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Estimates of the effects of centralization policy for surgery in Japan: does centralization affect the quality of healthcare for esophagectomies?

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A Publisher Correction to this article was published on 11 April 2021

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Abstract

Purpose

This study compared the quality of healthcare before and after implementation of a policy restructuring the healthcare delivery system and estimated the impact of centralization.

Methods

We used the National Clinical Database to study patients undergoing esophagectomies from 2011 to 2016. We compared the effect of centralization based on the patient background, surgical mortality, and year of surgery. Difference-in-difference methods based on the generalized estimating equation logistic regression model were used for before-and-after comparisons after adjusting for patient-level expected surgical mortality.

Results

In total, 34,640 cases were identified. More cases with risk factors were noted in ultra-low-volume hospitals, where 38.4% of cases in underpopulated areas were treated, than in higher volume facilities, and the operative mortality, readmission within 30 days and length of stay were worse among patients treated in these hospitals. In centralized prefectures, the number of cases per hospital increased over time (7.2 in 2011 to 9.5 in 2016) while the crude operative mortality tended to decrease (3.4% in 2011 to 1.8% in 2016). The difference-in-difference estimator was 0.856 (95% confidence interval: 0.639–1.147, p = 0.298).

Conclusion

The centralization of ultra-low-volume hospitals did not lead to a deterioration in the quality of care but rather an improving trend.

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Change history

Abbreviations

Alb:

Albumin

ADL:

Activity of daily life

CD:

Clavien–Dindo

COPD:

Chronic obstructive pulmonary disease

NCD:

National Clinical Database

PT-INR:

Prothrombin time-international normalized ratio

BUN:

Blood urea nitrogen

WBC:

White blood cell

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Acknowledgements

The author would like to thank all of the data administrators and hospitals who participated in the NCD project and put effort into data entry. The authors also thank Drs. T. Iwanaka, Y. Ueda, S. Takamoto, N. Motomura, Y. Tokuda, S, Endo, T, Okamoto, H. Kumamaru and N. Ichihara for their cooperation. This work was supported by a grant from the Ministry of Health, Labour and Welfare of Japan. A portion of the results of this study was presented at The 78th Annual Meeting of Japanese Society of Public Health (October 25, 2019; Kochi, Japan).

Funding

This work was supported by a grant from the Ministry of Health, Labour and Welfare of Japan.

Author information

Authors and Affiliations

  1. Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan

    Arata Takahashi, Hiroyuki Yamamoto & Hiroaki Miyata

  2. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Arata Takahashi, Hiroyuki Yamamoto & Hiroaki Miyata

  3. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yoshihiro Kakeji, Shigeru Marubashi, Mitsukazu Gotoh & Yasuyuki Seto

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  1. Arata Takahashi
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  7. Hiroaki Miyata
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Contributions

AT, HY, and HM planned the present study and wrote the manuscript. AT, HY, and HM analyzed the data. YK, SM, MG, and YS reviewed the manuscript and revised it critically for important intellectual content.

Corresponding author

Correspondence to Hiroaki Miyata.

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Conflict of interest

Arata Takahashi, Hiroyuki Yamamoto, and Hiroaki Miyata are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by grants from the National Clinical Database, Johnson and Johnson K.K. and Nipro Co.; no other authors have any conflicts of interest.

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595_2021_2245_MOESM1_ESM.docx

Supplementary file1 (DOCX 80 KB) Supplemental material: The percentage of hospitals performing fewer than two esophagectomy procedures per year in Japan (2011-2016). The percentage of hospitals performing fewer than two esophagectomy procedures per year and the percentage of esophagectomy procedures performed in those hospitals have been decreasing.

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Takahashi, A., Yamamoto, H., Kakeji, Y. et al. Estimates of the effects of centralization policy for surgery in Japan: does centralization affect the quality of healthcare for esophagectomies?. Surg Today 51, 1010–1019 (2021). https://doi.org/10.1007/s00595-021-02245-1

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