scholarly journals Impact of certification status of the institute and surgeon on short-term outcomes after surgery for thoracic esophageal cancer: evaluation using data on 16,752 patients from the National Clinical Database in Japan

Esophagus ◽  
2019 ◽  
Vol 17 (1) ◽  
pp. 41-49 ◽  
Author(s):  
Satoru Motoyama ◽  
Hiroyuki Yamamoto ◽  
Hiroaki Miyata ◽  
Masahiko Yano ◽  
Takushi Yasuda ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Mortality Rates ◽  
Clinical Database ◽  
Short Term ◽  
National Clinical Database ◽  
Thoracic Esophageal Cancer ◽  
Certification System ◽  
Related Mortality

Abstract Background In 2009, the Japan Esophageal Society (JES) established a system for certification of qualified surgeons as “Board Certified Esophageal Surgeons” (BCESs) or institutes as “Authorized Institutes for Board Certified Esophageal Surgeons” (AIBCESs). We examined the short-term outcomes after esophagectomy, taking into consideration the certifications statuses of the institutes and surgeons. Methods This study investigated patients who underwent esophagectomy for thoracic esophageal cancer and who were registered in the Japanese National Clinical Database (NCD) between 2015 and 2017. Using hierarchical multivariable logistic regression analysis adjusted for patient-level risk factors, we determined whether the institute’s or surgeon’s certification status had greater influence on surgery-related mortality or postoperative complications. Results Enrolled were 16,752 patients operated on at 854 institutes by 1879 surgeons. There were significant differences in the backgrounds and incidences of postoperative complications and surgery-related mortality rates between the 11,162 patients treated at AIBCESs and the 5590 treated at Non–AIBCESs (surgery-related mortality rates: 1.6% vs 2.8%). There were also differences between the 6854 patients operated on by a BCES and the 9898 treated by a Non-BCES (1.7% vs 2.2%). Hierarchical logistic regression analysis revealed that surgery-related mortality was significantly lower among patients treated at AIBCESs. The institute’s certification had greater influence on short-term surgical outcomes than the operating surgeon’s certification. Conclusions The certification system for surgeons and institutes established by the JES appears to be appropriate, as indicated by the improved surgery-related mortality rate. It also appears that the JES certification system contributes to a more appropriate medical delivery system for thoracic esophageal cancer in Japan.

scholarly journals The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database

2009 ◽  
Vol 137 (5) ◽  
pp. 1133-1140 ◽  
Author(s):  
Karl F. Welke ◽  
Sean M. O'Brien ◽  
Eric D. Peterson ◽  
Ross M. Ungerleider ◽  
Marshall L. Jacobs ◽  
...  
Keyword(s):  
Mortality Rates ◽  
Complex Relationship ◽  
Clinical Database ◽  
National Clinical Database ◽  
Surgical Case

scholarly journals The impact of age, gender, acuteness and etiology on short-term clinical outcome in patients with subdural hematomas - international dual-center study

2018 ◽  
Vol 146 (9-10) ◽  
pp. 538-542
Author(s):  
Ivo Kehayov ◽  
Aleksandar Kostic ◽  
Borislav Kitov ◽  
Vesna Nikolov ◽  
Hristo Zhelyazkov ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Clinical Outcome ◽  
Logistic Regression Analysis ◽  
Predictive Factors ◽  
Subdural Hematoma ◽  
Short Term ◽  
Subdural Hematomas ◽  
The Impact ◽  
Positive Effect

Introduction/Objective. Subdural hematoma is one of the most common intracranial types of bleeding with high risk of disability and mortality. The aim of this study was to determine the influence of age, sex, acuteness, and etiology of subdural hematoma on short-term clinical outcome in these patients. Methods. We retrospectively studied 288 patients who were diagnosed and operated on for subdural hematomas (SDH) with different etiology (traumatic and spontaneous) and acuteness (acute, subacute, and chronic) for a period of five years. Patients scored ? 5 points on the Glasgow Coma Scale at hospital admission were not included in this study. Clinical outcome was assessed by the modified Rankin Scale (mRS) score at hospital discharge. Descriptive statistics and logistic regression analysis were used to determine the effect of the investigated factors on short-term clinical outcome. Results. Logistic regression analysis was conducted to predict degree of recovery (good = mRS ?1 vs. poor = mRS ? 2 or death) using sex, age, acuteness, and etiology of SDH as predictive factors. It was established that the following three factors made a significant contribution to the outcome: age (p = 0.004), acuteness (p < 0.001), and etiology of a hematoma (p = 0.023), with acuteness being the strongest predictive factor. Sex was not a significant predictor, while age under 70 years and spontaneous origin of SDH were associated with lower mRS scores and had a positive effect on recovery chances. Conclusion. Age, acuteness, and etiology of hematoma are important predictive factors that influence the short-term clinical outcome in patients with SDH. These parameters should be taken into account when giving prognosis for recovery chances to a patient?s family and relatives.

P5739Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: exploring prognostic variables and risk prediction tools

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P M Goncalves Teixeira ◽  
M Passos Silva ◽  
D Mbala ◽  
M Ana Canelas ◽  
M Varela ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Sofa Score ◽  
Ecmo Support ◽  
Risk Scores ◽  
Short Term ◽  
Va Ecmo

Abstract Introduction The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) to support patients in cardiogenic shock has been increasing in Portugal over the past few years. Nonetheless, epidemiologic, prognostic and clinical outcome data are scarce. Purpose We aim to identify clinical variables with prognostic significance in this challenging population, as well as the performance of various risk scores in mortality prediction. Methods All patients that underwent VA-ECMO support at our Cardiac ICU between 2011 and 2018 were included in the analysis. Logistic regression analysis was used to assess the relationship between clinical variables and outcomes. Results Short-term mechanical support with VA-ECMO was given to 40 patients, with a mean age of 52±11 years. At the time of the implant, the mean SOFA score was 11.2±4.0, and mean SAVE score was −4.75±4.6. Mean ECMO support duration was 116±96 hours. In 70% (N=28) of patients, VA-ECMO was successfully weaned. In-hospital mortality was observed in 52.5% of patients, which was in accordance with the predicted mortality by SOFA score (22.5% to 82% in our population risk range) and by SAVE score (60 to 70%). Those who placed the VA-ECMO as a bridge to transplant or to long-term mechanical LV assist device had greater in-hospital mortality rates (91.6 vs 41.9%, p=0.013), as well as those under ≥2 inotropic/vasopressors (69.2 vs 21.4%, p=0.012) or when adrenaline use was needed (100% vs 44.1%, p=0.01). No other between-group differences were observed in what concerns short-term mortality. After logistic regression analysis, independent predictors of in-hospital mortality included AMI setting, number of vasoactive amines used, and necessity of a LV venting device. SAVE score had the greater predictive ability in these patients (AUC = 0.638) among the most utilized clinical risk scores (SOFA score AUC = 0.37; APACHE II score AUC = 0.59; SAPS II score AUC = 0.54). Conclusion In our analysis, patients in profound cardiogenic shock on VA-ECMO support had slightly better survival rates than predicted by classical Risk Scores. The SAVE score may be the most accurate tool to predict in-hospital mortality in this specific, and yet heterogeneous, clinical subset. Other well recognized clinical markers of severity may also help refine short-term prognosis, and potentially improve organ transplant or other destination therapy prioritization.

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