Comparison of National Operative Mortality in Gastroenterological Surgery Using Web-based Prospective Data Entry Systems.
Comparison of National Operative Mortality in Gastroenterological Surgery Using Web-based Prospective Data Entry Systems.
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DOI：
10.1097/md.0000000000002194
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发表时间：
2015-12
期刊：
影响因子：
1.6
通讯作者：
Mori M
中科院分区：
文献类型：
--
作者：
Anazawa T;Paruch JL;Miyata H;Gotoh M;Ko CY;Cohen ME;Hirahara N;Zhou L;Konno H;Wakabayashi G;Sugihara K;Mori M
国际合作是重要的医疗质量评价，但是，很少有国际比较的普通外科手术的结果已经完成。此外，风险分层的预测模型应用尚未在国际上进行评估。日本的国家临床数据库（NCD）是与美国外科医生学会国家外科质量改进计划（ACS-NSQIP）合作开发的，目的是创建一个标准化的外科数据库，以提高质量。本研究旨在使用基于网络的前瞻性数据输入系统比较日本和美国（US）3种主要胃肠外科手术风险因素的一致性和影响：右半结肠切除术（RH）、低位前切除术（LAR）和胰腺切除术（PD）。从NCD和ACS-NSQIP，收集超过2年的数据进行了检查。Logistic回归模型用于预测这两个国家的30天死亡率。交换模型并进行评价，以确定为一个群体构建的模型是否对另一个群体准确。我们获得了113，980名患者的数据; 50，501名（日本：34，638;美国：15，863）、42，770名（日本：35，445;美国：7325）和20，709名（日本：15，527;美国：5182）分别接受了RH、LAR和PD。RH的30天死亡率为0.76%（日本）和1.88%（美国）; LAR的30天死亡率为0.43%和1.08%; PD的30天死亡率为1.35%和2.57%。日本和美国的患者背景、合并症和实践方式不同。在模型中，NCD和ACS-NSQIP之间每个变量的比值比相似。当地风险模型可以使用当地数据预测死亡率，但无法使用其他国家的数据准确预测死亡率。我们证明了日本和美国之间的国际合作研究的可行性和有效性，但发现当地风险模型仍然是质量改进的关键。
International collaboration is important in healthcare quality evaluation; however, few international comparisons of general surgery outcomes have been accomplished. Furthermore, predictive model application for risk stratification has not been internationally evaluated. The National Clinical Database (NCD) in Japan was developed in collaboration with the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), with a goal of creating a standardized surgery database for quality improvement. The study aimed to compare the consistency and impact of risk factors of 3 major gastroenterological surgical procedures in Japan and the United States (US) using web-based prospective data entry systems: right hemicolectomy (RH), low anterior resection (LAR), and pancreaticoduodenectomy (PD). Data from NCD and ACS-NSQIP, collected over 2 years, were examined. Logistic regression models were used for predicting 30-day mortality for both countries. Models were exchanged and evaluated to determine whether the models built for one population were accurate for the other population. We obtained data for 113,980 patients; 50,501 (Japan: 34,638; US: 15,863), 42,770 (Japan: 35,445; US: 7325), and 20,709 (Japan: 15,527; US: 5182) underwent RH, LAR, and, PD, respectively. Thirty-day mortality rates for RH were 0.76% (Japan) and 1.88% (US); rates for LAR were 0.43% versus 1.08%; and rates for PD were 1.35% versus 2.57%. Patient background, comorbidities, and practice style were different between Japan and the US. In the models, the odds ratio for each variable was similar between NCD and ACS-NSQIP. Local risk models could predict mortality using local data, but could not accurately predict mortality using data from other countries. We demonstrated the feasibility and efficacy of the international collaborative research between Japan and the US, but found that local risk models remain essential for quality improvement.