Takehito Otsubo1, Shinjiro Kobayashi1, Keiji Sano2, Takeyuki Misawa2, Satoshi Katagiri3, Hisashi Nakayama4, Shuji Suzuki5, Manabu Watanabe6, Shunichi Ariizumi7, Michiaki Unno8, Minoru Tanabe9, Hiroaki Nagano10, Norihiro Kokudo11, Satoshi Hirano12, Masafumi Nakamura13, Ken Shirabe14, Yasuyuki Suzuki15, Masahiro Yoshida16, Yasutsugu Takada17, Toshio Nakagohri18, Akihiko Horiguchi19, Hideki Ohdan20, Susumu Eguchi21, Masayuki Ohtsuka22, Masayuki Sho23, Toshiki Rikiyama24, Etsuro Hatano25, Akinobu Taketomi26, Tsutomu Fujii27, Hiroki Yamaue28, Masaru Miyazaki29, Masakazu Yamamoto30, Tadahiro Takada2, Itaru Endo31. 1. Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan. 2. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 3. Department of Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan. 4. Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan. 5. Department of Gastroenterological Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan. 6. Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan. 7. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 8. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 9. Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Tokyo, Japan. 10. Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan. 11. National Center for Global Health and Medicine, Tokyo, Japan. 12. Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan. 13. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 14. Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan. 15. Department of Gastroenterological Surgery, Kagawa University, Takamatsu, Japan. 16. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health & Welfare, Chiba, Japan. 17. Department of Hepato-Pancreatic-Biliary and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Japan. 18. Department of Surgery, Tokai University School of Medicine, Isehara, Japan. 19. Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Japan. 20. Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 21. Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. 22. Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. 23. Department of Surgery, Nara Medical University, Kashihara, Japan. 24. Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan. 25. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 26. Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 27. Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan. 28. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan. 29. Digestive Diseases Center, International University of Health and Welfare Narita Hospital, Narita, Japan. 30. Department of Gastroenterological Surgery, Utsunomiya Memorial Hospital, Utsunomiya, Japan. 31. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Abstract
BACKGROUND: To ensure that highly advanced hepatobiliary-pancreatic surgery (HBPS) is performed safely, the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) board certification system for expert surgeons established a safety committee to monitor surgical safety. METHODS: We investigated postoperative mortality rates based on summary reports of numbers and outcomes of highly advanced HBPS submitted annually by the board-certified training institutions from 2012 to 2019. We also analyzed summary reports on mortality cases submitted by institutions with high 90-day post-HBPS mortality rates and recommended site visits and surveys as necessary. RESULTS: Highly advanced HBPS was performed in 121 518 patients during the 8-year period. Thirty-day mortality rates from 2012 to 2019 were 0.92%, 0.8%, 0.61%, 0.63%, 0.70%, 0.59%, 0.48%, and 0.52%, respectively (P < .001). Ninety-day mortality rates were 2.1%, 1.82%, 1.62%, 1.28%, 1.46%, 1.22%, 1.19%, and 0.98%, respectively (P < .001). Summary reports were submitted by 20 hospitals between 2015 and 2019. Mortality rates before and after the start of report submission and audit were 5.72% and 2.79%, respectively (odds ratio 0.690, 95% confidence interval 0.487-0.977; P = .037). CONCLUSIONS: Development of a system for designation of board-certified expert surgeons and safety management improved the mortality rate associated with highly advanced HBPS.
BACKGROUND: To ensure that highly advanced hepatobiliary-pancreatic surgery (HBPS) is performed safely, the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) board certification system for expert surgeons established a safety committee to monitor surgical safety. METHODS: We investigated postoperative mortality rates based on summary reports of numbers and outcomes of highly advanced HBPS submitted annually by the board-certified training institutions from 2012 to 2019. We also analyzed summary reports on mortality cases submitted by institutions with high 90-day post-HBPS mortality rates and recommended site visits and surveys as necessary. RESULTS: Highly advanced HBPS was performed in 121 518 patients during the 8-year period. Thirty-day mortality rates from 2012 to 2019 were 0.92%, 0.8%, 0.61%, 0.63%, 0.70%, 0.59%, 0.48%, and 0.52%, respectively (P < .001). Ninety-day mortality rates were 2.1%, 1.82%, 1.62%, 1.28%, 1.46%, 1.22%, 1.19%, and 0.98%, respectively (P < .001). Summary reports were submitted by 20 hospitals between 2015 and 2019. Mortality rates before and after the start of report submission and audit were 5.72% and 2.79%, respectively (odds ratio 0.690, 95% confidence interval 0.487-0.977; P = .037). CONCLUSIONS: Development of a system for designation of board-certified expert surgeons and safety management improved the mortality rate associated with highly advanced HBPS.