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Comparative Study
. 2020 Jan;17(1):41-49.
doi: 10.1007/s10388-019-00694-9. Epub 2019 Oct 3.

Impact of certification status of the institute and surgeon on short-term outcomes after surgery for thoracic esophageal cancer: evaluation using data on 16,752 patients from the National Clinical Database in Japan

Satoru Motoyama  1   2 , Hiroyuki Yamamoto  3 , Hiroaki Miyata  3 , Masahiko Yano  4 , Takushi Yasuda  4 , Masaichi Ohira  4 , Yoshiaki Kajiyama  4 , Yasushi Toh  4 , Masayuki Watanabe  4 , Yoshihiro Kakeji  5 , Yasuyuki Seto  5 , Yuichiro Doki  4 , Hisahiro Matsubara  4
Affiliations
Comparative Study

Impact of certification status of the institute and surgeon on short-term outcomes after surgery for thoracic esophageal cancer: evaluation using data on 16,752 patients from the National Clinical Database in Japan

Satoru Motoyama et al. Esophagus. 2020 Jan.

Abstract

Background: In 2009, the Japan Esophageal Society (JES) established a system for certification of qualified surgeons as "Board Certified Esophageal Surgeons" (BCESs) or institutes as "Authorized Institutes for Board Certified Esophageal Surgeons" (AIBCESs). We examined the short-term outcomes after esophagectomy, taking into consideration the certifications statuses of the institutes and surgeons.

Methods: This study investigated patients who underwent esophagectomy for thoracic esophageal cancer and who were registered in the Japanese National Clinical Database (NCD) between 2015 and 2017. Using hierarchical multivariable logistic regression analysis adjusted for patient-level risk factors, we determined whether the institute's or surgeon's certification status had greater influence on surgery-related mortality or postoperative complications.

Results: Enrolled were 16,752 patients operated on at 854 institutes by 1879 surgeons. There were significant differences in the backgrounds and incidences of postoperative complications and surgery-related mortality rates between the 11,162 patients treated at AIBCESs and the 5590 treated at Non-AIBCESs (surgery-related mortality rates: 1.6% vs 2.8%). There were also differences between the 6854 patients operated on by a BCES and the 9898 treated by a Non-BCES (1.7% vs 2.2%). Hierarchical logistic regression analysis revealed that surgery-related mortality was significantly lower among patients treated at AIBCESs. The institute's certification had greater influence on short-term surgical outcomes than the operating surgeon's certification.

Conclusions: The certification system for surgeons and institutes established by the JES appears to be appropriate, as indicated by the improved surgery-related mortality rate. It also appears that the JES certification system contributes to a more appropriate medical delivery system for thoracic esophageal cancer in Japan.

Keywords: Certification; Esophageal cancer; Esophagectomy; Mortality; Postoperative complication.

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Conflict of interest statement

There are no financial or other relations that could lead to a conflict of interest regarding this study. Hiroyuki Yamamoto and Hiroaki Miyata are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by grants from the National Clinical Database, Johnson & Johnson K.K., and Nipro Co.

Figures

Fig. 1
Fig. 1
Results of a hierarchical multivariable logistic regression analysis of the incidence of surgery-related mortality and operative complications (anastomotic leakage, postoperative pneumonia and recurrent laryngeal nerve palsy) adjusted for patient-level risk factors in the indicated four categories
See this image and copyright information in PMC

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