Ohki Takeshi, Yamamoto Masakazu, Miyata Hiroaki, Sato Yasuto, Saida Yoshihisa, Morimoto Tsuyoshi, Konno Hiroyuki, Seto Yasuyuki, Hirata Koichi
aDepartment of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University bNational Clinical Database cDepartment of Health Policy and Management, School of Medicine, Keio University dDepartment of Public Health, Tokyo Women's Medical University eDepartment of Surgery, Toho University Ohashi Medical Centre, Tokyo fDepartment of Radiology, St. Marianna University School of Medicine, Kawasaki gThe Japanese Society of Gastroenterological Surgery, Tokyo hSecond Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu iDepartment of Gastrointestinal Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo jThe Japanese Society for Abdominal Emergency Medicine, Tokyo kFirst department of surgery of Sapporo Medical university school of Medicine, Sapporo lDepartment of Surgery, JR Sapporo Hospital, Sapporo, Japan.
Medicine (Baltimore). 2017 Jan;96(2):e5818. doi: 10.1097/MD.0000000000005818.
Colorectal perforation has a high rate of mortality. We compared the incidence and fatality rates of colorectal perforation among different hospitals in Japan using data from the nationwide surgical database.Patients were registered in the National Clinical Database (NCD) between January 1st, 2011 and December 31st, 2013. Patients with colorectal perforation were identified from surgery records by examining if acute diffuse peritonitis (ADP) and diseases associated with a high probability of colorectal perforation were noted. The primary outcome measures included the 30-day postsurgery mortality and surgical mortality of colorectal perforation. We analyzed differences in the observed-to-expected mortality (O/E) ratio between the two groups of hospitals, that is, specialized and non-specialized, using the logistic regression analysis forward selection method.There were 10,090 cases of disease-induced colorectal perforation during the study period. The annual average postoperative fatality rate was 11.36%. There were 3884 patients in the specialized hospital group and 6206 in the non-specialized hospital group. The O/E ratio (0.9106) was significantly lower in the specialized hospital group than in the non-specialized hospital group (1.0704). The experience level of hospitals in treating cases of colorectal perforation negatively correlated with the O/E ratio.We conducted the first study investigating differences among hospitals with respect to their fatality rate of colorectal perforation on the basis of data from a nationwide database. Our data suggest that patients with colorectal perforation should choose to be treated at a specialized hospital or a hospital that treats five or more cases of colorectal perforation per year. The results of this study indicate that specialized hospitals may provide higher quality medical care, which in turn proves that government policy on healthcare is effective at improving the medical system in Japan.
结直肠穿孔的死亡率很高。我们使用全国外科数据库的数据，比较了日本不同医院之间结直肠穿孔的发病率和死亡率。
患者于2011年1月1日至2013年12月31日在国家临床数据库（NCD）中进行登记。通过检查是否记录有急性弥漫性腹膜炎（ADP）以及与结直肠穿孔高概率相关的疾病，从手术记录中识别出结直肠穿孔患者。主要结局指标包括结直肠穿孔术后30天死亡率和手术死亡率。我们使用逻辑回归分析向前选择法，分析了两组医院（即专科医院和非专科医院）观察到的与预期死亡率（O/E）之比的差异。
研究期间共有10090例疾病诱发的结直肠穿孔病例。年平均术后死亡率为11.36%。专科医院组有3884例患者，非专科医院组有6206例患者。专科医院组的O/E比（0.9106）显著低于非专科医院组（1.0704）。医院治疗结直肠穿孔病例的经验水平与O/E比呈负相关。
我们基于全国数据库的数据，首次开展了一项关于不同医院结直肠穿孔死亡率差异的研究。我们的数据表明，结直肠穿孔患者应选择在专科医院或每年治疗五例及以上结直肠穿孔病例的医院接受治疗。本研究结果表明，专科医院可能提供更高质量的医疗服务，这反过来证明了日本政府的医疗保健政策在改善医疗系统方面是有效的。
