Risk stratification of 7,732 hepatectomy cases in 2011 from the National Clinical Database for Japan

Akira Kenjo, Hiroaki Miyata, Mitsukazu Gotoh, Yuukou Kitagawa, Mitsuo Shimada, Hideo Baba, Naohiro Tomita, Wataru Kimura, Kenichi Sugihara, Masaki Mori

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Abstract

Background There has been no report on risk stratification for hepatectomy using a nationwide surgical database in Japan. The objective of this study was to evaluate mortality and variables associated with surgical outcomes of hepatectomy at a national level. Study Design We analyzed records of 7,732 patients who underwent hepatectomy for more than 1 segment (MOS) during 2011 in 987 different hospitals, as identified in the National Clinical Database (NCD) of Japan. The NCD captured 30-day morbidity and mortality as well as 90-day in-hospital mortality outcomes, which were submitted through a web-based data entry system. Based on 80% of the population, independent predictors for 30-day mortality and 90-day in-hospital mortality were calculated using a logistic regression model. The risk factors were validated with the remaining 20% of the cohort. Results The median postoperative length of hospitalization was 16.0 days. The overall patient morbidity rate was 32.1%. Thirty-day mortality and 90-day in-hospital mortality rates were 2.0% and 4.0%, respectively. Totals of 14 and 23 risk factors were respectively identified for 30-day mortality and 90-day in-hospital mortality. Factors associated with risk for 90-day in-hospital mortality were preoperative condition and comorbidity, operative indication (emergency surgery, intrahepatic/perihilar cholangiocarcinoma, or gallbladder cancer), preoperative laboratory data, and extent and location of resected segments (segment 1, 7, or 8). As a performance metric, c-indices of 30-day mortality and 90-day in-hospital mortality were 0.714 and 0.761, respectively. Conclusions Here we report the first risk stratification analysis of hepatectomy using a Japanese nationwide surgical database. This system would predict surgical outcomes of hepatectomy and be useful to evaluate and benchmark performance.

Original languageEnglish
Pages (from-to)412-422
Number of pages11
JournalJournal of the American College of Surgeons
Volume218
Issue number3
DOIs
Publication statusPublished - 2014 Mar

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ASJC Scopus subject areas

  • Surgery

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