TY - JOUR
T1 - Validation of the board certification system for expert surgeons (hepato-biliary-pancreatic field) using the data of the National Clinical Database of Japan
T2 - part 2 – Pancreatoduodenectomy
AU - Miura, Fumihiko
AU - Yamamoto, Masakazu
AU - Gotoh, Mitsukazu
AU - Konno, Hiroyuki
AU - Fujimoto, Jiro
AU - Yanaga, Katsuhiko
AU - Kokudo, Norihiro
AU - Yamaue, Hiroki
AU - Wakabayashi, Go
AU - Seto, Yasuyuki
AU - Unno, Michiaki
AU - Miyata, Hiroaki
AU - Hirahara, Norimichi
AU - Miyazaki, Masaru
N1 - Publisher Copyright:
© 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background: Data of pancreatoduodenectomy (PD) cases from the National Clinical Database (NCD) were analyzed in order to validate the board certification system established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS). Methods: Board-certified A training institutions and board-certified B training institutions were required to perform at least 50 and 30 high-level hepato-biliary-pancreatic (HBP) surgeries per year, respectively. Records of 17,563 patients who had undergone PD during 2011 and 2012 were retrospectively analyzed according to the category of the board-certified institution and with or without participation of board-certified instructors or expert surgeons. Results: Operative mortality rates after PDs performed at certified A institutions, certified B institutions, and non-certified institutions were 1.5%, 3.0%, and 3.9%, respectively (P < 0.001). The operative mortality rates after PDs performed with participation of certified instructors or expert surgeons were better than those without (2.2% vs. 3.8%, P < 0.001). A multiple logistic regression model showed that cutoffs of high-level HBP surgeries performed per year at hospitals that predicted 30-day mortality after PDs were 10 and 50, and that those that predicted operative mortality were 10 and 70. Conclusions: The requirements for board-certified institutions, instructors, and expert surgeons to perform PD were appropriate. The requirements for board-certified A institutions were close to the identified cutoffs. Further analyses are necessary to elucidate the implications of the board certification system.
AB - Background: Data of pancreatoduodenectomy (PD) cases from the National Clinical Database (NCD) were analyzed in order to validate the board certification system established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS). Methods: Board-certified A training institutions and board-certified B training institutions were required to perform at least 50 and 30 high-level hepato-biliary-pancreatic (HBP) surgeries per year, respectively. Records of 17,563 patients who had undergone PD during 2011 and 2012 were retrospectively analyzed according to the category of the board-certified institution and with or without participation of board-certified instructors or expert surgeons. Results: Operative mortality rates after PDs performed at certified A institutions, certified B institutions, and non-certified institutions were 1.5%, 3.0%, and 3.9%, respectively (P < 0.001). The operative mortality rates after PDs performed with participation of certified instructors or expert surgeons were better than those without (2.2% vs. 3.8%, P < 0.001). A multiple logistic regression model showed that cutoffs of high-level HBP surgeries performed per year at hospitals that predicted 30-day mortality after PDs were 10 and 50, and that those that predicted operative mortality were 10 and 70. Conclusions: The requirements for board-certified institutions, instructors, and expert surgeons to perform PD were appropriate. The requirements for board-certified A institutions were close to the identified cutoffs. Further analyses are necessary to elucidate the implications of the board certification system.
KW - Board certification
KW - Centralization
KW - Hepatectomy
KW - Hepato-biliary-pancreatic surgery
KW - High-volume hospital
KW - Pancreatoduodenectomy
UR - http://www.scopus.com/inward/record.url?scp=84975318197&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84975318197&partnerID=8YFLogxK
U2 - 10.1002/jhbp.348
DO - 10.1002/jhbp.348
M3 - Article
C2 - 26994315
AN - SCOPUS:84975318197
VL - 23
SP - 353
EP - 363
JO - Journal of Hepato-Biliary-Pancreatic Sciences
JF - Journal of Hepato-Biliary-Pancreatic Sciences
SN - 1868-6974
IS - 6
ER -