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

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.