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

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.