Abstract
The Japanese National Clinical Database (NCD) started its data registration since 2011, has grown up to a large nationwide database covering more than 95% of the surgeries performed by regular surgeons in Japan. The NCD grew rapidly harvesting over 11 million cases data between 2011 and 2018 from more than 5,000 facilities.
Methods
In this period, the surgeries of the esophagus were performed for 70,528 cases. In 2018, 93.8% of surgeries were performed at certified institutions, and 94.7% did with the participation of the board-certified surgeon. The board-certified surgeons operated 75.2% of the surgeries.
Results
Esophagectomy was performed for 47,055 patients in eight years. In 2018, 23.3% of the cases were 75 years old or more. Postoperative complications of Clavien Dindo classification grade III or higher occurred in 22.9% of all. As the patients have been getting older, the morbidities have been increasing. However, the mortalities have been kept at a low level. Postoperative 30-day and 90-day mortalities were 0.9% and 1.9%, respectively. The rates of endoscopic surgery have been increasing year by year, especially high in esophagectomy, which was 61.0% in 2018.
Conclusion
A risk-adjusted analysis based on nationwide data allows personnel to establish and provide feedback on the risks that patients face before undergoing a procedure. The risk calculator for eight main procedures are available on the websites of the hospitals that are a part of NCD. Nationwide this database is surely expecting to ensure the quality of board certification system and surgical outcomes in gastroenterological surgery.
Use of the National Clinical Database to evaluate the association between preoperative liver function and postoperative complications among patients undergoing hepatectomy
