Influence of Facility Size on Perioperative Outcomes in Minimally Invasive Esophagectomy for 14 152 Patients With Esophageal Cancer Based on the Japanese National Clinical Database: A Multicenter Cohort Study

IF 3.3 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Taro Oshikiri, Hisateru Tachimori, Hiroaki Miyata, Yoshihiro Kakeji, Ken Shirabe
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Abstract

Background

Conventional minimally invasive esophagectomy (C-MIE) is the mainstay for locally advanced esophageal cancer. However, the relationship among facility size, risk-adjusted mortality and morbidity in C-MIE remains unclear. This study aims to clarify whether C-MIE should be consolidated into high-volume centers in Japan.

Methods

Risk models for perioperative mortality and morbidity were created using the Japanese National Clinical Database (NCD) data. NCD data registered between January 2016 and December 2020, including 14 152 C-MIE records. The developed risk models were used to estimate the ratio of expected to observed events (perioperative deaths or complications) (O/E ratio) for each facility.

Results

Regarding the risk model performances, the C-indices of the perioperative mortality risk prediction models were 0.793. The O/E ratio and 95% confidence interval (CI) for perioperative mortality were facility size < 10 MIEs/year, O/E ratio: 1.368 and 95% CI: 1.140–1.597; facility size 10–29 MIEs/year, O/E ratio: 0.886 and 95% CI: 0.644–1.127; and facility size ≥ 30 MIEs/year, O/E ratio: 0. 61 and 95% CI: 0.342–0.892. Conversely, there were no significant differences in morbidity rate by facility size.

Conclusions

The risk of perioperative mortality from C-MIE was lower in hospitals with larger facilities than those with smaller facilities; therefore, consolidating patients for C-MIE in high-volume hospitals is necessary.

Abstract Image

基于日本国家临床数据库的14152例食管癌患者微创食管切除术设施大小对围手术期预后的影响:一项多中心队列研究
背景常规微创食管切除术(C-MIE)是局部晚期食管癌的主要治疗方法。然而,设施规模、风险调整死亡率和C-MIE发病率之间的关系尚不清楚。本研究旨在阐明C-MIE是否应该整合到日本的高容量中心。方法利用日本国家临床数据库(NCD)数据建立围手术期死亡率和发病率风险模型。2016年1月至2020年12月期间登记的非传染性疾病数据,包括14 152例C-MIE记录。开发的风险模型用于估计每个设施的预期事件与观察事件(围手术期死亡或并发症)的比率(O/E比率)。结果围手术期死亡风险预测模型的c指数为0.793。围手术期死亡率的O/E比和95%可信区间(CI)分别为:设施大小和10密斯/年,O/E比:1.368和95% CI: 1.140 ~ 1.597;设施规模10 ~ 29密斯/年,O/E比值:0.886,95% CI: 0.644 ~ 1.127;设施规模≥30密斯/年,O/E比为0。61和95% CI: 0.342-0.892。相反,设施大小在发病率方面没有显著差异。结论设施大的医院C-MIE围手术期死亡风险低于设施小的医院;因此,在大容量医院合并C-MIE患者是必要的。
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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
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