Susumu Kunisawa1, Haku Ishida2, Hiroshi Ikai3, Hiroaki Nagano4, Toshiyoshi Fujiwara5, Hideki Ohdan6, Yoshiyuki Fujiwara7, Yoshitsugu Tajima8, Tomio Ueno9, Yoshinori Fujiwara9, Mitsuo Shimada10, Yasuyuki Suzuki11, Yuji Watanabe12, Kazuhiro Hanazaki13, Yoshihiro Kakeji14, Hiraku Kumamaru15, Arata Takahashi15,16, Hiroaki Miyata15,16, Yuichi Imanaka17. 1. Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8501, Japan. 2. Department of Medical Informatics and Decision Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan. 3. Department of Medical Informatics and Clinical Epidemiology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 4. Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan. 5. Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan. 6. Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 7. Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan. 8. Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Japan. 9. Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan. 10. Department of Surgery, Tokushima University, Tokushima, Japan. 11. Department of Surgery, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan. 12. Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Touon, Japan. 13. Department of Surgery, Kochi Medical School, Nankoku, Japan. 14. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 15. Department of Healthcare Quality Assessment Graduate School of Medicine, University of Tokyo, Bunkyo City, Tokyo, Japan. 16. Department of Health Policy and Management, School of Medicine, Keio University, Minato City, Japan. 17. Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8501, Japan. imanaka-y@umin.net.
Abstract
PURPOSE: A research subgroup was established by the Japanese Society of Gastroenterological Surgery to improve the health care quality in the Chushikoku area of Western Japan. METHODS: The records of four surgical procedures were extracted from the Japanese National Clinical Database and analyzed retrospectively to establish the association between hospital characteristics, defined using a combination of hospital case-volume and patients' hospital travel distance, and the incidences of perioperative complications of ≥ Grade 3 of the Clavien-Dindo classification after gastroenterological surgery. RESULTS: This study analyzed 11,515 cases of distal gastrectomy for gastric cancer, 4,705 cases of total gastrectomy for gastric cancer, 4,996 cases of right hemicolectomy for colon cancer, and 5,243 cases of lower anterior resection for rectal cancer, with composite outcome incidences of 5.6%, 10.2%, 5.5%, and 10.7%, respectively. After adjusting for patient characteristics and surgical procedures, no association was identified between the hospital category and surgical outcomes. CONCLUSION: The findings of our study of the Chushikoku region did not provide positive support for the consolidation and centralization of hospitals, based solely on hospital case volume. Our grouping was unique in that we included patient travel distance in the analysis, but further investigations from other perspectives are needed.
PURPOSE: A research subgroup was established by the Japanese Society of Gastroenterological Surgery to improve the health care quality in the Chushikoku area of Western Japan. METHODS: The records of four surgical procedures were extracted from the Japanese National Clinical Database and analyzed retrospectively to establish the association between hospital characteristics, defined using a combination of hospital case-volume and patients' hospital travel distance, and the incidences of perioperative complications of ≥ Grade 3 of the Clavien-Dindo classification after gastroenterological surgery. RESULTS: This study analyzed 11,515 cases of distal gastrectomy for gastric cancer, 4,705 cases of total gastrectomy for gastric cancer, 4,996 cases of right hemicolectomy for colon cancer, and 5,243 cases of lower anterior resection for rectal cancer, with composite outcome incidences of 5.6%, 10.2%, 5.5%, and 10.7%, respectively. After adjusting for patient characteristics and surgical procedures, no association was identified between the hospital category and surgical outcomes. CONCLUSION: The findings of our study of the Chushikoku region did not provide positive support for the consolidation and centralization of hospitals, based solely on hospital case volume. Our grouping was unique in that we included patient travel distance in the analysis, but further investigations from other perspectives are needed.