Mortality After Common Rectal Surgery in Japan: A Study on Low Anterior Resection From a Newly Established Nationwide Large-Scale Clinical Database
Mortality After Common Rectal Surgery in Japan: A Study on Low Anterior Resection From a Newly Established Nationwide Large-Scale Clinical Database
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DOI：
10.1097/dcr.0000000000000176
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发表时间：
2014-09-01
影响因子：
3.9
通讯作者：
Mori, Masaki
中科院分区：
文献类型：
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作者：
Matsubara, Nagahide;Miyata, Hiroaki;Mori, Masaki
背景技术背景：与西方国家相比，日本的医疗保健系统、同质种族和低位直肠癌手术的手术策略在某种程度上是独特的。国家临床数据库是日本新建立的全国性大规模手术数据库。目的：为了阐明日本国家临床护理标准，并为优化患者护理提供依据，我们使用该数据库构建了一个结直肠手术中常见手术-低位直肠癌低位前切除术的风险模型。设计：对2011年期间接受低位前切除术患者的国家临床数据库数据进行了分析。进行多元逻辑回归分析以生成30天死亡率和手术死亡率的预测模型。接收器操作者的特征曲线，并使用一致性指数来评估模型的歧视能力。结果：在研究期间，收集了16,695例接受低前切除术的患者的数据。平均年龄为66.2岁，64.5%为男性; 1.1%需要急诊手术。原始30天死亡率为0.4%，手术死亡率为0.9%。术后吻合口瘘发生率为10.2%。风险模型显示以下变量是30天和手术死亡率的独立风险因素：BMI> 30 kg/m2、既往外周血管疾病、术前输血和播散性癌症。一致性指数为0.77手术死亡率和0.75为30天mortals.Limitations：国家临床数据库是新建立的，数据输入依赖于每家hospital.CONCLUSIONS：这是第一次报告的风险分层低前切除术，代表直肠手术，使用的大型国家手术数据库，我们最近在日本建立。由此产生的直肠手术30天和手术死亡率的风险模型可能为全球接受GI手术的患者提供重要的医疗保健。
BACKGROUND: The health-care system, homogenous ethnicity, and operative strategy for lower rectal cancer surgery in Japan are to some extent unique compared to those in Western countries. The National Clinical Database is a newly established nationwide, large-scale surgical database in Japan.OBJECTIVE: To illuminate Japanese national standards of clinical care and provide a basis for efforts to optimize patient care, we used this database to construct a risk model for a common procedure in colorectal surgery-low anterior resection for lower rectal cancer.DESIGN: Data from the National Clinical Database on patients who underwent low anterior resection during 2011 were analyzed. Multiple logistic regression analyses were performed to generate predictive models of 30-day mortality and operative mortality. Receiver-operator characteristic curves were generated, and the concordance index was used to assess the model's discriminatory ability.RESULTS: During the study period, data from 16,695 patients who had undergone low anterior resection were collected. The mean age was 66.2 years and 64.5% were male; 1.1% required an emergency procedure. Raw 30-day mortality was 0.4% and operative mortality was 0.9%. The postoperative incidence of anastomotic leakage was 10.2%. The risk model showed the following variables to be independent risk factors for both 30-day and operative mortality: BMI greater than 30 kg/m(2), previous peripheral vascular disease, preoperative transfusions, and disseminated cancer. The concordance indices were 0.77 for operative mortality and 0.75 for 30-day mortality.LIMITATIONS: The National Clinical Database is newly established and data entry depends on each hospital.CONCLUSIONS: This is the first report of risk stratification on low anterior resection, as representative of rectal surgery, with the use of the large-scale national surgical database that we have recently established in Japan. The resulting risk models for 30-day and operative mortality from rectal surgery may provide important insights into the delivery of health care for patients undergoing GI surgery worldwide.