TY - JOUR
T1 - Total gastrectomy risk model
T2 - Data from 20,011 Japanese patients in a nationwide internet-based database
AU - Watanabe, Masayuki
AU - Miyata, Hiroaki
AU - Gotoh, Mitsukazu
AU - Baba, Hideo
AU - Kimura, Wataru
AU - Tomita, Naohiro
AU - Nakagoe, Tohru
AU - Shimada, Mitsuo
AU - Kitagawa, Yuko
AU - Sugihara, Kenichi
AU - Mori, Masaki
PY - 2014/1/1
Y1 - 2014/1/1
N2 - Objective: To construct a risk model for total gastrectomy outcomes using a nationwide Internet-based database. Background: Total gastrectomy is a very common procedure in Japan. This procedure is among themost invasive gastrointestinal procedures and is known to carry substantial surgical risks. Methods: The National Clinical Database was used to retrieve records on more than 1,200,000 surgical cases from 3500 hospitals in 2011. After data cleanup, 20,011 records from 1623 hospitals were analyzed for procedures performed between January 1, 2011, and December 31, 2011. Results: The average patient age was 68.9 years; 73.7% were male. The overall morbidity was 26.2%, with a 30-day mortality rate of 0.9%, in-hospital mortality rate of 2.2%, and overall operative mortality rate of 2.3%. The odds ratios for 30-day mortality were as follows: ASA (American Society of Anesthesiologists) grade 4 or 5, 9.4; preoperative dialysis requirement, 3.9; and platelet count less than 50,000 per microliter, 3.1. The odds ratios for operative mortality were as follows: ASA grade 4 or 5, 5.2; disseminated cancer, 3.5; and alkaline phosphatase level of more than 600 IU/L, 3.1. The C-index of 30-day mortality and operative mortality was 0.811 (95% confidence interval [CI], 0.744-0.879) and 0.824 (95% CI, 0.781-0.866), respectively. Conclusions: We have performed the first reported risk stratification study for total gastrectomy, using a nationwide Internet-based database. The total gastrectomy outcomes in the nationwide populationwere satisfactory. The risk models that we have created will help improve the quality of surgical practice.
AB - Objective: To construct a risk model for total gastrectomy outcomes using a nationwide Internet-based database. Background: Total gastrectomy is a very common procedure in Japan. This procedure is among themost invasive gastrointestinal procedures and is known to carry substantial surgical risks. Methods: The National Clinical Database was used to retrieve records on more than 1,200,000 surgical cases from 3500 hospitals in 2011. After data cleanup, 20,011 records from 1623 hospitals were analyzed for procedures performed between January 1, 2011, and December 31, 2011. Results: The average patient age was 68.9 years; 73.7% were male. The overall morbidity was 26.2%, with a 30-day mortality rate of 0.9%, in-hospital mortality rate of 2.2%, and overall operative mortality rate of 2.3%. The odds ratios for 30-day mortality were as follows: ASA (American Society of Anesthesiologists) grade 4 or 5, 9.4; preoperative dialysis requirement, 3.9; and platelet count less than 50,000 per microliter, 3.1. The odds ratios for operative mortality were as follows: ASA grade 4 or 5, 5.2; disseminated cancer, 3.5; and alkaline phosphatase level of more than 600 IU/L, 3.1. The C-index of 30-day mortality and operative mortality was 0.811 (95% confidence interval [CI], 0.744-0.879) and 0.824 (95% CI, 0.781-0.866), respectively. Conclusions: We have performed the first reported risk stratification study for total gastrectomy, using a nationwide Internet-based database. The total gastrectomy outcomes in the nationwide populationwere satisfactory. The risk models that we have created will help improve the quality of surgical practice.
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U2 - 10.1097/SLA.0000000000000781
DO - 10.1097/SLA.0000000000000781
M3 - Article
C2 - 25072429
AN - SCOPUS:84922334605
VL - 260
SP - 1034
EP - 1039
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 6
ER -