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Observational Study
. 2018 Mar 5;13(3):e0193186.
doi: 10.1371/journal.pone.0193186. eCollection 2018.

Association between institutional procedural preference and in-hospital outcomes in laparoscopic surgeries; Insights from a retrospective cohort analysis of a nationwide surgical database in Japan

Hiroaki Miyata  1   2 , Masaki Mori  3   4   5 , Norihiro Kokudo  5   6 , Mitsukazu Gotoh  3   7 , Hiroyuki Konno  3   8 , Go Wakabayashi  3   9 , Hisahiro Matsubara  5   10 , Toshiaki Watanabe  5   11 , Minoru Ono  1   12 , Hideki Hashimoto  1   13 , Hiroyuki Yamamoto  1   14 , Hiraku Kumamaru  1   14 , Shun Kohsaka  1   15 , Tadashi Iwanaka  1   16
Affiliations
Observational Study

Association between institutional procedural preference and in-hospital outcomes in laparoscopic surgeries; Insights from a retrospective cohort analysis of a nationwide surgical database in Japan

Hiroaki Miyata et al. PLoS One. .

Abstract

Objective: To assess the use of laparoscopic surgeries (LS) and the association between its performance and hospitals' preference for LS over open surgeries.

Summary background data: LS is increasingly used in many abdominal surgeries, albeit both with and without solid guideline recommendations. To date, the hospitals' preference (LS vs. open surgeries) and its association with in-hospital outcomes has not been evaluated.

Methods: We enrolled patients undergoing 8 types of gastrointestinal surgeries in 2011-2013 in the Japanese National Clinical Database. We assessed the use of LS and the occurrences of surgery-related morbidity and mortality during the study period. Further, for 4 typical LS procedures, we assessed the hospitals' preference for LS by modeling the propensity to perform LS (over open surgeries) from patient-level factors, and estimating each institution's observed/expected (O/E) ratio for LS use. Institutions with O/E>2 were defined as LS-dominant. Using hierarchical logistic regression models, we assessed the association between LS preference and in-hospital outcomes.

Results: Among 1,377,118 patients undergoing gastrointestinal procedures in 2,336 participating hospitals, use of LS increased in all 8 procedures (35.1% to 44.7% for distal gastrectomy (DG), and 27.5% to 43.2% for right hemi colectomy (RHC)). Those operated at LS-dominant hospitals were at an increased risk of operative death (OR 1.83 [95%CI, 1.37-2.45] for DG, 1.79 [95%CI, 1.43-2.25] for RHC) compared to standard O/E level hospitals (0.5≤O/E<2.0).

Conclusions: LS use widely increased during 2011-2013 in Japan. Facilities with higher than expected LS use had higher mortality compared to other hospitals, suggesting a need for careful patient selection and dissemination of the procedure.

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Conflict of interest statement

Competing Interests: Hiroaki Miyata, Shun Kohsaka and Hiraku Kumamaru are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo, and the department is endowed by Johnson & Johnson K.K., Nipro Co., Teijin Pharma Ltd., Kaketsuken K.K., St. Jude Medical Japan Co., Ltd., Novartis Pharma K.K., Taiho Pharmaceutical Co., Ltd., W. L. Gore & Associates, Co., Ltd., Olympus Corporation, and Chugai Pharmaceutical Co., Ltd. None of the organizations had any role in design and conduct of the study, data collection, data analysis, data management, data interpretation, or the preparation, review, approval of this manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Proportion of LS among all surgeries by surgical procedure type over time.
Q, quarter.
Fig 2
Fig 2. Relationship between annual procedure volume vs. observed/expected operative mortality ratio for all surgeries and for LS by procedure.
O/E, observed/expected.
Fig 3
Fig 3. Association between a 10 case increase in surgical and LS volume and odds of operative mortality.
The point estimates of the odds ratio (closed triangle) and the 95% confidence interval are demonstrated.
Fig 4
Fig 4. Increased odds of operative mortality associated with increased LS institutional preference score.
The point estimates of the odds ratio (closed triangle) and the 95% confidence interval are demonstrated.
See this image and copyright information in PMC

References

    1. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004. May 13;350(20):2050–9. doi: 10.1056/NEJMoa032651 - DOI - PubMed
    1. Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J. Long-term outcome of laparoscopic surgery for colorectal cancer: a Cochrane systematic review of randomized controlled trials. Cancer Treat Rev. 2008;34:498–504. doi: 10.1016/j.ctrv.2008.03.011 - DOI - PubMed
    1. Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703) Gastric Cancer. 2010;13:238–244. doi: 10.1007/s10120-010-0565-0 - DOI - PubMed
    1. Choi YY, Bae JM, An JY, Hyung WJ, Noh SH. Laparoscopic gastrectomy for advanced gastric cancer: are the long-term results comparable with conventional open gastrectomy? A systematic review and meta-analysis. J Surg Oncol. 2013. December;108(8):550–6. doi: 10.1002/jso.23438 - DOI - PubMed
    1. Chen K, Pan Y, Cai JQ, Xu XW, Wu D, Mou YP. Totally laparoscopic gastrectomy for gastric cancer: a systematic review and meta-analysis of outcomes compared with open surgery. World J Gastroenterol. 2014. November 14;20(42):15867–78. doi: 10.3748/wjg.v20.i42.15867 - DOI - PMC - PubMed

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