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A Risk Model for Esophagectomy Using Data of 5354 Patients Included in a Japanese Nationwide Web-Based Database

Takeuchi, Hiroya MD, PhD*; Miyata, Hiroaki PhD†,‡; Gotoh, Mitsukazu MD, PhD†,‡; Kitagawa, Yuko MD, PhD; Baba, Hideo MD, PhD; Kimura, Wataru MD, PhD; Tomita, Naohiro MD, PhD; Nakagoe, Tohru MD, PhD; Shimada, Mitsuo MD, PhD; Sugihara, Kenichi MD, PhD§; Mori, Masaki MD, PhD§

doi: 10.1097/SLA.0000000000000644
Original Articles

Objective: This study aimed to create a risk model of mortality associated with esophagectomy using a Japanese nationwide database.

Methods: A total of 5354 patients who underwent esophagectomy in 713 hospitals in 2011 were evaluated. Variables and definitions were virtually identical to those adopted by the American College of Surgeons National Surgical Quality Improvement Program.

Results: The mean patient age was 65.9 years, and 84.3% patients were male. The overall morbidity rate was 41.9%. Thirty-day and operative mortality rates after esophagectomy were 1.2% and 3.4%, respectively. Overall morbidity was significantly higher in the minimally invasive esophagectomy group than in the open esophagectomy group (44.3% vs 40.8%, P = 0.016). The odds ratios for 30-day mortality in patients who required preoperative assistance in activities of daily living (ADL), those with a history of smoking within 1 year before surgery, and those with weight loss more than 10% within 6 months before surgery were 4.2, 2.6, and 2.4, respectively. The odds ratios for operative mortality in patients who required preoperative assistance in ADL, those with metastasis/relapse, male patients, and those with chronic obstructive pulmonary disease were 4.7, 4.5, 2.3, and 2.1, respectively.

Conclusions: This study was the first, as per our knowledge, to perform risk stratification for esophagectomy using a Japanese nationwide database. The 30-day and operative mortality rates were relatively lower than those in previous reports. The risk models developed in this study may contribute toward improvements in quality control of procedures and creation of a novel scoring system.

We created a risk model of mortality for 5354 patients undergoing esophagectomy using a nationwide database in Japan. Outcomes in the study population were 1.2% for 30-day mortality and 3.4% for operative mortality. The risk models developed for esophagectomy may contribute toward improved quality control and creating a novel scoring system.

*Japanese Society of Gastroenterological Surgery, Working Group database committee

The Japanese Society of Gastroenterological Surgery, database committee

National Clinical Database; and

§The Japanese Society of Gastroenterological Surgery, Japan.

Reprints: Yuko Kitagawa, MD, PhD, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. E-mail: kitagawa@a3.keio.jp.

Disclosure: This study was supported by a research grant from Ministry of Health, Labour and Welfare, Japan (M.G.). The other authors declare no conflicts of interest regarding this research.

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© 2014 by Lippincott Williams & Wilkins.