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Mortality, morbidity, and failure to rescue in hepatopancreatoduodenectomy: An analysis of patients registered in the National Clinical Database in Japan
Author(s) -
Endo Itaru,
Hirahara Norimichi,
Miyata Hiroaki,
Yamamoto Hiroyuki,
Matsuyama Ryusei,
Kumamoto Takafumi,
Homma Yuki,
Mori Masaki,
Seto Yasuyuki,
Wakabayashi Go,
Kitagawa Yuko,
Miura Fumihiko,
Kokudo Norihiro,
Kosuge Tomoo,
Nagino Masato,
Horiguchi Akihiko,
Hirano Satoshi,
Yamaue Hiroki,
Yamamoto Masakazu,
Miyazaki Masaru
Publication year - 2021
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.918
Subject(s) - medicine , certification , logistic regression , mortality rate , board certification , surgery , hepatectomy , complication , emergency medicine , database , continuing education , residency training , management , resection , computer science , medical education , economics
Abstract 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.