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Risk model for right hemicolectomy based on 19,070 Japanese patients in the National Clinical Database

  • Original Article—ALIMENTARY TRACT
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Abstract

Background

Right hemicolectomy is a very common procedure throughout the world, although this procedure is known to carry substantial surgical risks. The present study aimed to develop a risk model for right hemicolectomy outcomes based on a nationwide internet-based database.

Methods

The National Clinical Database (NCD) collected records on over 1,200,000 surgical cases from 3,500 Japanese hospitals in 2011. After data cleanup, we analyzed 19,070 records regarding right hemicolectomy performed between January 2011 and December 2011.

Results

The 30-day and operative mortality rates were 1.1 and 2.3 %, respectively. The 30-day mortality rates of patients after elective and emergency surgery were 0.7 and 6.0 %, respectively (P < 0.001). The odds ratios of preoperative risk factors for 30-day mortality were: platelet <50,000/μl, 5.6; ASA grade 4 or 5, 4.0; acute renal failure, 3.2; total bilirubin over 3 mg/dl, 3.1; and AST over 35 U/l, 3.1. The odds ratios for operative mortality were: previous peripheral vascular disease, 3.1; cancer with multiple metastases, 3.1; and ASA grade 4 or 5, 2.9. Sixteen and 26 factors were selected for risk models of 30-day and operative mortality, respectively. The c-index of both models was 0.903 [95 % confidence interval (CI) 0.877–0.928; P < 0.001] and 0.891 (95 % CI 0.873–0.908; P < 0.001), respectively.

Conclusion

We performed the first reported risk stratification study for right hemicolectomy based on a nationwide internet-based database. The outcomes of right hemicolectomy in the nationwide population were satisfactory. The risk models developed in this study will help to improve the quality of surgical practice.

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Acknowledgments

We thank all data managers and hospitals participating in this National Clinical Database project for their great efforts in entering the data. We also thank Prof. Hideki Hashimoto and Noboru Motomura, MD for providing direction for the foundation of NCD and the working members of the JSGS database committee (Masayuki Watanabe, MD; Satoru Imura, MD; Fumihiko Miura, MD; Hiroya Takeuchi, MD; Ichiro Hirai, MD; Yoshio Takesue, MD; Hiroyuki Suzuki, MD; Megumi Ishiguro, MD; Hiroyuki Konno, MD; Makoto Gega, MD; Nagahide Matsubara MD; and Akihiko Horiguch, MD). This study was supported by a research grant from the Ministry of Health, Labour and Welfare in Japan.

Conflict of interest

All authors declare that there is no conflict of interest in this manuscript.

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Authors and Affiliations

  1. The Japanese Society of Gastroenterological Surgery, Database Committee Working Group, Tokyo, Japan

    Hirotoshi Kobayashi

  2. National Clinical Database, Tokyo, Japan

    Hiroaki Miyata & Mitsukazu Gotoh

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

    Hiroaki Miyata, Mitsukazu Gotoh, Hideo Baba, Wataru Kimura, Yuko Kitagawa, Tohru Nakagoe, Mitsuo Shimada & Naohiro Tomita

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

    Kenichi Sugihara & Masaki Mori

  5. Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Hirotoshi Kobayashi

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  1. Hirotoshi Kobayashi
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  2. Hiroaki Miyata
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Correspondence to Hirotoshi Kobayashi.

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Kobayashi, H., Miyata, H., Gotoh, M. et al. Risk model for right hemicolectomy based on 19,070 Japanese patients in the National Clinical Database. J Gastroenterol 49, 1047–1055 (2014). https://doi.org/10.1007/s00535-013-0860-8

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  • DOI: https://doi.org/10.1007/s00535-013-0860-8

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