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 1 - Hepatectomy of more than one segment.
abstract: BACKGROUND
  The objective of this study was to validate the board certification system of the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) using the data of hepatectomy cases from the National Clinical Database (NCD) of Japan.
  
  
  METHODS
  Minimal required annual numbers of high-level hepato-biliary-pancreatic (HBP) surgeries were 50 for a board-certified A training institution and 30 for a board-certified B training institution. Records of 14,970 patients who had undergone hepatectomy of more than one segment (MOS), excluding lateral segmentectomy, during 2011 and 2012 were analyzed according to the category of board-certified institution and with or without participation of board-certified instructors or expert surgeons.
  
  
  RESULTS
  Thirty-day mortality and operative mortality of 14,970 patients after MOS hepatectomy were 1.9% and 3.8%, respectively. Operative mortality rates after MOS hepatectomies performed at certified A institutions, certified B institutions, and non-certified institutions were 3.1%, 3.8%, and 4.5%, respectively (P < 0.001). The operative mortality rates after MOS hepatectomies performed with participation of certified instructors or expert surgeons were better than those without (3.5% vs. 4.3%, P = 0.012). A multiple logistic regression model showed that the cutoffs of high-level HBP surgeries performed per year at hospitals that predicted operative mortality after MOS hepatectomies were 10 and 50.
  
  
  CONCLUSIONS
  Competences and requirements for board-certified institutions, instructors, and expert surgeons to perform hepatectomy were found to be appropriate.
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 / Q000592:standards*; D002983:Clinical Competence; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000193:education / Q000592:standards; D005260:Female; D006498:Hepatectomy / Q000193:education* / Q000592:standards*; D061847:Hospitals, High-Volume / Q000592:standards; D006801:Humans; D007564:Japan; D008297:Male; D012955:Societies, Medical / Q000592:standards; D013044:Specialty Boards; D066231:Surgeons / Q000193:education
keywords: Board certification; Centralization; Hepatectomy; Hepato-biliary-pancreatic surgery; High-volume hospital; Pancreatoduodenectomy