Association between institutional procedural preference and in-hospital outcomes in laparoscopic surgeries; Insights from a retrospective cohort analysis of a nationwide surgical database in Japan.
To assess the use of laparoscopic surgeries (LS) and the association between its performance and hospitals' preference for LS over open surgeries.LS is increasingly used in many abdominal surgeries, albeit both with and without solid guideline recommendations. To date, the hospitals' prefe...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5837082?pdf=render |
| _version_ | 1811264137607512064 |
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| author | Hiroaki Miyata Masaki Mori Norihiro Kokudo Mitsukazu Gotoh Hiroyuki Konno Go Wakabayashi Hisahiro Matsubara Toshiaki Watanabe Minoru Ono Hideki Hashimoto Hiroyuki Yamamoto Hiraku Kumamaru Shun Kohsaka Tadashi Iwanaka |
| author_facet | Hiroaki Miyata Masaki Mori Norihiro Kokudo Mitsukazu Gotoh Hiroyuki Konno Go Wakabayashi Hisahiro Matsubara Toshiaki Watanabe Minoru Ono Hideki Hashimoto Hiroyuki Yamamoto Hiraku Kumamaru Shun Kohsaka Tadashi Iwanaka |
| author_sort | Hiroaki Miyata |
| collection | DOAJ |
| description | To assess the use of laparoscopic surgeries (LS) and the association between its performance and hospitals' preference for LS over open surgeries.LS is increasingly used in many abdominal surgeries, albeit both with and without solid guideline recommendations. To date, the hospitals' preference (LS vs. open surgeries) and its association with in-hospital outcomes has not been evaluated.We enrolled patients undergoing 8 types of gastrointestinal surgeries in 2011-2013 in the Japanese National Clinical Database. We assessed the use of LS and the occurrences of surgery-related morbidity and mortality during the study period. Further, for 4 typical LS procedures, we assessed the hospitals' preference for LS by modeling the propensity to perform LS (over open surgeries) from patient-level factors, and estimating each institution's observed/expected (O/E) ratio for LS use. Institutions with O/E>2 were defined as LS-dominant. Using hierarchical logistic regression models, we assessed the association between LS preference and in-hospital outcomes.Among 1,377,118 patients undergoing gastrointestinal procedures in 2,336 participating hospitals, use of LS increased in all 8 procedures (35.1% to 44.7% for distal gastrectomy (DG), and 27.5% to 43.2% for right hemi colectomy (RHC)). Those operated at LS-dominant hospitals were at an increased risk of operative death (OR 1.83 [95%CI, 1.37-2.45] for DG, 1.79 [95%CI, 1.43-2.25] for RHC) compared to standard O/E level hospitals (0.5≤O/E<2.0).LS use widely increased during 2011-2013 in Japan. Facilities with higher than expected LS use had higher mortality compared to other hospitals, suggesting a need for careful patient selection and dissemination of the procedure. |
| first_indexed | 2024-04-12T19:57:30Z |
| format | Article |
| id | doaj.art-42425171a4494f548d4d65d4bbe9a897 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T19:57:30Z |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-42425171a4494f548d4d65d4bbe9a8972022-12-22T03:18:37ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01133e019318610.1371/journal.pone.0193186Association between institutional procedural preference and in-hospital outcomes in laparoscopic surgeries; Insights from a retrospective cohort analysis of a nationwide surgical database in Japan.Hiroaki MiyataMasaki MoriNorihiro KokudoMitsukazu GotohHiroyuki KonnoGo WakabayashiHisahiro MatsubaraToshiaki WatanabeMinoru OnoHideki HashimotoHiroyuki YamamotoHiraku KumamaruShun KohsakaTadashi IwanakaTo assess the use of laparoscopic surgeries (LS) and the association between its performance and hospitals' preference for LS over open surgeries.LS is increasingly used in many abdominal surgeries, albeit both with and without solid guideline recommendations. To date, the hospitals' preference (LS vs. open surgeries) and its association with in-hospital outcomes has not been evaluated.We enrolled patients undergoing 8 types of gastrointestinal surgeries in 2011-2013 in the Japanese National Clinical Database. We assessed the use of LS and the occurrences of surgery-related morbidity and mortality during the study period. Further, for 4 typical LS procedures, we assessed the hospitals' preference for LS by modeling the propensity to perform LS (over open surgeries) from patient-level factors, and estimating each institution's observed/expected (O/E) ratio for LS use. Institutions with O/E>2 were defined as LS-dominant. Using hierarchical logistic regression models, we assessed the association between LS preference and in-hospital outcomes.Among 1,377,118 patients undergoing gastrointestinal procedures in 2,336 participating hospitals, use of LS increased in all 8 procedures (35.1% to 44.7% for distal gastrectomy (DG), and 27.5% to 43.2% for right hemi colectomy (RHC)). Those operated at LS-dominant hospitals were at an increased risk of operative death (OR 1.83 [95%CI, 1.37-2.45] for DG, 1.79 [95%CI, 1.43-2.25] for RHC) compared to standard O/E level hospitals (0.5≤O/E<2.0).LS use widely increased during 2011-2013 in Japan. Facilities with higher than expected LS use had higher mortality compared to other hospitals, suggesting a need for careful patient selection and dissemination of the procedure.http://europepmc.org/articles/PMC5837082?pdf=render |
| spellingShingle | Hiroaki Miyata Masaki Mori Norihiro Kokudo Mitsukazu Gotoh Hiroyuki Konno Go Wakabayashi Hisahiro Matsubara Toshiaki Watanabe Minoru Ono Hideki Hashimoto Hiroyuki Yamamoto Hiraku Kumamaru Shun Kohsaka Tadashi Iwanaka Association between institutional procedural preference and in-hospital outcomes in laparoscopic surgeries; Insights from a retrospective cohort analysis of a nationwide surgical database in Japan. PLoS ONE |
| title | Association between institutional procedural preference and in-hospital outcomes in laparoscopic surgeries; Insights from a retrospective cohort analysis of a nationwide surgical database in Japan. |
| title_full | Association between institutional procedural preference and in-hospital outcomes in laparoscopic surgeries; Insights from a retrospective cohort analysis of a nationwide surgical database in Japan. |
| title_fullStr | Association between institutional procedural preference and in-hospital outcomes in laparoscopic surgeries; Insights from a retrospective cohort analysis of a nationwide surgical database in Japan. |
| title_full_unstemmed | Association between institutional procedural preference and in-hospital outcomes in laparoscopic surgeries; Insights from a retrospective cohort analysis of a nationwide surgical database in Japan. |
| title_short | Association between institutional procedural preference and in-hospital outcomes in laparoscopic surgeries; Insights from a retrospective cohort analysis of a nationwide surgical database in Japan. |
| title_sort | association between institutional procedural preference and in hospital outcomes in laparoscopic surgeries insights from a retrospective cohort analysis of a nationwide surgical database in japan |
| url | http://europepmc.org/articles/PMC5837082?pdf=render |
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