Trends in the Outcomes of Advanced Hepatobiliary-Pancreatic Surgery: The Impact of a Nationwide Clinical Database and Surgeon Certification System.

IF 3.2 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2025-05-13 DOI:10.1002/jhbp.12158

Takayuki Anazawa, Hiroyuki Yamamoto, Etsuro Hatano, Mitsukazu Gotoh, Masafumi Nakamura, Masayuki Ohtsuka, Itaru Endo

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引用次数: 0

Abstract

Background: The Japanese Society of Hepatobiliary and Pancreatic Surgery has established a certification system for experienced surgeons. Evaluating its efficacy requires accounting for patient risk variations. The National Clinical Database (NCD) facilitates this using risk-adjusted outcome measures to validate and compare surgical performance.

Methods: We analyzed the NCD from 2014 to 2020 to examine trends in adjusted odds ratios (AORs) for mortality and morbidity following pancreaticoduodenectomy using 2014 as the reference. Primary outcomes were surgical and 30-day postoperative mortality. Secondary outcomes included severe complications and grade C pancreatic fistula. Subgroup analyses considered surgeon and institutional certification.

Results: Analysis of 78 972 pancreaticoduodenectomy reports revealed a decrease in the AOR for surgical mortality from 0.906 (95% Confidence Interval [CI]: 0.759-1.082, p = 0.276) in 2015 to 0.647 (95% CI: 0.539-0.777, p < 0.001) in 2020. A significant downward trend in the incidence of Grade C pancreatic fistula was observed. Board-certified surgeons have demonstrated superior performance compared to nonboard-certified surgeons since 2014, with board-certified training institutions having significantly lower AORs than those without certification. The AOR for surgical mortality showed an annual decrease across institutions.

Conclusions: The certification system for hepatobiliary-pancreatic surgery and participation in the NCD significantly decreased surgical mortality after pancreaticoduodenectomy.

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晚期肝胆胰手术预后的趋势：全国临床数据库和外科医生认证系统的影响。

背景：日本肝胆胰外科学会为经验丰富的外科医生建立了认证体系。评估其疗效需要考虑患者的风险变化。国家临床数据库（NCD）使用风险调整后的结果指标来验证和比较手术效果。方法：我们以2014年为参照，分析2014年至2020年NCD的死亡率和发病率的调整优势比（AORs）趋势。主要结局为手术死亡率和术后30天死亡率。次要结局包括严重并发症和C级胰瘘。亚组分析考虑了外科医生和机构认证。结果：对78 972份胰十二指肠切除术报告的分析显示，手术死亡率的AOR从2015年的0.906（95%可信区间[CI]: 0.759-1.082, p = 0.276）降至0.647 （95% CI: 0.539-0.777, p）。结论：肝胆胰手术认证系统和参与NCD显著降低了胰十二指肠切除术后的手术死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY

自引率

10.00%

发文量

178

审稿时长

6-12 weeks

期刊介绍： The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.