Risk Models of Operative Morbidities in 16,930 Critically Ill Surgical Patients Based on a Japanese Nationwide Database

Saze, Zenichiro; Matsubara, Hiroaki; Konno, Hiroyuki; Gotoh, Mitsukazu; Anazawa, Takayuki; Tomotaki, Ai; Wakabayashi, Go; Mori, Masaki

doi:10.1097/md.0000000000001224

Cited by 16 publications

(21 citation statements)

References 36 publications

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“…All data including variables, definitions, and inclusion criteria for the NCD are accessible online (http://www.ncd.or.jp) to participating hospitals. Risk models for certain procedures such as ADP surgery, [11,12] esophagectomy, [13] total gastrectomy, [14] right hemicolectomy, [15] hepatectomy, [16] and pancreaticoduodenectomy [17] have been created using these data. A risk-adjusted analysis on the basis of NCD data has provided feedback to NCD users on patients’ operative risk.…”

Section: Discussionmentioning

confidence: 99%

A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database

et al. 2017

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Colorectal perforation has a high rate of mortality. We compared the incidence and fatality rates of colorectal perforation among different hospitals in Japan using data from the nationwide surgical database.Patients were registered in the National Clinical Database (NCD) between January 1st, 2011 and December 31st, 2013. Patients with colorectal perforation were identified from surgery records by examining if acute diffuse peritonitis (ADP) and diseases associated with a high probability of colorectal perforation were noted. The primary outcome measures included the 30-day postsurgery mortality and surgical mortality of colorectal perforation. We analyzed differences in the observed-to-expected mortality (O/E) ratio between the two groups of hospitals, that is, specialized and non-specialized, using the logistic regression analysis forward selection method.There were 10,090 cases of disease-induced colorectal perforation during the study period. The annual average postoperative fatality rate was 11.36%. There were 3884 patients in the specialized hospital group and 6206 in the non-specialized hospital group. The O/E ratio (0.9106) was significantly lower in the specialized hospital group than in the non-specialized hospital group (1.0704). The experience level of hospitals in treating cases of colorectal perforation negatively correlated with the O/E ratio.We conducted the first study investigating differences among hospitals with respect to their fatality rate of colorectal perforation on the basis of data from a nationwide database. Our data suggest that patients with colorectal perforation should choose to be treated at a specialized hospital or a hospital that treats five or more cases of colorectal perforation per year. The results of this study indicate that specialized hospitals may provide higher quality medical care, which in turn proves that government policy on healthcare is effective at improving the medical system in Japan.

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Section: Discussionmentioning

confidence: 99%

A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database

et al. 2017

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“…Better or worse outcomes can be detected by the monitoring report. Furthermore, we are proceeding with papers on complications related to each of the eight operative methods for the evaluation of medical standards using data from 2011 and 2012 . To assure collection of high‐quality data, the Japanese Society of Gastroenterological Surgery (JSGS) have started data verification activities for a gastroenterological session in NCD in 2016.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcomes in gastroenterological surgery in Japan: Report of National Clinical database 2011–2016

Kakeji

Takahashi

Udagawa

et al. 2017

Annals of Gastroent Surgery

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The National Clinical Database (NCD) of Japan started its registration in 2011 and over 9 000 000 cases from more than 5000 facilities were registered over a 6‐year period. This is the report of NCD based upon gastrointestinal surgery information in excess of 3 200 000 cases from 2011 to 2016 adding data of complications. About 70% of all gastrointestinal surgeries were carried out at certified institutions, and the percentage of surgeries done at certified institutions was particularly high for the esophagus (92.4% in 2016), liver (88.4%), pancreas (89.8%), and spleen (86.8%). The percentage of anesthesiologist participation was more than 90% for almost all organs, except 85.7% for the rectum and anus. Approximately, more than two‐thirds of the surgeries were carried out with the participation of a board‐certified surgeon. Although patients have been getting older, mortalities have not been increasing. There were differences in the incidence of complications according to organ site and procedure. Remarkably, mortality rates of low anterior resection were very low, and those of hepatectomy and acute diffuse peritonitis surgery have been gradually decreasing. Although the complication rates were gradually increasing for esophagectomy or pancreaticoduodenectomy, the mortality rates for these procedures were decreasing. Nationwide, this database is expected to ensure the quality of the board‐certification system and surgical outcomes in gastroenterological surgery.

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“…Other factors included in Risk for delayed surgical recovery evaluated in this research were not shown significant for surgical recovery, but were strongly supported by evidence and, therefore, could not be disregarded, as ASA score of physical state equal to or greater than 3 (Jakobson et al, 2014;Ricci et al, 2015;Saze et al, 2015); diabetes mellitus (Aga et al, 2015), obesity (Tjeertes et al, 2015); immunosuppressive and chemotherapeutic drugs (Aga et al, 2015), chronic use of corticosteroids, (Huang et al, 2015), trauma at the surgical site (Nicholson, Dowrick, & Liew, 2012), emergency surgeries (Anderson et al, 2014), impaired functional capacity (Aga et al, 2015), and advanced age (Aga et al, 2015;Jakobson et al, 2014;Nicholson, Dowrick & Liew, 2012).…”

Section: Discussionmentioning

confidence: 69%

“…Transfusion of blood products during the intraoperative or in the immediate postoperative period were associated with extended recovery by four times in this study. Several studies have supported the association between the use of blood products and the development of postoperative surgical site infections (Saze et al, 2015;Schwarzkopf et al, 2010). Current theories support that blood transfusions may have modulatory effects on the immune system of the recipients and encourage surgeons to favor a more restrictive policy with regard to transfusions (Schwarzkopf et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Nursing Diagnosis Risk for Delayed Surgical Recovery (00246) in Adult and Elderly: A Case‐Control Study

Rembold

Santana

Lopes

et al. 2020

Int J of Nursing Knowl

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The study's objective was the clinical validation of the nursing diagnosis Risk for delayed surgical recovery (00246). METHOD: Case control study was conducted in a university hospital; the charts of 239 patient, 71 cases and 168 controls. Odds ratio was calculated for the association between each risk factor and the outcome of delayed surgical recovery. RESULTS: Risk factors with higher odds of association were malnutrition, pain, and postoperative emotional response. The associated conditions were perioperative surgical site infection, psychological disorder in the postoperative period, and surgical site contamination. CONCLUSION: Risk factors have different impact on the postoperative recovery. IMPLICATIONS FOR NURSING PRACTICE: Knowing the magnitude of the risk factors allows a decision making best interventions for a fast surgical recovery.

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Risk Models of Operative Morbidities in 16,930 Critically Ill Surgical Patients Based on a Japanese Nationwide Database

Abstract: Supplemental Digital Content is available in the text

Cited by 16 publications

References 36 publications

A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database

A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database

Surgical outcomes in gastroenterological surgery in Japan: Report of National Clinical database 2011–2016

Nursing Diagnosis Risk for Delayed Surgical Recovery (00246) in Adult and Elderly: A Case‐Control Study

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