Impact of certification status of the institute and surgeon on short-term outcomes after surgery for thoracic esophageal cancer: evaluation using data on 16,752 patients from the National Clinical Database in Japan

Satoru Motoyama,Masaichi Ohira,Yasushi Toh,Hiroyuki Yamamoto,Hiroaki Miyata,Yasuyuki Seto,Masayuki Watanabe,Yuichiro Doki,Yoshihiro Kakeji,Hisahiro Matsubara,Yoshiaki Kajiyama,Masahiko Yano,Takushi Yasuda

doi:10.1007/s10388-019-00694-9

Abstract

BackgroundIn 2009, the Japan Esophageal Society (JES) established a system for certification of qualified surgeons as “Board Certified Esophageal Surgeons” (BCESs) or institutes as “Authorized Institutes for Board Certified Esophageal Surgeons” (AIBCESs). We examined the short-term outcomes after esophagectomy, taking into consideration the certifications statuses of the institutes and surgeons.MethodsThis study investigated patients who underwent esophagectomy for thoracic esophageal cancer and who were registered in the Japanese National Clinical Database (NCD) between 2015 and 2017. Using hierarchical multivariable logistic regression analysis adjusted for patient-level risk factors, we determined whether the institute’s or surgeon’s certification status had greater influence on surgery-related mortality or postoperative complications.ResultsEnrolled were 16,752 patients operated on at 854 institutes by 1879 surgeons. There were significant differences in the backgrounds and incidences of postoperative complications and surgery-related mortality rates between the 11,162 patients treated at AIBCESs and the 5590 treated at Non–AIBCESs (surgery-related mortality rates: 1.6% vs 2.8%). There were also differences between the 6854 patients operated on by a BCES and the 9898 treated by a Non-BCES (1.7% vs 2.2%). Hierarchical logistic regression analysis revealed that surgery-related mortality was significantly lower among patients treated at AIBCESs. The institute’s certification had greater influence on short-term surgical outcomes than the operating surgeon’s certification.ConclusionsThe certification system for surgeons and institutes established by the JES appears to be appropriate, as indicated by the improved surgery-related mortality rate. It also appears that the JES certification system contributes to a more appropriate medical delivery system for thoracic esophageal cancer in Japan.

Highlights

Esophagectomy for thoracic esophageal cancer continues to have high morbidity and mortality rates today [1]
Using data from the National Database of Hospital-based Cancer Registries in Japan, we recently verified the appropriateness of the certification system for Authorized Institutes for Board Certified Esophageal Surgeons” (AIBCESs) by the Japan Esophageal Society (JES) by examining the survival outcomes among patients with thoracic esophageal cancer who underwent an esophagectomy at an AIBCES or a Non-AIBCES [2]
There were fewer patients with T2–4 tumors treated at AIBCESs, but more with cN1–3 stage disease

Summary

Introduction

Esophagectomy for thoracic esophageal cancer continues to have high morbidity and mortality rates today [1]. Using data from the National Database of Hospital-based Cancer Registries in Japan, we recently verified the appropriateness of the certification system for AIBCES by the JES by examining the survival outcomes among patients with thoracic esophageal cancer who underwent an esophagectomy at an AIBCES or a Non-AIBCES [2]. In 2009, the Japan Esophageal Society (JES) established a system for certification of qualified surgeons as “Board Certified Esophageal Surgeons” (BCESs) or institutes as “Authorized Institutes for Board Certified Esophageal Surgeons” (AIBCESs). Using hierarchical multivariable logistic regression analysis adjusted for patient-level risk factors, we determined whether the institute’s or surgeon’s certification status had greater influence on surgery-related mortality or postoperative complications. Hierarchical logistic regression analysis revealed that surgery-related mortality was significantly lower among patients treated at AIBCESs. The institute’s certification had greater influence on short-term surgical outcomes than the operating surgeon’s certification.

Methods

Results

Conclusion