A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database.
A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database.
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在日本国家临床数据库中，由于不同医院的结直肠穿孔而引起的外科手术死亡率与10,090例病例的数据进行了比较。
DOI：
10.1097/md.0000000000005818
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发表时间：
2017-01
期刊：
影响因子：
1.6
通讯作者：
Hirata K
中科院分区：
文献类型：
--
作者：
Ohki T;Yamamoto M;Miyata H;Sato Y;Saida Y;Morimoto T;Konno H;Seto Y;Hirata K
结直肠穿孔的死亡率很高。我们使用全国外科数据库的数据，比较了日本不同医院结直肠穿孔的发病率和死亡率。患者于2011年1月1日至2013年12月31日期间在国家临床数据库（NCD）中登记。通过检查是否发现急性弥漫性腹膜炎（ADP）和与结肠直肠穿孔高概率相关的疾病，从手术记录中确定结肠直肠穿孔患者。主要结局指标包括术后30天死亡率和结直肠穿孔的手术死亡率。我们分析了两组医院，即专业和非专业之间的预期死亡率（O/E）比的差异，使用logistic回归分析正向选择方法。在研究期间，有10，090例疾病引起的结直肠穿孔。术后年平均病死率为11.36%。专科医院组3884例，非专科医院组6206例。专科医院组的O/E比值（0.9106）显著低于非专科医院组（1.0704）。医院治疗结直肠穿孔的经验水平与O/E比值呈负相关。我们进行了第一项研究，根据全国数据库的数据，调查医院之间结直肠穿孔死亡率的差异。我们的数据表明，结直肠穿孔患者应选择在专科医院或每年治疗5例或5例以上结直肠穿孔的医院接受治疗。研究结果表明，专科医院可以提供更高质量的医疗服务，这也证明了政府的医疗政策对改善日本的医疗体系是有效的。
Colorectal perforation has a high rate of mortality. We compared the incidence and fatality rates of colorectal perforation among different hospitals in Japan using data from the nationwide surgical database. Patients were registered in the National Clinical Database (NCD) between January 1st, 2011 and December 31st, 2013. Patients with colorectal perforation were identified from surgery records by examining if acute diffuse peritonitis (ADP) and diseases associated with a high probability of colorectal perforation were noted. The primary outcome measures included the 30-day postsurgery mortality and surgical mortality of colorectal perforation. We analyzed differences in the observed-to-expected mortality (O/E) ratio between the two groups of hospitals, that is, specialized and non-specialized, using the logistic regression analysis forward selection method. There were 10,090 cases of disease-induced colorectal perforation during the study period. The annual average postoperative fatality rate was 11.36%. There were 3884 patients in the specialized hospital group and 6206 in the non-specialized hospital group. The O/E ratio (0.9106) was significantly lower in the specialized hospital group than in the non-specialized hospital group (1.0704). The experience level of hospitals in treating cases of colorectal perforation negatively correlated with the O/E ratio. We conducted the first study investigating differences among hospitals with respect to their fatality rate of colorectal perforation on the basis of data from a nationwide database. Our data suggest that patients with colorectal perforation should choose to be treated at a specialized hospital or a hospital that treats five or more cases of colorectal perforation per year. The results of this study indicate that specialized hospitals may provide higher quality medical care, which in turn proves that government policy on healthcare is effective at improving the medical system in Japan.