title: A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database.
abstract: OBJECTIVE
  This study aimed to create a risk model of mortality associated with esophagectomy using a Japanese nationwide database.
  
  
  METHODS
  A total of 5354 patients who underwent esophagectomy in 713 hospitals in 2011 were evaluated. Variables and definitions were virtually identical to those adopted by the American College of Surgeons National Surgical Quality Improvement Program.
  
  
  RESULTS
  The mean patient age was 65.9 years, and 84.3% patients were male. The overall morbidity rate was 41.9%. Thirty-day and operative mortality rates after esophagectomy were 1.2% and 3.4%, respectively. Overall morbidity was significantly higher in the minimally invasive esophagectomy group than in the open esophagectomy group (44.3% vs 40.8%, P = 0.016). The odds ratios for 30-day mortality in patients who required preoperative assistance in activities of daily living (ADL), those with a history of smoking within 1 year before surgery, and those with weight loss more than 10% within 6 months before surgery were 4.2, 2.6, and 2.4, respectively. The odds ratios for operative mortality in patients who required preoperative assistance in ADL, those with metastasis/relapse, male patients, and those with chronic obstructive pulmonary disease were 4.7, 4.5, 2.3, and 2.1, respectively.
  
  
  CONCLUSIONS
  This study was the first, as per our knowledge, to perform risk stratification for esophagectomy using a Japanese nationwide database. The 30-day and operative mortality rates were relatively lower than those in previous reports. The risk models developed in this study may contribute toward improvements in quality control of procedures and creation of a novel scoring system.
authors.affiliation: *Japanese Society of Gastroenterological Surgery, Working Group database committee †The Japanese Society of Gastroenterological Surgery, database committee ‡National Clinical Database; and §The Japanese Society of Gastroenterological Surgery, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.forename: Mitsukazu
authors.initials: M
authors.lastname: Gotoh
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.forename: Wataru
authors.initials: W
authors.lastname: Kimura
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagoe
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000368:Aged; D016208:Databases, Factual; D016629:Esophagectomy / Q000401:mortality*; D005260:Female; D006801:Humans; D020407:Internet; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010043:Outcome and Process Assessment, Health Care; D018570:Risk Assessment; D012307:Risk Factors