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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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Spari D, Zwicky SN, Yilmaz B, Salm L, Candinas D, Beldi G. Intestinal dysbiosis as an intraoperative predictor of septic complications: evidence from human surgical cohorts and preclinical models of peritoneal sepsis. Sci Rep 2023; 13:22921. [PMID: 38129468 PMCID: PMC10739899 DOI: 10.1038/s41598-023-49034-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
Major surgery exposes the intestinal microbiota to inflammatory and antibiotic stressors, which alter the microbiota composition of the intestinal lumen and fecal contents. However, it is not sufficiently understood, if such dysbiosis develops already during surgery and if alterations in microbiota may be the cause of surgical complications. End-of-surgery composition of the microbiota in the rectum was assessed in 41 patients undergoing either rectal or duodenopancreatic resection and was compared to baseline before surgery using 16S-rRNA sequencing. A subset of patients developed severe dysbiosis at the end of surgery, which was characterized by an overgrowth of the Proteobacteria phylum that includes the facultative pathogen E. coli. To test if dysbiosis impacts on surgical outcomes, dysbiosis was modeled in mice by a single oral administration of vancomycin prior to cecal ligation and puncture. Dysbiosis was associated with impaired post-surgical survival, dysregulation of the host's immune response, elevated bacterial virulence and reduced bacterial metabolism of carbon sources. In conclusion, dysbiosis can be detected already at the end of surgery in a fraction of patients undergoing major surgery. Modelling surgery-associated dysbiosis in mice using single-shot administration of vancomycin induced dysbiosis and resulted in elevated mortality.
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Affiliation(s)
- Daniel Spari
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Simone N Zwicky
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Bahtiyar Yilmaz
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Lilian Salm
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
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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: 13] [Impact Index Per Article: 13.0] [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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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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6
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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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7
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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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8
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Rembold SM, Santana RF, Oliveira Lopes MV, Melo UG. Nursing Diagnosis Risk for Delayed Surgical Recovery (00246) in Adult and Elderly: A Case‐Control Study. Int J Nurs Knowl 2020; 31:268-274. [DOI: 10.1111/2047-3095.12274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Tomotaki A, Kumamaru H, Hashimoto H, Takahashi A, Ono M, Iwanaka T, Miyata H. Evaluating the quality of data from the Japanese National Clinical Database 2011 via a comparison with regional government report data and medical charts. Surg Today 2018; 49:65-71. [PMID: 30088123 DOI: 10.1007/s00595-018-1700-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to examine the quality of data from the National Clinical Database (NCD) via a comparison with regional government report data and medical charts. METHODS A total of 1,165,790 surgical cases from 3007 hospitals were registered in the NCD in 2011. To evaluate the NCD's data coverage, we retrieved regional government report data for specified lung and esophageal surgeries and compared the number with registered cases in the NCD for corresponding procedures. We also randomly selected 21 sites for on-site data verification of eight demographic and surgical data components to assess the accuracy of data entry. RESULTS The numbers of patients registered in the NCD and regional government report were 46,143 and 48,716, respectively, for lung surgeries and 7494 and 8399, respectively, for esophageal surgeries, leading to estimated coverages of 94.7% for lung surgeries and 89.2% for esophageal surgeries. According to on-site verification of 609 cases at 18 sites, the overall agreement between the NCD data components and medical charts was 97.8%. CONCLUSION Approximately, 90-95% of the specified lung surgeries and esophageal surgeries performed in Japan were registered in the NCD in 2011. The NCD data were accurate relative to medical charts.
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Affiliation(s)
- Ai Tomotaki
- Informatics, National College of Nursing, 1-2-1, Umezono, Kiyose-shi, Tokyo, 204-8575, Japan.,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Arata Takahashi
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Minoru Ono
- Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tadashi Iwanaka
- Bureau of Saitama Prefectural Hospitals, 3-13-3 Takasago, Urawa-ku, Saitama-shi, Saitama, 330-0063, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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10
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Yoshida T, Miyata H, Konno H, Kumamaru H, Tangoku A, Furukita Y, Hirahara N, Wakabayashi G, Gotoh M, Mori M. Risk assessment of morbidities after right hemicolectomy based on the National Clinical Database in Japan. Ann Gastroenterol Surg 2018; 2:220-230. [PMID: 29863168 PMCID: PMC5980426 DOI: 10.1002/ags3.12067] [Citation(s) in RCA: 10] [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: 09/13/2017] [Accepted: 02/16/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Nationwide databases are expected to provide critical data to improve medical practice. The present study used such data to develop risk models for clinically important outcomes after right hemicolectomy based on preoperative risk factors. METHODS Japan's National Clinical Database (NCD) identified 38 030 cases of right hemicolectomy in the years 2011 and 2012. These were used to analyze correlations between mortality and eight selected clinical outcomes of interest by Pearson's correlation coefficient (r). To construct risk models for the eight selected clinical outcomes, 80% of all the examined cases were extracted randomly as a development cohort, and preoperative risk factors for each clinical outcome were identified using a forward stepwise selection method. Morbidities predicted from the risk models were used to find areas under the receiver operator curves among the remaining 20% of the testing cohort. RESULTS The following clinical outcomes were identified as highly associated with operative mortality: systemic sepsis (r = .360), renal failure (r = .341), unplanned intubation (r = .316) and central nervous system (CNS) occurrences (r = .301). Risk models containing up to 21 preoperative variables were constructed for these eight postoperative clinical outcomes. Predictive values of the eight models were as follows: surgical site infections (0.634), anastomotic leakage (0.656), systemic sepsis (0.816), pneumonia (0.846), unplanned intubation (0.838), renal failure (0.883), CNS occurrences (0.833) and transfusion >5 units (0.846). CONCLUSIONS This study indicated that the NCD-generated risk models for six of the eight selected critical postoperative outcomes had high discrimination among right hemicolectomy patients. These risk models can accurately identify high-risk patients prior to surgery.
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Affiliation(s)
- Takahiro Yoshida
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
| | - Hiroaki Miyata
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
| | - Hiraku Kumamaru
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Akira Tangoku
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
| | - Yoshihito Furukita
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
| | | | - Go Wakabayashi
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
| | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological SurgeryDatabase Committee Working GroupTokyoJapan
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
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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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12
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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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13
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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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14
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Montravers P, Blot S, Dimopoulos G, Eckmann C, Eggimann P, Guirao X, Paiva JA, Sganga G, De Waele J. Therapeutic management of peritonitis: a comprehensive guide for intensivists. Intensive Care Med 2016; 42:1234-47. [PMID: 26984317 DOI: 10.1007/s00134-016-4307-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/04/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE The management of peritonitis in critically ill patients is becoming increasingly complex due to their changing characteristics and the growing prevalence of multidrug-resistant (MDR) bacteria. METHODS A multidisciplinary panel summarizes the latest advances in the therapeutic management of these critically ill patients. RESULTS Appendicitis, cholecystitis and bowel perforation represent the majority of all community-acquired infections, while most cases of healthcare-associated infections occur following suture leaks and/or bowel perforation. The micro-organisms involved include a spectrum of Gram-positive and Gram-negative bacteria, as well as anaerobes and fungi. Healthcare-associated infections are associated with an increased likelihood of MDR pathogens. The key elements for success are early and optimal source control and adequate surgery and appropriate antibiotic therapy. Drainage, debridement, abdominal cleansing, irrigation, and control of the source of contamination are the major steps to ensure source control. In life-threatening situations, a "damage control" approach is the safest way to gain time and achieve stability. The initial empirical antiinfective therapy should be prescribed rapidly and must target all of the micro-organisms likely to be involved, including MDR bacteria and fungi, on the basis of the suspected risk factors. Dosage adjustment needs to be based on pharmacokinetic parameters. Supportive care includes pain management, optimization of ventilation, haemodynamic and fluid monitoring, improvement of renal function, nutrition and anticoagulation. CONCLUSIONS The majority of patients with peritonitis develop complications, including worsening of pre-existing organ dysfunction, surgical complications and healthcare-associated infections. The probability of postoperative complications must be taken into account in the decision-making process prior to surgery.
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Affiliation(s)
- P Montravers
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.
| | - S Blot
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
| | - G Dimopoulos
- Department of Critical Care, University Hospital Attikon, Medical School, University of Athens, Athens, Greece
| | - C Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Peine, Germany
| | - P Eggimann
- Department of Intensive Care Medicine and Burn Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - X Guirao
- Department of Endocrine and Head and Neck Surgery, Corporació Sanitaria del Parc Tauli, University Hospital, Sabadell, Barcelona, Spain
| | - J A Paiva
- Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - G Sganga
- Department of Surgery, Catholic University of Sacred Heart, Policlinico A Gemelli, Rome, Italy
| | - J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
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