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 |
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| Authors: | Fumihiko Miura Masakazu Yamamoto Mitsukazu Gotoh Hiroyuki Konno Jiro Fujimoto Katsuhiko Yanaga Norihiro Kokudo Hiroki Yamaue Go Wakabayashi Yasuyuki Seto Michiaki Unno Hiroaki Miyata Norimichi Hirahara Masaru Miyazaki |
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| Affiliation: | 1. Committee of the Board Certification System for Expert Surgeons, Japanese Society of Hepato‐Biliary‐Pancreatic Surgery, Tokyo, Japan;2. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan;3. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan;4. Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan;5. Japanese Society of Hepato‐Biliary‐Pancreatic Surgery, Tokyo, Japan |
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| 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. |
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| Keywords: | Board certification Centralization Hepatectomy Hepato‐biliary‐pancreatic surgery High‐volume hospital Pancreatoduodenectomy |
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