Mortality, morbidity, and failure to rescue in hepatopancreatoduodenectomy: An analysis of patients registered in the National Clinical Database in Japan.

Autor: Endo I; Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan., Hirahara N; Department of Healthcare Quality Assessment, University of Tokyo, Japan., Miyata H; Department of Healthcare Quality Assessment, University of Tokyo, Japan., Yamamoto H; Department of Healthcare Quality Assessment, University of Tokyo, Japan., Matsuyama R; Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan., Kumamoto T; Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan., Homma Y; Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan., Mori M; The Japanese Society of Gastroenterological Surgery, Tokyo, Japan., Seto Y; The Japanese Society of Gastroenterological Surgery, Tokyo, Japan., Wakabayashi G; The Japanese Society of Gastroenterological Surgery, Tokyo, Japan., Kitagawa Y; The Japanese Society of Gastroenterological Surgery, Tokyo, Japan., Miura F; Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan., Kokudo N; Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan., Kosuge T; Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan., Nagino M; Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan., Horiguchi A; Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan., Hirano S; Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan., Yamaue H; Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan., Yamamoto M; Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan., Miyazaki M; Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Jazyk: angličtina
Zdroj: Journal of hepato-biliary-pancreatic sciences [J Hepatobiliary Pancreat Sci] 2021 Apr; Vol. 28 (4), pp. 305-316. Date of Electronic Publication: 2021 Mar 20.
DOI: 10.1002/jhbp.918
Abstrakt: Background: The high operative mortality rate after hepatopancreatoduodenectomy (HPD) is still a major issue. The present study explored why operative mortality differs significantly due to hospital volume.
Method: Surgical case data were extracted from the National Clinical Database (NCD) in Japan from 2011 to 2014. Surgical procedures were categorized as major (≥2 sections) and minor (<2 sections) hepatectomy. Hospitals were categorized according to the certification system by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) based on the number of major hepato-biliary-pancreatic surgeries performed per year. The FTR rate was defined as death in a patient with at least one postoperative complication.
Results: A total of 422 patients who underwent HPD were analyzed. The operative mortality rates in board-certified A training institutions, board-certified B training institutions, and non-certified institution were 7.2%, 11.6%, and 21.4%, respectively. Multiple logistic regression showed that certified A institutions, major hepatectomy, and blood transfusion were the predictors of operative mortality. Failure to rescue rates were lowest in certified A institutions (9.3%, 17.0%, and 33.3% in certified A, certified B, and non-certified, respectively).
Conclusions: To reduce operative mortality after HPD, further centralization of this procedure is desirable. Future studies should clarify specific ways to improve the failure-to-rescue rates in certified institutions.
(© 2021 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)
Databáze: MEDLINE
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