odds ratios for surgical mortality. RESULTS Surgical mortality rates were 8.8%, 15.0%, and 14.1% for patients with gastroduodenal, small bowel, and large bowel perforations, respectively. Unadjusted odds ratios for surgical mortality differed significantly on Wednesdays only for patients with large bowel perforation (odds ratio: 0.772, 95% confidence interval: 0.613-0.972, P = 0.03). However, there was no significant difference in adjusted odds ratios. CONCLUSION The quality of emergency surgical treatment is uniform in Japan throughout the week in terms of mortality.
Collapse
|
14
|
Itamoto K, Kumamaru H, Aikou S, Yagi K, Yamashita H, Nomura S, Miyata H, Kuroda S, Fujiwara T, Endo S, Kitagawa Y, Kakeji Y, Seto Y. No association between hospital volume and short-term outcomes of some common surgeries: a retrospective cohort study based on a Japanese nationwide database. Surg Today 2022; 52:941-952. [DOI: 10.1007/s00595-022-02467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
|
15
|
Is radiological psoas muscle area measurement a predictor of postoperative complications after rectal resection for rectal cancer? A retrospective study. Surg Today 2021; 52:306-315. [PMID: 34309711 DOI: 10.1007/s00595-021-02346-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies have reported that sarcopenia increases the risk of postoperative complications following colorectal resection. This retrospective study assessed the postoperative complications of rectal resection associated with sarcopenia. METHODS We retrospectively analyzed 262 patients who underwent curative low anterior resection for primary rectal cancer from January 2008 to May 2020 at our institution. The patients were divided into a sarcopenia group (normalized total psoas muscle area < 6.36 cm2/m2 in males and < 3.92 cm2/m2 in females; N = 49) and a non-sarcopenia group (N = 213). RESULTS The overall rate of postoperative complications within 30 days of surgery was higher in the sarcopenia group than in the non-sarcopenia group (46.9 vs. 29.6%; P = 0.028). The rate of postoperative remote infections was higher in the sarcopenia group than in the non-sarcopenia group (12.2 vs. 2.8%; P = 0.012). Sarcopenia was found to be a predictor of remote infection by a multivariate analysis (odds ratio, 4.08; 95% confidence interval, 1.12-14.80; P = 0.033). CONCLUSION Sarcopenia diagnosed using the psoas muscle index was found to be an independent predictive factor for postoperative remote infection after curative low anterior resection for rectal cancer.
Collapse
|
16
|
Bergdahl C, Nilsson F, Wennergren D, Ekholm C, Möller M. Completeness in the Swedish Fracture Register and the Swedish National Patient Register: An Assessment of Humeral Fracture Registrations. Clin Epidemiol 2021; 13:325-333. [PMID: 34045902 PMCID: PMC8149280 DOI: 10.2147/clep.s307762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Register-based clinical research is important. However, it is essential that the collected data are reliable for the registers to be a valuable source of information. This study evaluated the quality of humeral fracture data in the Swedish Fracture Register (SFR) and in the Swedish National Patient Register (NPR). Furthermore, a model for improved case ascertainment was developed for future validation processes. Materials and Methods Data were obtained from the NPR and SFR for all individuals aged ≥16 years with an acute humeral fracture ICD-code treated at Sahlgrenska University Hospital. The true number of humeral fractures (“gold standard”) was determined by cross-linkage between the two registers and a medical charts review. The completeness of registrations in each register was measured as the proportion of registrations compared with the gold standard, and accuracy was measured as positive predictive values (PPV). Results The NPR demonstrated a high level of completeness (97%) and lower accuracy (PPV 70%) for acute humeral fractures, whereas the SFR had slightly lower completeness (88%) but perfect accuracy (PPV 100%). The most common systematic error was the registration of re-admissions as acute fractures in the NPR (84% of all erroneous registrations). With this knowledge, an adjustment model for NPR data was constructed to increase the accuracy of fracture registrations (PPV 92%) without excluding valid registrations. Conclusion Data from the NPR tend to overestimate the true number of fractures, and proper case selection is needed in order for the data to function as a solid basis for epidemiological research and healthcare planning. In contrast, the SFR constitutes a complete, accurate and efficient source of information. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/eh0mBFzrWBk
Collapse
Affiliation(s)
- Carl Bergdahl
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Filip Nilsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - David Wennergren
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Carl Ekholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Michael Möller
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| |
Collapse
|
17
|
Maeda H, Endo H, Ichihara N, Miyata H, Hasegawa H, Kamiya K, Kakeji Y, Yoshida K, Seto Y, Yamaue H, Yamamoto M, Kitagawa Y, Uemura S, Hanazaki K. Association of day of the week with mortality after elective right hemicolectomy for colon cancer: Case analysis from the National Clinical Database. Ann Gastroenterol Surg 2021; 5:331-337. [PMID: 34095723 PMCID: PMC8164462 DOI: 10.1002/ags3.12420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/07/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022] Open
Abstract
AIM We aimed to investigate whether later weekdays are related to worse short-term outcomes after elective right hemicolectomy for colon cancer. METHODS We retrospectively analyzed adult patients who underwent elective right hemicolectomy for colon cancer between 2012 and 2017. Records lacking details about surgical mortality were excluded, and multiple imputation was performed for other missing data (variables). The primary endpoint was surgical mortality, defined as the sum of 30-day mortality and in-hospital deaths within 90 days postoperatively. Using 22 clinical variables, hierarchal logistic regression modeling with clustering of patients from the same institutes was performed. RESULTS Of the 112 658 patients undergoing elective right hemicolectomy for colon cancer, the 30-day mortality and surgical mortality were 0.6% and 1.1%, respectively. Surgery on Friday was less frequent, accounting for 17.1% of all cases. The occurrence of severe postoperative complications, anastomotic leakage, or unadjusted odds ratio for surgical mortality did not show significant differences between weekdays. A hierarchal logistic regression model identified 19 independent factors for surgical mortality. Adjusted odds ratios for surgical mortality were 1.01 (95% confidence interval: 0.83-1.22, P = .915), 0.86 (95% confidence interval: 0.71-1.05, P = .144), 0.86 (95% confidence interval: 0.71-1.05, P = .408), and 0.83 (95% confidence interval: 0.68-1.03, P = .176) for Tuesday, Wednesday, Thursday, and Friday, respectively, showing no significant differences. CONCLUSION This study did not identify an evident difference in surgical mortality between weekdays; a safe elective right hemicolectomy for colon cancer is being offered throughout the week in Japan.
Collapse
Affiliation(s)
| | - Hideki Endo
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Nao Ichihara
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Hiroaki Miyata
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Hiroshi Hasegawa
- Project Management SubcommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Kinji Kamiya
- Project Management SubcommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Yoshihiro Kakeji
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Kazuhiro Yoshida
- Department of Surgical OncologyGraduate School of MedicineGifu UniversityGifuJapan
| | - Yasuyuki Seto
- Department of Gastrointestinal SurgeryGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Hiroki Yamaue
- Second Department of SurgerySchool of MedicineWakayama Medical UniversityWakayamaJapan
| | - Masakazu Yamamoto
- Department of SurgeryInstitute of GastroenterologyTokyo Women's Medical UniversityShinjuku‐kuJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Sunao Uemura
- Department of SurgeryKochi Medical SchoolNankokuJapan
| | | |
Collapse
|
18
|
Hosaka A, Kumamaru H, Takahashi A, Azuma N, Obara H, Miyata T, Obitsu Y, Zempo N, Miyata H, Komori K. Nationwide study of surgery for primary infected abdominal aortic and common iliac artery aneurysms. Br J Surg 2021; 108:286-295. [PMID: 33793720 DOI: 10.1093/bjs/znaa090] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/10/2020] [Accepted: 10/22/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Primary infected aneurysms of the abdominal aorta and iliac arteries are potentially life-threatening. However, because of the rarity of the disease, its pathogenesis and optimal treatment strategy remain poorly defined. METHODS A nationwide retrospective cohort study investigated patients who underwent surgical treatment for a primary infected abdominal aortic and/or common iliac artery (CIA) aneurysm between 2011 and 2017 using a Japanese clinical registry. The study evaluated the relationships between preoperative factors and postoperative outcomes including 90-day and 3-year mortality, and persistent or recurrent aneurysm-related infection. Propensity score matching was used to compare survival between patients who underwent in situ prosthetic grafting and those who had endovascular aneurysm repair (EVAR). RESULTS Some 862 patients were included in the analysis. Preceding infection was identified in 30.2 per cent of the patients. The median duration of postoperative follow-up was 639 days. Cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years and 5 years were 94.0, 89.7, 82.6, 74.9 and 68.5 per cent respectively. Age, preoperative shock and hypoalbuminaemia were independently associated with short-term and late mortality. Compared with open repair, EVAR was more closely associated with persistent or recurrent aneurysm-related infection (odds ratio 2.76, 95 per cent c.i. 1.67 to 4.58; P < 0.001). Propensity score-matched analyses demonstrated no significant differences between EVAR and in situ graft replacement in terms of 3-year all-cause and aorta-related mortality rates (P = 0.093 and P =0.472 respectively). CONCLUSION In patients undergoing surgical intervention for primary infected abdominal aortic and CIA aneursyms, postoperative survival rates were encouraging. Eradication of infection following EVAR appeared less likely than with open repair, but survival rates were similar in matched patients between EVAR and in situ graft replacement.
Collapse
Affiliation(s)
- A Hosaka
- Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Centre, Tokyo, Japan
| | - H Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - A Takahashi
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - N Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - H Obara
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - T Miyata
- Department of Medical Education, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Y Obitsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - N Zempo
- Division of Vascular Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - H Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - K Komori
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, Nagoya University, Aichi, Japan
| |
Collapse
|
19
|
Miyata T, Mii S, Kumamaru H, Takahashi A, Miyata H. Risk prediction model for early outcomes of revascularization for chronic limb-threatening ischaemia. Br J Surg 2021; 108:941-950. [PMID: 33693591 DOI: 10.1093/bjs/znab036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/15/2020] [Accepted: 01/17/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Quantifying the risks and benefits of revascularization for chronic limb-threatening ischaemia (CLTI) is important. The aim of this study was to create a risk prediction model for treatment outcomes 30 days after revascularization in patients with CLTI. METHODS Consecutive patients with CLTI who had undergone revascularization between 2013 and 2016 were collected from the JAPAN Critical Limb Ischemia Database (JCLIMB). The cohort was divided into a development and a validation cohort. In the development cohort, multivariable risk models were constructed to predict major amputation and/or death and major adverse limb events using least absolute shrinkage and selection operator logistic regression. This developed model was applied to the validation cohort and its performance was evaluated using c-statistic and calibration plots. RESULTS Some 2906 patients were included in the analysis. The major amputation and/or mortality rate within 30 days of arterial reconstruction was 5.0 per cent (144 of 2906), and strong predictors were abnormal white blood cell count, emergency procedure, congestive heart failure, body temperature of 38°C or above, and hemodialysis. Conversely, moderate, low or no risk in the Geriatric Nutritional Risk Index (GNRI) and ambulatory status were associated with improved results. The c-statistic value was 0.82 with high prediction accuracy. The rate of major adverse limb events was 6.4 per cent (185 of 2906), and strong predictors were abnormal white blood cell count and body temperature of 38°C or above. Moderate, low or no risk in the GNRI, and age greater than 84 years were associated with improved results. The c-statistic value was 0.79, with high prediction accuracy. CONCLUSION This risk prediction model can help in deciding on the treatment strategy in patients with CLTI and serve as an index for evaluating the quality of each medical facility.
Collapse
Affiliation(s)
- T Miyata
- Office of Medical Education, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - S Mii
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, Fukuoka, Japan
| | - H Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - A Takahashi
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - H Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | |
Collapse
|
20
|
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.
Collapse
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.
| |
Collapse
|
21
|
Certified thoracic surgeons in Japan: a national database survey on risk-adjusted mortality associated with lung resection. Surg Today 2021; 51:1268-1275. [PMID: 33515364 DOI: 10.1007/s00595-021-02227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We investigated the association between the number of certified general thoracic surgeons (GTSs) and the mortality after lung cancer surgery, based on the data from the National Clinical Database (NCD). METHODS We analyzed the characteristics and operative and postoperative data of 120,946 patients who underwent lung cancer surgery in one of the 905 hospitals in Japan. The number of GTSs in each hospital was categorized as 0, 1-2, or 3 or more. Multivariable analysis was applied to adjust the patients' preoperative risk factors, as identified in a previous study. We calculated 95% confidence intervals (CI) for the mortality rate based on the odds ratios (ORs). RESULTS The patients' characteristics were distributed almost uniformly regardless of the number of GTSs. Crude mortality according to the number of GTSs of 0, 1-2, or 3 or more was 0.9%, 0.8%, and 0.7%, respectively (p = 0.03). However, after adjustment, the ORs for 1-2 and 3 or more GTSs (reference: 0) were 0.86 (p = 0.23, 95% CI: 0.67-1.10) and 0.84 (p = 0.18, 95% CI: 0.64-1.09), respectively. The number of GTSs did not have a significant association with mortality. Similar results were observed for patients in the lobectomy cohort. CONCLUSION Low surgical mortality was consistent, regardless of the number of GTSs in each hospital.
Collapse
|
22
|
Oshiro T, Kasama K, Nabekura T, Sato Y, Kitahara T, Matsunaga R, Arai M, Kadoya K, Nagashima M, Okazumi S. Current Status and Issues Associated with Bariatric and Metabolic Surgeries in Japan. Obes Surg 2021; 31:343-349. [PMID: 33170443 PMCID: PMC7808999 DOI: 10.1007/s11695-020-05056-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022]
Abstract
Among Asian countries, laparotomic and laparoscopic bariatric surgeries were introduced in Japan after its establishment in Taiwan. However, despite high prevalence of potential patients with obesity and diabetes, the wider incorporation of surgery into treatment regimen has been stalling for decades in Japan. While the unique Japanese national health insurance system has guaranteed fair healthcare delivery, it might have worked as a barrier to the development of bariatric and metabolic surgeries (BMS). The present article reviews the status of BMS in Japan and discusses recent issues related to its use. To focus on and identify the major obstacles inhibiting the widespread use of BMS, we have comprehensively covered some major areas including the insurance system, surgical indication, accreditation and training system, original research, and national registry.
Collapse
Affiliation(s)
- Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Taiki Nabekura
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Yu Sato
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Tomoaki Kitahara
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Rie Matsunaga
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Motoaki Arai
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Kengo Kadoya
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Makoto Nagashima
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741 Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741 Japan
| |
Collapse
|
23
|
Hoshino N, Endo H, Hida K, Ichihara N, Takahashi Y, Hasegawa H, Kimura T, Kitagawa Y, Kakeji Y, Miyata H, Nakayama T, Sakai Y. Emergency surgery for gastrointestinal cancer: A nationwide study in Japan based on the National Clinical Database. Ann Gastroenterol Surg 2020; 4:549-561. [PMID: 33005850 PMCID: PMC7511565 DOI: 10.1002/ags3.12353] [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: 03/04/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Emergency gastrointestinal surgery, although rare, is known for its high mortality and morbidity. However, the risks of emergency surgery for gastrointestinal cancer have not been investigated in depth. This study aimed to investigate the impact of emergency surgery on mortality and morbidity in patients with gastrointestinal cancers and to identify associated risk factors. METHODS We extracted data from the National Clinical Database, a nationwide surgery registration system in Japan, for patients with gastrointestinal cancer who underwent esophageal resection, total gastrectomy, distal gastrectomy, right hemicolectomy, or low anterior resection between 2012 and 2017. The impacts of emergency surgery on 30-day mortality and incidence of overall postoperative complications were compared with those of non-emergency surgery. Risk factors for mortality and overall postoperative complications were then sought in patients who underwent emergency surgery. RESULTS Thirty-day mortality and incidence of overall postoperative complications were significantly higher in emergency surgeries for gastric, colon, and rectal cancers than in non-emergency surgeries (odds ratios 4.86-6.98 and 1.68-2.18, respectively; all P < .001). Various risk factors were identified in the group that underwent emergency surgery, including preoperative sepsis and lower body mass index. Some of the risk factors were common to all types of surgery and others were specific to a certain type of surgery. CONCLUSION The actual risk of emergency surgery and the risk factors for overall postoperative complications in emergency cases are shown to serve as a reference for postoperative management. Emergency surgery had an additional burden on patients depending on the type of surgery.
Collapse
Affiliation(s)
- Nobuaki Hoshino
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
- Department of Health InformaticsKyoto University School of Medicine and Public HealthKyotoJapan
| | - Hideki Endo
- Department of Healthcare Quality AssessmentTokyo University Graduate School of MedicineTokyoJapan
| | - Koya Hida
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Nao Ichihara
- Department of Healthcare Quality AssessmentTokyo University Graduate School of MedicineTokyoJapan
| | - Yoshimitsu Takahashi
- Department of Health InformaticsKyoto University School of Medicine and Public HealthKyotoJapan
| | - Hiroshi Hasegawa
- Department of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Toshimoto Kimura
- Department of SurgeryIwate Medical University School of MedicineIwateJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Yoshihiro Kakeji
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroaki Miyata
- Department of Healthcare Quality AssessmentTokyo University Graduate School of MedicineTokyoJapan
| | - Takeo Nakayama
- Department of Health InformaticsKyoto University School of Medicine and Public HealthKyotoJapan
| | - Yoshiharu Sakai
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| |
Collapse
|
24
|
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.
Collapse
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
| | | | | |
Collapse
|
25
|
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
Collapse
|
26
|
Safe Dissemination of Laparoscopic Liver Resection in 27,146 Cases Between 2011 and 2017 From the National Clinical Database of Japan. Ann Surg 2020; 274:1043-1050. [DOI: 10.1097/sla.0000000000003799] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
|
27
|
Hashimoto D, Mizuma M, Kumamaru H, Miyata H, Chikamoto A, Igarashi H, Itoi T, Egawa S, Kodama Y, Satoi S, Hamada S, Mizumoto K, Yamaue H, Yamamoto M, Kakeji Y, Seto Y, Baba H, Unno M, Shimosegawa T, Okazaki K. Risk model for severe postoperative complications after total pancreatectomy based on a nationwide clinical database. Br J Surg 2020; 107:734-742. [PMID: 32003458 DOI: 10.1002/bjs.11437] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/18/2019] [Accepted: 10/28/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Total pancreatectomy is required to completely clear tumours that are locally advanced or located in the centre of the pancreas. However, reports describing clinical outcomes after total pancreatectomy are rare. The aim of this retrospective observational study was to assess clinical outcomes following total pancreatectomy using a nationwide registry and to create a risk model for severe postoperative complications. METHODS Patients who underwent total pancreatectomy from 2013 to 2017, and who were recorded in the Japan Society of Gastroenterological Surgery and Japanese Society of Hepato-Biliary-Pancreatic Surgery database, were included. Severe complications at 30 days were defined as those with a Clavien-Dindo grade III needing reoperation, or grade IV-V. Occurrence of severe complications was modelled using data from patients treated from 2013 to 2016, and the accuracy of the model tested among patients from 2017 using c-statistics and a calibration plot. RESULTS A total of 2167 patients undergoing total pancreatectomy were included. Postoperative 30-day and in-hospital mortality rates were 1·0 per cent (22 of 2167 patients) and 2·7 per cent (58 of 167) respectively, and severe complications developed in 6·0 per cent (131 of 2167). Factors showing a strong positive association with outcome in this risk model were the ASA performance status grade and combined arterial resection. In the test cohort, the c-statistic of the model was 0·70 (95 per cent c.i. 0·59 to 0·81). CONCLUSION The risk model may be used to predict severe complications after total pancreatectomy.
Collapse
Affiliation(s)
- D Hashimoto
- Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.,Department of Gastroenterological Surgery, Omuta Tenryo Hospital, Fukuoka, Japan
| | - M Mizuma
- Department of Surgery, Tohoku University, Miyagi, Japan
| | - H Kumamaru
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan
| | - H Miyata
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan.,Department of Health Policy and Management, Keio University, Tokyo, Japan
| | - A Chikamoto
- Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan
| | - H Igarashi
- Department of Medicine and Bioregulatory Science, Kyushu University, Fukuoka, Japan
| | - T Itoi
- Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan
| | - S Egawa
- Division of International Cooperation for Disaster Medicine, Tohoku University, Miyagi, Japan
| | - Y Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University, Kobe, Japan
| | - S Satoi
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - S Hamada
- Division of Gastroenterology, Tohoku University, Miyagi, Japan
| | - K Mizumoto
- Cancer Centre, Kyushu University Hospital, Fukuoka, Japan
| | - H Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - M Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Y Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University, Kobe, Japan
| | - Y Seto
- Department of Gastrointestinal Surgery, University of Tokyo, Tokyo, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan
| | - M Unno
- Department of Surgery, Tohoku University, Miyagi, Japan
| | - T Shimosegawa
- Department of Gastroenterology, South Miyagi Medical Centre, Miyagi, Japan
| | - K Okazaki
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
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
| |
Collapse
|