Definition of the objective threshold of pancreatoduodenectomy with nationwide data systems

Kohei Nakata, Hiroyuki Yamamoto, Hiroaki Miyata, Yoshihiro Kakeji, Yasuyuki Seto, Hiroki Yamaue, Masakazu Yamamoto, Masafumi Nakamura

研究成果: Contribution to journalArticle査読

4 被引用数 (Scopus)

抄録

Background: This study aimed to define an objective evidence-based threshold of high-volume hospitals (HVHs) for pancreatoduodenectomy (PD) using nationwide data systems. Methods: A total of 36,453 patients underwent PD in 1,499 hospitals from 2012 to 2015 were collected from the National Clinical Database in Japan. Restricted cubic spline model with risk adjustment was used for definition of an objective evidence-based threshold of HVHs. Results: The restricted cubic spline curve of 30-day and in-hospital mortality showed a continuous decrease with an increase in hospital volume and plateau phase of mortality was detected between approximately 30 and 50 PDs/year. On the basis of this curve, we defined hospitals ≥30 PDs/year as HVHs and ≤29 PDs/year as non-HVHs. We also sub-classified hospitals <5, 5–29, 30–49, and ≥50 PDs/year as low-volume, intermediate-volume, high-volume, and very high-volume hospitals using the spline curve. The odds ratio (OR) of risk-adjusted mortality decreased as hospital volume increased, with an OR of 0.34 for HVHs and 0.26 for very HVHs compared with low-volume hospitals. Conclusions: We consider that this concept is applicable to other high-risk procedures for reducing mortality after these procedures, which could improve medical care and health services.

本文言語英語
ページ(範囲)107-113
ページ数7
ジャーナルJournal of Hepato-Biliary-Pancreatic Sciences
27
3
DOI
出版ステータス出版済み - 3 1 2020

All Science Journal Classification (ASJC) codes

  • 外科
  • 肝臓学

フィンガープリント

「Definition of the objective threshold of pancreatoduodenectomy with nationwide data systems」の研究トピックを掘り下げます。これらがまとまってユニークなフィンガープリントを構成します。

引用スタイル