Impact of a board certification system and implementation of clinical practice guidelines for pancreatic cancer on morta
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ORIGINAL ARTICLE
Impact of a board certification system and implementation of clinical practice guidelines for pancreatic cancer on mortality of pancreaticoduodenectomy Masamichi Mizuma1 · Hiroyuki Yamamoto2 · Hiroaki Miyata2 · Mitsukazu Gotoh3 · Michiaki Unno1 · Tooru Shimosegawa1 · Yasushi Toh3 · Yoshihiro Kakeji3 · Yasuyuki Seto3 Received: 18 February 2020 / Accepted: 14 April 2020 © The Author(s) 2020
Abstract Purposes The aim of this study was to clarify the impact of a board certification system and the implementation of clinical practice guidelines for pancreatic cancer (PC) on the mortality of pancreaticoduodenectomy in Japan. Methods By a web questionnaire survey via the National Clinical Database (NCD) for departments participating in the NCD, quality indicators (QIs) related to the treatment for PC, namely the board certification systems of various societies and the adherence to clinical practice guidelines for PC, were investigated between October 2014 and January 2015. A multivariable logistic regression analysis was performed to evaluate the relationship between the QIs and mortality of pancreaticoduodenectomy. Results Of 1415 departments that registered at least 1 pancreaticoduodenectomy between 2013 and 2014 in NCD, 631 departments (44.6%), which performed pancreaticoduodenectomy for a total of 11,684 cases, answered the questionnaire. The mortality of pancreaticoduodenectomy was positively affected by the board certification systems of the Japanese Society of Gastroenterological Surgery, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Japanese Society of Gastroenterology, and Japanese Society of Medical Oncology as well as by institutions that used magnetic resonance imaging of ≥ 3 T for the diagnosis of PC in principle. Conclusions The measurement of the appropriate QIs is suggested to help improve the mortality in pancreaticoduodenectomy. Masamichi Mizuma and Hiroyuki Yamamoto equally contributed Keywords Pancreaticoduodenectomy · Pancreatic cancer · Quality indicator · Board certification · Clinical practice guideline Abbreviations ADL Activity of daily life AOR Adjusted odds ratio APTT Activated partial thromboplastin time ASA American Society of Anesthesiologists BMI Body mass index CA Celiac artery CI Confidence interval * Mitsukazu Gotoh [email protected] 1
Japan Pancreas Society, Osaka, Japan
2
Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
3
The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
CT Computed tomography JSGE Japanese Society of Gastroenterology JSGS Japanese Society of Gastroenterological Surgery JSHBPS Japanese Society of Hepato-Biliary-Pancreatic Surgery JSMO Japanese Society of Medical Oncology JSS Japan Surgical Society MRI Magnetic resonance imaging NCD National Clinical Database PD Pancreaticoduodenectomy PT-INR Prothrombin time- international normalized ratio QI Quality indicator SMA Superior mesenteric artery WBC White blood cell
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