Total Gastrectomy Risk Model Data From 20,011 Japanese Patients in a Nationwide Internet-Based Database
Total Gastrectomy Risk Model Data From 20,011 Japanese Patients in a Nationwide Internet-Based Database
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DOI：
10.1097/sla.0000000000000781
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发表时间：
2014-12-01
影响因子：
9
通讯作者：
Mori, Masaki
中科院分区：
文献类型：
--
作者：
Watanabe, Masayuki;Miyata, Hiroaki;Mori, Masaki
目的：建立一个风险模型，全胃切除术的结果，使用一个全国性的互联网为基础的database.Background：全胃切除术是一个非常常见的程序在日本。该程序是最具侵入性的胃肠道程序之一，并被称为进行大量的手术risks.Methods：国家临床数据库被用来检索记录超过120万例手术病例，从3500家医院在2011年。经过数据清理后，分析了2011年1月1日至2011年12月31日期间1623家医院的20，011份记录。结果：患者平均年龄为68.9岁，73.7%为男性。总发病率为26.2%，30天死亡率为0.9%，住院死亡率为2.2%，总手术死亡率为2.3%。30天死亡率的比值比如下：阿萨（美国麻醉医师协会）4级或5级，9.4;术前透析要求，3.9;血小板计数低于50，000/微升，3.1。手术死亡率的比值比如下：阿萨4或5级，5.2;播散性癌症，3.5;碱性磷酸酶水平超过600 IU/L，3.1。30天死亡率和手术死亡率的C指数分别为0.811（95%可信区间[CI]，0.744-0.879）和0.824（95%可信区间，0.781-0.866），respectively.Conclusions：我们已经进行了首次报道的全胃切除术的风险分层研究，使用全国性的互联网数据库。全胃切除术在全国人群中的结局令人满意。我们创建的风险模型将有助于提高外科实践的质量。
Objective: To construct a risk model for total gastrectomy outcomes using a nationwide Internet-based database.Background: Total gastrectomy is a very common procedure in Japan. This procedure is among the most invasive gastrointestinal procedures and is known to carry substantial surgical risks.Methods: The National Clinical Database was used to retrieve records on more than 1,200,000 surgical cases from 3500 hospitals in 2011. After data cleanup, 20,011 records from 1623 hospitals were analyzed for procedures performed between January 1, 2011, and December 31, 2011.Results: The average patient age was 68.9 years; 73.7% were male. The overall morbidity was 26.2%, with a 30-day mortality rate of 0.9%, in-hospital mortality rate of 2.2%, and overall operative mortality rate of 2.3%. The odds ratios for 30-day mortality were as follows: ASA (American Society of Anesthesiologists) grade 4 or 5, 9.4; preoperative dialysis requirement, 3.9; and platelet count less than 50,000 per microliter, 3.1. The odds ratios for operative mortality were as follows: ASA grade 4 or 5, 5.2; disseminated cancer, 3.5; and alkaline phosphatase level of more than 600 IU/L, 3.1. The C-index of 30-day mortality and operative mortality was 0.811 (95% confidence interval [CI], 0.744-0.879) and 0.824 (95% CI, 0.781-0.866), respectively.Conclusions: We have performed the first reported risk stratification study for total gastrectomy, using a nationwide Internet-based database. The total gastrectomy outcomes in the nationwide population were satisfactory. The risk models that we have created will help improve the quality of surgical practice.