title: Risk model for right hemicolectomy based on 19,070 Japanese patients in the National Clinical Database.
abstract: BACKGROUND
  Right hemicolectomy is a very common procedure throughout the world, although this procedure is known to carry substantial surgical risks. The present study aimed to develop a risk model for right hemicolectomy outcomes based on a nationwide internet-based database.
  
  
  METHODS
  The National Clinical Database (NCD) collected records on over 1,200,000 surgical cases from 3,500 Japanese hospitals in 2011. After data cleanup, we analyzed 19,070 records regarding right hemicolectomy performed between January 2011 and December 2011.
  
  
  RESULTS
  The 30-day and operative mortality rates were 1.1 and 2.3 %, respectively. The 30-day mortality rates of patients after elective and emergency surgery were 0.7 and 6.0 %, respectively (P < 0.001). The odds ratios of preoperative risk factors for 30-day mortality were: platelet <50,000/μl, 5.6; ASA grade 4 or 5, 4.0; acute renal failure, 3.2; total bilirubin over 3 mg/dl, 3.1; and AST over 35 U/l, 3.1. The odds ratios for operative mortality were: previous peripheral vascular disease, 3.1; cancer with multiple metastases, 3.1; and ASA grade 4 or 5, 2.9. Sixteen and 26 factors were selected for risk models of 30-day and operative mortality, respectively. The c-index of both models was 0.903 [95 % confidence interval (CI) 0.877-0.928; P < 0.001] and 0.891 (95 % CI 0.873-0.908; P < 0.001), respectively.
  
  
  CONCLUSIONS
  We performed the first reported risk stratification study for right hemicolectomy based on a nationwide internet-based database. The outcomes of right hemicolectomy in the nationwide population were satisfactory. The risk models developed in this study will help to improve the quality of surgical practice.
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Database Committee Working Group, Tokyo, Japan, h-kobayashi.srg2@tmd.ac.jp.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.forename: Mitsukazu
authors.initials: M
authors.lastname: Gotoh
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.forename: Wataru
authors.initials: W
authors.lastname: Kimura
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagoe
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D003082:Colectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007564:Japan; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
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