Significance of the board-certified surgeon systems and clinical practice guideline adherence to surgical treatment of esophageal cancer in Japan: a questionnaire survey of departments registered in the National Clinical Database
Significance of the board-certified surgeon systems and clinical practice guideline adherence to surgical treatment of esophageal cancer in Japan: a questionnaire survey of departments registered in the National Clinical Database
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DOI：
10.1007/s10388-019-00672-1
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发表时间：
2019-10-01
期刊：
影响因子：
2.4
通讯作者：
Seto, Yasuyuki
中科院分区：
文献类型：
--
作者：
Toh, Yasushi;Yamamoto, Hiroyuki;Seto, Yasuyuki
背景在日本，食管癌的医疗机构结构和临床实践指南的实施过程在多大程度上能提高手术结果的质量仍是未知的。方法对2014年10月至2015年1月登记在日本国家临床数据库的科室进行网络问卷调查。质量指标（QIs）包括结构和过程指标（临床实践指南依从性），对2013年和2014年数据库中登记的食管切除术和重建患者的手术死亡率（AOR）的风险调整优势比进行评估。结果在916个科室中，有454个科室（49.6%）回答了问卷调查。对6661例病例的分析显示，两种结构QIs（日本食管学会认证的培训医院和委员会认证的食管外科医生的存在）与AOR显著降低相关（分别p < 0.001和p = 0.005）。术前化疗的一个高度推荐的过程QI与较低的AOR有很强的相关性（p = 0.053）。在两个过程QIs中，回答“遵医嘱执行”对预后有显著的负面影响，说明制度统一性的重要性。结论日本食道外科医师认证培训机构和食道外科医师参与的医疗机构结构改善了手术效果。建立适当的质量指标并统一实施，对今后提高食管切除术医疗质量至关重要。
Background It remains unknown how much institutional medical structure and process of implementation of clinical practice guidelines for esophageal cancers can improve quality of surgical outcome in Japan. Methods A web-based questionnaire survey was performed for departments registered in the National Clinical Database in Japan from October 2014 to January 2015. Quality indicators (QIs) including structure and process indicators (clinical practice guideline adherence) were evaluated on the risk-adjusted odds ratio for operative mortality (AOR) of the patients using registered cases in the database who underwent esophagectomy and reconstruction in 2013 and 2014. Results Among 916 departments which registered at least one esophagectomy case during the study period, 454 departments (49.6%) responded to the questionnaire. Analyses of 6661 cases revealed that two structure QIs (certification of training hospitals by Japan Esophageal Society and presence of board-certified esophageal surgeons) were associated with significantly lower AOR (p < 0.001 and p = 0.005, respectively). One highly recommended process QI regarding preoperative chemotherapy had strong tendency to associate with lower AOR (p = 0.053). In two process QIs, the answer "performed at the doctor's discretion" showed a significant negative impact on prognosis, suggesting importance of institutional uniformity. Conclusions The medical institutional structure of board-certified training sites for esophageal surgeons and of participation of board-certified esophageal surgeons improves surgical outcome in Japan. Establishment of appropriate QIs and their uniform implementation would be crucial for future quality improvement of medical care in esophagectomy.