Association between the participation of board-certified surgeons in gastroenterological surgery and operative mortality after eight gastroenterological procedures

Purpose: The aim of this study is to evaluate the association between the participation of board-certified surgeons in gastroenterological surgery (BCS-Gs) and the surgical outcomes of gastroenterological surgery. Methods: Data from the National Clinical Database on patients who underwent eight major gastroenterological procedures were analyzed retrospectively. First, the ratio of cases in which BCS-G were involved to the total cases was calculated for each procedure, and the impact of BCS-G involvement on surgical outcome was assessed by comparing mortality rates in the group with BCS-G involvement vs. the group without BCS-G involvement. Second, the differences in the observed/expected ratio were assessed among four hospital categories according to the available BCS-G number. Finally, the impact of the hospital BCS-G number on mortality was evaluated. Results: The ratio of BCS-G involvement ranged from 59.0 % for acute diffuse peritonitis to 89.1 % for hepatectomy, and the mortality rate was significantly lower for three procedures when BCS-Gs participated as the operator or assistant. The observed/expected ratio of hospitals with four or more BCS-Gs was less than 1.0 for all the procedures assessed. A multivariable logistic regression model showed that the hospital BCS-G number was a predictor of operative mortality. Conclusions: BCS-Gs contribute to favorable outcomes of gastroenterological surgery in Japan. The hospital BCS-G number is a surrogate marker of operative mortality.