Association between the participation of board-certified surgeons in gastroenterological surgery and operative mortality after eight gastroenterological procedures.
OBJECTIVE
The aim of this study is to evaluate the association between the participation of board-certified surgeons in gastroenterological surgery (BCS-Gs) and the surgical outcomes of gastroenterological surgery.


METHODS
Data from the National Clinical Database on patients who underwent eight major gastroenterological procedures were analyzed retrospectively. First, the ratio of cases in which BCS-G were involved to the total cases was calculated for each procedure, and the impact of BCS-G involvement on surgical outcome was assessed by comparing mortality rates in the group with BCS-G involvement vs. the group without BCS-G involvement. Second, the differences in the observed/expected ratio were assessed among four hospital categories according to the available BCS-G number. Finally, the impact of the hospital BCS-G number on mortality was evaluated.


RESULTS
The ratio of BCS-G involvement ranged from 59.0 % for acute diffuse peritonitis to 89.1 % for hepatectomy, and the mortality rate was significantly lower for three procedures when BCS-Gs participated as the operator or assistant. The observed/expected ratio of hospitals with four or more BCS-Gs was less than 1.0 for all the procedures assessed. A multivariable logistic regression model showed that the hospital BCS-G number was a predictor of operative mortality.


CONCLUSIONS
BCS-Gs contribute to favorable outcomes of gastroenterological surgery in Japan. The hospital BCS-G number is a surrogate marker of operative mortality.
The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan. kon_6416@hama-med.ac.jp.|Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Higashi-ku, Hamamatsu, 431-3192, Japan. kon_6416@hama-med.ac.jp.
Hiroyuki
H
Konno
Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Higashi-ku, Hamamatsu, 431-3192, Japan.
Kinji
K
Kamiya
Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Higashi-ku, Hamamatsu, 431-3192, Japan.
Hirotoshi
H
Kikuchi
The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan.|National Clinical Database, Tokyo, Japan.
Hiroaki
H
Miyata
National Clinical Database, Tokyo, Japan.
Norimichi
N
Hirahara
The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan.|National Clinical Database, Tokyo, Japan.
Mitsukazu
M
Gotoh
The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan.
Go
G
Wakabayashi
The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
Tetsuo
T
Ohta
Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Norihiro
N
Kokudo
The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
Masaki
M
Mori
The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
Yasuyuki
Y
Seto
D002568:Certification; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data*; D000072102:Gastroenterologists; D006801:Humans; D016015:Logistic Models; D017063:Outcome Assessment, Health Care; D013044:Specialty Boards; D066231:Surgeons
Board-certified surgeons in gastroenterological surgery; National Clinical Database; Operative mortality
J Gastroenterol. 2014 Jun;49(6):1047-55
23892987
Medicine (Baltimore). 2015 Dec;94(49):e2194
26656350
Ann Surg. 2015 Apr;261(4):642-7
25072442
Int J Clin Oncol. 2015 Feb;20(1):5-10
25376769
Ann Surg. 2005 Jul;242(1):83-91
15973105
Surg Today. 2016 Jan;46(1):38-47
25797948
Ann Surg Oncol. 2006 Sep;13(9):1175-81
16947008
Ann Surg. 2015 Aug;262(2):295-303
25719804
J Hepatobiliary Pancreat Sci. 2016 Jun;23 (6):353-63
26994315
J Hepatobiliary Pancreat Sci. 2016 Jun;23 (6):313-23
26991462
Arch Surg. 2010 Jul;145(7):634-40
20644125
Ann Surg. 2014 Dec;260(6):1034-9
25072429
Lancet. 2012 Sep 22;380(9847):1059-65
22998715
J Am Coll Surg. 2014 Mar;218(3):412-22
24468222
Ann Surg. 2014 Apr;259(4):773-80
24253151
Ann Surg. 2014 Aug;260(2):259-66
24743609
Dis Colon Rectum. 2014 Sep;57(9):1075-81
25101603
Surg Today. 2015 Oct;45(10):1271-9
26263911
Medicine (Baltimore). 2015 Jul;94(30):e1224
26222854
Cancer Sci. 2011 Jan;102(1):226-30
20961361
Surg Today. 2014 Nov;44(11):1991-9
24849141
Surg Today. 2015 Oct;45(10):1233-43
25228380