Validation of the board certification system for expert surgeons (hepato-biliary-pancreatic field) using the data of the National Clinical Database of Japan: part 1-Hepatectomy of more than one segment

被引:43
作者
Miura, Fumihiko [1 ]
Yamamoto, Masakazu [1 ]
Gotoh, Mitsukazu [2 ]
Konno, Hiroyuki [2 ]
Fujimoto, Jiro [1 ]
Yanaga, Katsuhiko [1 ]
Kokudo, Norihiro [1 ]
Yamaue, Hiroki [1 ]
Wakabayashi, Go [1 ]
Seto, Yasuyuki [3 ]
Unno, Michiaki [1 ]
Miyata, Hiroaki [2 ,4 ]
Hirahara, Norimichi [4 ]
Miyazaki, Masaru [5 ]
机构
[1] Japanese Soc Hepatobiliary Pancreat Surg, Comm Board Certificat Syst Expert Surg, Tokyo, Japan
[2] Japanese Soc Gastroenterol Surg, Database Comm, Tokyo, Japan
[3] Japanese Soc Gastroenterol Surg, Tokyo, Japan
[4] Keio Univ, Sch Med, Dept Hlth Policy & Management, Tokyo, Japan
[5] Japanese Soc Hepatobiliary Pancreat Surg, Tokyo, Japan
关键词
Board certification; Centralization; Hepatectomy; Hepato-biliary-pancreatic surgery; High-volume hospital; Pancreatoduodenectomy; HIGHLY ADVANCED SURGERY; HOSPITAL VOLUME; OPERATIVE MORTALITY; CANCER-SURGERY; RESECTION; HEPATOBILIARY; DISPARITIES; SURVIVAL; OUTCOMES; TRENDS;
D O I
10.1002/jhbp.344
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BackgroundThe objective of this study was to validate the board certification system of the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) using the data of hepatectomy cases from the National Clinical Database (NCD) of Japan. MethodsMinimal required annual numbers of high-level hepato-biliary-pancreatic (HBP) surgeries were 50 for a board-certified A training institution and 30 for a board-certified B training institution. Records of 14,970 patients who had undergone hepatectomy of more than one segment (MOS), excluding lateral segmentectomy, during 2011 and 2012 were analyzed according to the category of board-certified institution and with or without participation of board-certified instructors or expert surgeons. ResultsThirty-day mortality and operative mortality of 14,970 patients after MOS hepatectomy were 1.9% and 3.8%, respectively. Operative mortality rates after MOS hepatectomies performed at certified A institutions, certified B institutions, and non-certified institutions were 3.1%, 3.8%, and 4.5%, respectively (P < 0.001). The operative mortality rates after MOS hepatectomies performed with participation of certified instructors or expert surgeons were better than those without (3.5% vs. 4.3%, P = 0.012). A multiple logistic regression model showed that the cutoffs of high-level HBP surgeries performed per year at hospitals that predicted operative mortality after MOS hepatectomies were 10 and 50. ConclusionsCompetences and requirements for board-certified institutions, instructors, and expert surgeons to perform hepatectomy were found to be appropriate.
引用
收藏
页码:313 / 323
页数:11
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