Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer
Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer
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DOI：
10.1007/s10120-016-0634-0
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发表时间：
2017-05-01
期刊：
影响因子：
7.4
通讯作者：
Mori, Masaki
中科院分区：
文献类型：
--
作者：
Kunisaki, Chikara;Miyata, Hiroaki;Mori, Masaki
大多数远端胃切除术后死亡率和发病率的风险模型都是基于相对较小的回顾性研究建立的，缺乏来自全国数据库的模型。本研究旨在利用日本全国性网络数据库——国家临床数据库（NCD）的数据，确定预测胃癌远端切除术患者术后发病率与死亡率密切相关的术前危险因素。我们分析了NCD在2011年和2012年期间在1986家医院接受远端胃切除术的65,906名患者的记录。使用80%的患者，我们确定了与死亡率密切相关的发病率的独立术前预测因子。然后使用2011年至2012年剩余20%的患者和2013年的35,575份记录验证这些风险因素。手术死亡率为1.07%，总体发病率为14.2%。我们选择了8种与术后死亡率密切相关的疾病，然后为这8种疾病中的每一种确定了13到25种独立的术前危险因素。其中，老年、女性和较差的生活自理能力是与发病率最相关的因素。2011 - 2012年验证数据集各疾病的c -指数为：意外插管（0.797）、肺炎（0.784）、全体性败血症（0.748）、肾功能衰竭（0.832）、心脏事件（0.728）、大量输血（0.700）、中枢神经系统（CNS）事件（0.779）和吻合口漏（0.658）。使用2013年验证数据集获得了每个死亡率的相似c指数。在本研究中，我们成功构建了一个可接受的风险模型，利用术前危险因素预测胃癌患者术后8种与死亡率高度相关的发病率。该风险模型有助于制定围手术期管理和改善远端胃切除术患者的临床结果。
Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan.We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013.Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set.In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. This risk model could help to tailor perioperative management and improve clinical outcomes for patients who undergo distal gastrectomy.