Surgical risk model for acute diffuse peritonitis based on a Japanese nationwide database: an initial report on the surgical and 30-day mortality
Surgical risk model for acute diffuse peritonitis based on a Japanese nationwide database: an initial report on the surgical and 30-day mortality
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DOI：
10.1007/s00595-014-1026-x
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发表时间：
2015-10-01
期刊：
影响因子：
2.5
通讯作者：
Mori, Masaki
中科院分区：
文献类型：
--
作者：
Nakagoe, Tohru;Miyata, Hiroaki;Mori, Masaki
急性弥漫性腹膜炎（ADP）是一种重要的手术并发症，与高发病率和死亡率相关;然而，与不良结局相关的风险因素仍存在争议。本研究的目的是使用基于网络的国家数据库系统收集综合数据，以建立ADP术后死亡率的风险模型。我们纳入了日本国家临床数据库中登记的病例。数据整理后，分析了2011年1月1日至12月31日期间1，285家医院的8，482例ADP手术病例，原始30天和手术死亡率分别为9.0%和14.1%。30天死亡率的比值比（> 2.0）如下：美国麻醉医师协会（阿萨）3级，2.69;阿萨4级，4.28;阿萨5级，8.65;既往经皮冠状动脉介入治疗（PCI），2.05;既往外周血管疾病（PVD）手术，2.45和播散性癌症，2.16。手术死亡率的比值比（> 2.0）如下：阿萨3级，2.27;阿萨4级，4.67;阿萨5级，6.54;播散性癌症，2.09。30天和手术死亡率的C指数分别为0.851和0.852，这是第一份使用全国手术数据库对ADP手术后进行危险分层的报告。该系统可用于预测ADP手术的结果，并用于评估和基准性能研究。
Acute diffuse peritonitis (ADP) is an important surgical complication associated with high morbidity and mortality; however, the risk factors associated with a poor outcome have remained controversial. This study aimed in collecting integrated data using a web-based national database system to build a risk model for mortality after surgery for ADP.We included cases registered in the National Clinical Database in Japan. After data cleanup, 8,482 surgical cases of ADP from 1,285 hospitals treated between January 1 and December 31, 2011 were analyzed.The raw 30-day and surgical mortality rates were 9.0 and 14.1 %, respectively. The odds ratios (> 2.0) for 30-day mortality were as follows: American Society of Anesthesiologists (ASA) class 3, 2.69; ASA class 4, 4.28; ASA class 5, 8.65; previous percutaneous coronary intervention (PCI), 2.05; previous surgery for peripheral vascular disease (PVD), 2.45 and disseminated cancer, 2.16. The odds ratios (> 2.0) for surgical mortality were as follows: ASA class 3, 2.27; ASA class 4, 4.67; ASA class 5, 6.54, and disseminated cancer, 2.09. The C-indices of 30-day and surgical mortality were 0.851 and 0.852, respectively.This is the first report of risk stratification after surgery for ADP using a nationwide surgical database. This system could be useful to predict the outcome of surgery for ADP and for evaluations and benchmark performance studies.