title: Surgical risk model for acute diffuse peritonitis based on a Japanese nationwide database: an initial report on the surgical and 30-day mortality.
abstract: OBJECTIVE
  Acute diffuse peritonitis (ADP) is an important surgical complication associated with high morbidity and mortality; however, the risk factors associated with a poor outcome have remained controversial. This study aimed in collecting integrated data using a web-based national database system to build a risk model for mortality after surgery for ADP.
  
  
  METHODS
  We included cases registered in the National Clinical Database in Japan. After data cleanup, 8,482 surgical cases of ADP from 1,285 hospitals treated between January 1 and December 31, 2011 were analyzed.
  
  
  RESULTS
  The raw 30-day and surgical mortality rates were 9.0 and 14.1 %, respectively. The odds ratios (>2.0) for 30-day mortality were as follows: American Society of Anesthesiologists (ASA) class 3, 2.69; ASA class 4, 4.28; ASA class 5, 8.65; previous percutaneous coronary intervention (PCI), 2.05; previous surgery for peripheral vascular disease (PVD), 2.45 and disseminated cancer, 2.16. The odds ratios (>2.0) for surgical mortality were as follows: ASA class 3, 2.27; ASA class 4, 4.67; ASA class 5, 6.54, and disseminated cancer, 2.09. The C-indices of 30-day and surgical mortality were 0.851 and 0.852, respectively.
  
  
  CONCLUSIONS
  This is the first report of risk stratification after surgery for ADP using a nationwide surgical database. This system could be useful to predict the outcome of surgery for ADP and for evaluations and benchmark performance studies.
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagoe
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan.|National Clinical Database (NCD), Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan. mgotoh@fmu.ac.jp.|National Clinical Database (NCD), Tokyo, Japan. mgotoh@fmu.ac.jp.|Department of Regenerative Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan. mgotoh@fmu.ac.jp.
authors.forename: Mitsukazu
authors.initials: M
authors.lastname: Gotoh
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Anazawa
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Kimura
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000208:Acute Disease; D016208:Databases, Factual; D006801:Humans; D007564:Japan; D016015:Logistic Models; D010538:Peritonitis / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality* / Q000601:surgery*; D012306:Risk; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute diffuse peritonitis; Mortality; Risk factor; Risk model