Nagayasu Takeshi, Sato Shuntaro, Yamamoto Hiroshi, Yamasaki Naoya, Tsuchiya Tomoshi, Matsumoto Keitaro, Miyazaki Takuro, Endo Shunsuke, Tanaka Fumihiro, Yokomise Hiroyasu, Okumura Meinoshin
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan.
Eur J Cardiothorac Surg. 2016 May;49(5):e134-40. doi: 10.1093/ejcts/ezw006. Epub 2016 Jan 31.
The Japanese Board of General Thoracic Surgery and the annual survey by the Japanese Association for Thoracic Surgery (JATS) of certified hospitals began in 2005; since then, over 1300 specialists and 650 hospitals have been certified by this system. To evaluate how this system contributes to improving the outcomes of general thoracic surgery, the effects of the number of certified general thoracic surgeons (GTSs) and hospital volume on 30-day mortality or hospital mortality were evaluated.
Using data from the annual survey of JATS from 2005 to 2012, the outcomes of 211 619 patients who underwent lung resection for lung cancer were evaluated. The patients were divided into four groups by the level of surgery: first level, partial resection; second level, segmentectomy and lobectomy; third level, sleeve segmentectomy and lobectomy; and fourth level, pneumonectomy, sleeve pneumonectomy and pleuro-pneumonectomy. Multiple logistic regression analysis was used to examine the associations between operative mortality and the number of GTSs, hospital volume and level of surgical procedure.
Overall 30-day and hospital mortality rates were 0.40 and 0.77%, respectively. The 30-day and hospital mortality rates for each surgical level were 0.20 and 0.35% for the first level, 0.36 and 0.73% for the second level, 1.02 and 1.81% for the third level and 2.42 and 4.26% for the fourth level, respectively. The number of GTSs was associated with lower 30-day and hospital mortality rates (P < 0.0001). On logistic analysis, number of GTSs (<3 vs ≥3), hospital volume (<50 vs ≥50) and level of procedure (1 vs 2, 3 vs 2, 4 vs 2) were significantly associated with 30-day and hospital mortality rates. For 30-day mortality, the odds ratios were 0.688 (P < 0.0001) for higher number of GTSs and 0.856 (P = 0.0510) for higher volume hospitals. In the subgroup analysis by surgical level, low 30-day and hospital mortality rates in the second and fourth surgical levels were correlated with a higher number of GTSs.
The current decrease in overall 30-day mortality rates from the JATS data showed greater dependence on the number of GTSs than on the hospital volume. We believe that the certification system in Japan is useful for the establishment of GTS status.
日本普通胸外科委员会以及日本胸外科学会（JATS）对认证医院开展的年度调查始于2005年；自那时起，该系统已认证了1300多名专科医生和650家医院。为评估该系统如何有助于改善普通胸外科手术的结果，对认证普通胸外科医生（GTS）数量和医院手术量对30天死亡率或住院死亡率的影响进行了评估。
利用2005年至2012年JATS年度调查的数据，对211619例因肺癌接受肺切除术的患者的手术结果进行了评估。根据手术水平将患者分为四组：第一级，部分切除术；第二级，肺段切除术和肺叶切除术；第三级，袖状肺段切除术和袖状肺叶切除术；第四级，全肺切除术、袖状全肺切除术和胸膜全肺切除术。采用多因素logistic回归分析来检验手术死亡率与GTS数量、医院手术量和手术操作水平之间的关联。
总体30天和住院死亡率分别为0.40%和0.77%。各手术级别的30天和住院死亡率分别为：第一级0.20%和0.35%，第二级0.36%和0.73%，第三级1.02%和1.81%，第四级2.42%和4.26%。GTS数量与较低的30天和住院死亡率相关（P<0.0001）。logistic分析显示，GTS数量（<3与≥3）、医院手术量（<50与≥50）和手术级别（1与2、3与2、4与2）与30天和住院死亡率显著相关。对于30天死亡率，GTS数量较多时的比值比为0.688（P<0.0001），医院手术量较高时的比值比为0.856（P=0.0510）。在按手术级别进行的亚组分析中，第二和第四手术级别的低30天和住院死亡率与较多的GTS数量相关。
根据JATS数据，目前总体30天死亡率的下降显示出对GTS数量的依赖大于对医院手术量的依赖。我们认为日本的认证系统有助于确立GTS的地位。
