Changes in operative trends and short‐term outcomes of surgery for congenital biliary dilatation in adults using real‐world data: A multilevel analysis based on a nationwide administrative database in Japan

Abstract

Aim We aimed to evaluate the operative trends and compare the short‐term outcomes between open and laparoscopic surgery for congenital biliary dilatation (CBD) in adults using real‐world data from Japan. Methods Data from the Japanese Diagnosis Procedure Combination database on 941 patients undergoing surgery for CBD at 357 hospitals from April 1, 2016, to March 31, 2021, were analyzed. The patients were divided into two groups: open surgery (n = 764) and laparoscopic surgery (n = 177). We performed a retrospective analysis via a multilevel analysis of the short‐term surgical outcomes and costs between open and laparoscopic surgery. Results The rate of laparoscopic surgery has been increasing annually and had almost doubled to 25% by 2021. There were no significant differences in the in‐hospital mortality rate or postoperative morbidity between the two groups. The length of anesthesia was significantly longer in the laparoscopic than open surgery group (8.80 vs 6.16 hours, p < .001). The time to removal of the abdominal drain and length of hospital stay were significantly shorter in the laparoscopic than open surgery group (6.12 vs 8.35 days, p = .001 and 13.57 vs 15.79 days, p < .001, respectively). The coefficient for cost was 463 235 yen (95% confidence interval, 289 679‐636 792) higher in laparoscopic than open surgery ( p < .001). Conclusion The short‐term results were comparable between laparoscopic and open surgery for CBD. Further investigation is needed to validate our findings and long‐term outcomes.

How to interpret the results of clinical studies: “Multicenter cutting‐edge study” or “real‐world big data study”?

“…Using the DPC database on 941 patients undergoing surgery for congenital biliary dilatation (CBD) at 357 hospitals, Mori et al have demonstrated that laparoscopic surgery (177 patients) for CBD had short‐term results comparable to those of open surgery (764 patients), while high cost of laparoscopic surgery is an issue that requires further research to solve (DOI:10.1002/ags3.12630). 3 By using DPC data and analyzing through PSM, Oba et al compared the efficacy and safety of mechanical bowel preparation (MBP, 1756 cases) alone and MBP combined with oral antibiotic bowel preparation (MOABP, 1756 cases) for rectal cancer surgery (DOI:10.1002/ags3.12641). 4 While there has been a trend to simplify preoperative preparation before colorectal surgery due to the prevalence of enhanced recovery after surgery program, this study has shown the “ real‐world ” information that MOABP for rectal surgery was associated with a decreased incidence of postoperative complications without increasing the incidence of Clostridium difficile colitis and methicillin‐resistant Staphylococcus aureus colitis (DOI:10.1002/ags3.12641).…”

“…By extracting and examining the necessary information from “ big data ” of the DPC database, which is known as Japan's nationwide administrative database, we can truly see the current “ real‐world ” situation of the topic. Using the DPC database on 941 patients undergoing surgery for congenital biliary dilatation (CBD) at 357 hospitals, Mori et al have demonstrated that laparoscopic surgery (177 patients) for CBD had short‐term results comparable to those of open surgery (764 patients), while high cost of laparoscopic surgery is an issue that requires further research to solve (DOI:10.1002/ags3.12630) 3 . By using DPC data and analyzing through PSM, Oba et al compared the efficacy and safety of mechanical bowel preparation (MBP, 1756 cases) alone and MBP combined with oral antibiotic bowel preparation (MOABP, 1756 cases) for rectal cancer surgery (DOI:10.1002/ags3.12641) 4 .…”