title: Validation of the board certification system for expert surgeons (hepato-biliary-pancreatic field) using the data of the National Clinical Database of Japan: part 2 - Pancreatoduodenectomy.
abstract: BACKGROUND
  Data of pancreatoduodenectomy (PD) cases from the National Clinical Database (NCD) were analyzed in order to validate the board certification system established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS).
  
  
  METHODS
  Board-certified A training institutions and board-certified B training institutions were required to perform at least 50 and 30 high-level hepato-biliary-pancreatic (HBP) surgeries per year, respectively. Records of 17,563 patients who had undergone PD during 2011 and 2012 were retrospectively analyzed according to the category of the board-certified institution and with or without participation of board-certified instructors or expert surgeons.
  
  
  RESULTS
  Operative mortality rates after PDs performed at certified A institutions, certified B institutions, and non-certified institutions were 1.5%, 3.0%, and 3.9%, respectively (P < 0.001). The operative mortality rates after PDs performed with participation of certified instructors or expert surgeons were better than those without (2.2% vs. 3.8%, P < 0.001). A multiple logistic regression model showed that cutoffs of high-level HBP surgeries performed per year at hospitals that predicted 30-day mortality after PDs were 10 and 50, and that those that predicted operative mortality were 10 and 70.
  
  
  CONCLUSIONS
  The requirements for board-certified institutions, instructors, and expert surgeons to perform PD were appropriate. The requirements for board-certified A institutions were close to the identified cutoffs. Further analyses are necessary to elucidate the implications of the board certification system.
authors.affiliation: Committee of the Board Certification System for Expert Surgeons, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.affiliation: Committee of the Board Certification System for Expert Surgeons, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
authors.forename: Mitsukazu
authors.initials: M
authors.lastname: Gotoh
authors.affiliation: Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konno
authors.affiliation: Committee of the Board Certification System for Expert Surgeons, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Fujimoto
authors.affiliation: Committee of the Board Certification System for Expert Surgeons, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
authors.affiliation: Committee of the Board Certification System for Expert Surgeons, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.affiliation: Committee of the Board Certification System for Expert Surgeons, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
authors.affiliation: Committee of the Board Certification System for Expert Surgeons, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
authors.affiliation: The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Seto
authors.affiliation: Committee of the Board Certification System for Expert Surgeons, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
authors.affiliation: Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.|Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Norimichi
authors.initials: N
authors.lastname: Hirahara
authors.affiliation: Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D002568:Certification / Q000379:methods*; D002983:Clinical Competence; D016208:Databases, Factual; D005260:Female; D061847:Hospitals, High-Volume / Q000592:standards; D006801:Humans; D007564:Japan; D008297:Male; D016577:Pancreaticoduodenectomy / Q000193:education* / Q000592:standards; D012955:Societies, Medical / Q000592:standards; D013044:Specialty Boards / Q000592:standards; D066231:Surgeons / Q000193:education*
keywords: Board certification; Centralization; Hepatectomy; Hepato-biliary-pancreatic surgery; High-volume hospital; Pancreatoduodenectomy