title: Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database.
abstract: OBJECTIVE
  To construct a risk model for total gastrectomy outcomes using a nationwide Internet-based database.
  
  
  BACKGROUND
  Total gastrectomy is a very common procedure in Japan. This procedure is among the most invasive gastrointestinal procedures and is known to carry substantial surgical risks.
  
  
  METHODS
  The National Clinical Database was used to retrieve records on more than 1,200,000 surgical cases from 3500 hospitals in 2011. After data cleanup, 20,011 records from 1623 hospitals were analyzed for procedures performed between January 1, 2011, and December 31, 2011.
  
  
  RESULTS
  The average patient age was 68.9 years; 73.7% were male. The overall morbidity was 26.2%, with a 30-day mortality rate of 0.9%, in-hospital mortality rate of 2.2%, and overall operative mortality rate of 2.3%. The odds ratios for 30-day mortality were as follows: ASA (American Society of Anesthesiologists) grade 4 or 5, 9.4; preoperative dialysis requirement, 3.9; and platelet count less than 50,000 per microliter, 3.1. The odds ratios for operative mortality were as follows: ASA grade 4 or 5, 5.2; disseminated cancer, 3.5; and alkaline phosphatase level of more than 600 IU/L, 3.1. The C-index of 30-day mortality and operative mortality was 0.811 (95% confidence interval [CI], 0.744-0.879) and 0.824 (95% CI, 0.781-0.866), respectively.
  
  
  CONCLUSIONS
  We have performed the first reported risk stratification study for total gastrectomy, using a nationwide Internet-based database. The total gastrectomy outcomes in the nationwide population were satisfactory. The risk models that we have created will help improve the quality of surgical practice.
authors: *The 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, Tokyo, Japan.
authors: Masayuki
authors: M
authors: Watanabe
authors: Hiroaki
authors: H
authors: Miyata
authors: Mitsukazu
authors: M
authors: Gotoh
authors: Hideo
authors: H
authors: Baba
authors: Wataru
authors: W
authors: Kimura
authors: Naohiro
authors: N
authors: Tomita
authors: Tohru
authors: T
authors: Nakagoe
authors: Mitsuo
authors: M
authors: Shimada
authors: Yuko
authors: Y
authors: Kitagawa
authors: Kenichi
authors: K
authors: Sugihara
authors: Masaki
authors: M
authors: Mori
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D020407:Internet; D007564:Japan / Q000453:epidemiology; D008297:Male; D009017:Morbidity / Q000639:trends; D016017:Odds Ratio; D011159:Population Surveillance / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends