Japanese Inpatient Database Research Articles

Patient characteristics, procedure details including catheter devices, and complications of catheter ablation for ventricular tachycardia: a nationwide observational study.

BackgroundNationwide data are insufficient with respect to the characteristics of patients undergoing ventricular tachycardia (VT) ablation, complications of VT ablation, and procedure details including catheter devices used during VT ablation. The present study was performed to describe the patient characteristics, procedure details including catheter devices, and in‐hospital complications of catheter ablation for VT using a national inpatient database.MethodsWe used the Diagnosis Procedure Combination database, a national Japanese inpatient database, to identify patients who underwent VT ablation from July 2010 to March 2017. We examined patients’ age, gender, baseline diseases, comorbid conditions, admission status, catheter devices and drugs used, and in‐hospital complications of VT ablation.ResultsWe identified 10 641 patients (median age, 61 years) who underwent VT ablation. The most frequently observed background heart disease among patients with structural heart disease was ischemic cardiomyopathy. An irrigated ablation catheter was used in 73% of patients, a force‐sensing ablation catheter was used in 22%, and intracardiac echocardiography was used in 25%. The frequency of using these procedures continuously increased over time. Overall, the prevalence of in‐hospital complications was 3.5% (cardiac tamponade, 0.8%; stroke, 0.6%; critical bleeding, 1.9%; mechanical circulatory support, 0.9%; and in‐hospital death, 0.8%).ConclusionsThe results of this study show the clinical features of VT ablation in a real‐world clinical setting. The use of irrigated catheters, force‐sensing catheters, and intracardiac echocardiography increased over time. The prevalence of in‐hospital complications was 3.5%.

Epidemiology and volume-outcome relationship of extracorporeal membrane oxygenation for respiratory failure in Japan: A retrospective observational study using a national administrative database.

AimTo describe the epidemiology of patients on extracorporeal membrane oxygenation (ECMO) and investigate the possible association between outcomes for respiratory ECMO patients and hospital volume of ECMO treatment for any indications.MethodsUsing data from the Diagnosis Procedure Combination database, a nationwide Japanese inpatient database, between 1 July 2010 and 31 March 2018, we identified inpatients aged ≥18 years who underwent ECMO. Institutional case volume was defined as the mean annual number of ECMO cases; eligible patients were categorized into institutional case volume tertile groups. The primary outcome was in‐hospital mortality. For ECMO patients with respiratory failure, the association between institutional case volume group and in‐hospital mortality rate was analyzed using a multilevel logistic regression model including multiple imputation.ResultsExtracorporeal membrane oxygenation was carried out on 25,384 patients during the study period; of those, 1,227 cases were for respiratory failure. Respiratory cases were categorized into low‐ (<8 cases/year), medium‐ (8–16 cases/year), and high‐volume groups (≥17 cases/year). The overall in‐hospital mortality rate for respiratory ECMO was 62.5% in low‐, 54.7% in medium‐, and 50.4% in high‐volume institutions. With reference to low‐volume institutions, the adjusted odds ratios (95% confidence interval) of the medium‐ and high‐volume institutions for in‐hospital mortality were 0.72 (0.50–1.04; P = 0.082) and 0.65 (0.45–0.95; P = 0.024), respectively.ConclusionsThe present study showed that accumulating the experience of using ECMO for any indications could positively affect the outcome of ECMO treatment for respiratory failure, which suggests the effectiveness of consolidating ECMO cases in high‐volume centers in Japan.

Effects of preoperative oral management by dentists on postoperative outcomes following esophagectomy: Multilevel propensity score matching and weighting analyses using the Japanese inpatient database: Erratum.

Effects of preoperative oral management by dentists on postoperative outcomes following esophagectomy: Multilevel propensity score matching and weighting analyses using the Japanese inpatient database: Erratum.

Mortality and morbidity after pancreatoduodenectomy in patients undergoing hemodialysis: Analysis using a national inpatient database

Whether patients undergoing hemodialysis have greater risks of mortality and morbidity after pancreatoduodenectomy remains unknown. We used the Diagnosis Procedure Combination database, a national Japanese inpatient database, to identify patients who underwent pancreatoduodenectomy from July 2010 to March 2015. We conducted propensity-score-matching analyses to compare the outcomes, including postoperative complications and 30- and 90-day mortality after pancreatoduodenectomy between patients with and without hemodialysis. Of 30,495 eligible patients, 307 (1.0%) received hemodialysis. In the unmatched cohort, the proportions of male sex, younger age, pancreatic cancer, ischemic heart disease, diabetes mellitus, and hypertension were greater in patients with hemodialysis than those without hemodialysis. A 1-to-4 propensity score matching created a total of 1,535 patients, including 307 with hemodialysis and 1,228 without hemodialysis. Patients undergoing hemodialysis had greater proportions of postoperative complications, including peritonitis (8.8% vs 4.8%, P = .012), sepsis or disseminated intravascular coagulation (3.6% vs 0.7%, P = .001), intra-abdominal bleeding (4.9% vs 0.7%, P < .001), and acute coronary event (4.2% vs 1.7%, P = .015). Propensity score matching showed that patients undergoing hemodialysis had an increased risk of postoperative complications (OR, 1.62; 95% CI, 1.23-2.14; P = .001), 30-day mortality (OR, 7.45; 95% CI, 3.26-17.0; P < .001), and 90-day mortality (OR, 10.9; 95% CI, 6.58-18.2; P < .001) than those not undergoing hemodialysis. Patients undergoing hemodialysis had a significantly increased risk of postoperative complications and death after pancreatoduodenectomy. In particular, surgeons should consider the increased risk of intra-abdominal bleeding, peritonitis, sepsis or disseminated intravascular coagulation, and acute coronary event in patients with hemodialysis.

Trend in otolaryngological surgeries in an era of super-aging: Descriptive statistics using a Japanese inpatient database

ObjectiveTo reveal the age distribution and capture the longitudinal trend in otolaryngological surgeries performed in Japan, where society is rapidly aging. MethodsUsing the Diagnosis Procedure Combination database, we extracted data on patients who were hospitalized and underwent any type of otolaryngological surgery in departments of otolaryngology or head and neck surgery from fiscal year 2007 to fiscal year 2013. Type of surgery, patient’s age, and fiscal year were compared. We categorized >200 types of surgeries into eight specialties: ear surgery, functional endoscopic sinus surgery (FESS), other types of paranasal surgery (except for malignancy), head and neck cancer surgery, benign tumor surgery, upper airway surgery (including pharynx and larynx), removal of foreign body, and other. ResultsIn total, 558,732 patients were included. The proportions of patients in each age category formed two peaks in middle age and in children aged ≤9years. The proportion of all surgeries made up by FESS, other paranasal surgery, benign tumor surgery, and head and neck cancer surgery gradually increased with age, forming a peak in patients in their 60s. The proportion of ear surgery was highest in patients aged ≤9years (34.0% of all surgeries, mostly myringotomy and transtympanic ventilation tube insertion) and formed a gradual peak in patients in their 60s (mostly tympanoplasty). The proportion of upper airway surgery (tonsillectomy and adenoidectomy) was highest in patients aged ≤9years (25.3% of all surgeries). The proportion of foreign body removal was highest in patients aged ≤9years (52.2% of all surgeries) and increased slightly with age. In 2013, compared with 2007, those aged 65–74 years and ≥75years made up a larger percentage of patients undergoing each specific surgery, including tympanoplasty, stapedectomy/stapedotomy, FESS, head and neck cancer surgery, pharyngolaryngectomy, total/subtotal glossectomy, thyroid lobectomy, parotidectomy (for a benign tumor), submandibular gland resection, tonsillectomy, and vocal fold polypectomy. ConclusionThe age distribution of otolaryngological surgeries varied by specialty. We found an increased proportion of patients aged 65–74 and ≥75years in most specific surgeries.

Postoperative mechanical bowel obstruction after pharyngolaryngectomy for hypopharyngeal cancer: Retrospective analysis using a Japanese inpatient database.

Data have been limited on donor-site mechanical bowel obstruction after pharyngolaryngectomy with free jejunum graft reconstruction. Using a nationwide Japanese inpatient database, we extracted data on patients who underwent pharyngolaryngectomy for hypopharyngeal cancer between July 2007 and March 2014. A Cox proportional hazard model was used to determine the association between background characteristics and the occurrence of mechanical bowel obstruction. Among the 3320 eligible patients from 332 hospitals, 108 patients (3.3%) developed mechanical bowel obstruction after a median 88 (interquartile range 26-217) postoperative days. Multivariable Cox regression analysis revealed that older age (≥60 years old) was independently associated with an increased risk of mechanical bowel obstruction, whereas sex, body mass index [BMI], smoking status, comorbidity at admission, blood transfusion, history of surgery, and hospital type were not. In pharyngolaryngectomy, careful attention should be paid to the risk of abdominal complications and, thus, to the graft choice, especially in elderly patients.

Factors associated with prolonged duration of post-tympanoplasty local treatment in adult chronic otitis media patients: A retrospective observational study using a Japanese inpatient database.

The occurrence of persistent infection following tympanoplasty has been reported in many studies, and it is important to know the risks for site infection after tympanoplasty. In this study, we aimed to explore the factors affecting early wound complications after tympanoplasty for chronic otitis media. We conducted a retrospective cohort study using the Diagnosis Procedure Combination database. Data on a total of 13,094 adult patients from 420 acute-care hospitals who received tympanoplasty for chronic otitis media from 2010 to 2013 were extracted. The duration (days) of postsurgical local wound treatment was measured as an outcome, because this duration was assumed to be prolonged by the existence of wound infection. The associations between treatment duration and background characteristics (age, sex, body mass index, smoking status, diabetes mellitus, use of antithrombotic agents, with or without cholesteatoma, duration of anesthesia, academic hospital or not, and hospital volume) were assessed by multivariable linear regression analyses, fitted with a generalized estimating equation to adjust for within-hospital clustering. The median treatment duration in each hospital was 8 days (interquartile range: 7-11). Factors significantly associated with longer treatment duration were: older age (0.2 days for 10-year increase), use of antithrombotic agents during hospitalization (1.8 days), and prolonged duration of anesthesia (vs. <120min of anesthesia, additional 1, 2, 3, and 4 days for 120-179, 180-239, 240-299, and ≥300min of anesthesia, respectively). Body mass index and smoking status were not significantly associated with treatment duration. Older age, antithrombotic agents during hospitalization, and longer anesthesia time were independently associated with early local wound complications after tympanoplasty for chronic otitis media.

慢性中耳炎に対する鼓室形成術術後の創処置期間に関連する要因の探索:本邦の入院データベースを用いた後方視的検討

慢性中耳炎に対する鼓室形成術術後の創処置期間に関連する要因の探索:本邦の入院データベースを用いた後方視的検討

Effect of Japanese Herbal Kampo Medicine Goreisan on Reoperation Rates after Burr-Hole Surgery for Chronic Subdural Hematoma: Analysis of a National Inpatient Database.

Goreisan is a herbal Kampo medicine used for treating chronic subdural hematoma (CSDH) in Japan. Experimental studies have suggested that Goreisan exerts a hydrogogue effect, but clinical evidence for the effectiveness of Goreisan in CSDH is currently lacking. Using a national Japanese inpatient database, we examined the association between Goreisan use and reoperation rates after burr-hole surgery for CSDH. We identified 36,020 patients, including 3,889 Goreisan users and 32,131 nonusers. Propensity scores of receiving Goreisan were calculated based on hospital characteristics and patient backgrounds (age, sex, body mass index, activities of daily living, consciousness level, comorbidities, antithrombotic agent use, mannitol infusion, and corticosteroid infusion). One-to-one propensity-score matching created 3,879 pairs of Goreisan users and nonusers. Propensity-matched analysis revealed that Goreisan use was significantly associated with a lower reoperation rate (4.8%) compared with nonuse (6.2%) (risk difference, −1.4%; 95% confidence interval (CI), −2.4% to −0.38%). The number needed to prevent one reoperation was 72 (95% CI, 41–265). Instrumental-variable analysis showed similar results to the propensity-matched analysis. These results suggest that Goreisan use reduced the need for reoperation after burr-hole surgery for CSDH.

Factors associated with severe epiglottitis in adults: Analysis of a Japanese inpatient database.

The aim of the study was to evaluate the factors associated with the development of severe epiglottitis in adults to provide information for physicians to make early decisions on airway management. Retrospective cohort study. Adult patients admitted to acute care hospitals with a diagnosis of acute epiglottitis between January 2011 and December 2012 were identified in the Diagnosis Procedure Combination database of Japan. The main outcome measures were: 1) severe epiglottitis requiring airway intervention or resulting in early death within 2 days after admission and 2) 2-day mortality. Multivariable logistic regression analysis was performed to evaluate the association between patient characteristics and development of severe epiglottitis. A total of 6,072 epiglottitis patients from 599 hospitals were identified. The proportion of developing severe epiglottitis was 9.4%, and 2-day mortality was 0.4%. Factors significantly associated with severe epiglottitis were older age, male sex (adjusted odds ratio [OR] 1.60; 95% confidence interval [CI], 1.28-2.00; P < .001), body mass index (BMI) >25.0 kg/m(2) (OR 1.31; 95% CI, 1.05-1.63; P = .018), diabetes mellitus (OR 1.41; 95% CI, 1.06-1.86; P = .017), epiglottic cyst (OR 2.90; 95% CI, 1.46-5.78; P = .002), pneumonia (OR 2.90; 95% CI, 1.73-4.86; P < .001), and academic hospitals (OR 1.56; 95% CI, 1.21-2.00; P = .001). Epiglottitis-related admission was summer-dominant, but seasonality was not significantly associated with severe epiglottitis. Development of severe epiglottitis was significantly associated with older age, BMI >25.0 kg/m(2), diabetes mellitus, epiglottic cyst, or pneumonia at admission. 2b.