Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer
Background Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative...
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| Autor*in: |
Kunisaki, Chikara [verfasserIn] Miyata, Hiroaki [verfasserIn] Konno, Hiroyuki [verfasserIn] Saze, Zenichiro [verfasserIn] Hirahara, Norimichi [verfasserIn] Kikuchi, Hirotoshi [verfasserIn] Wakabayashi, Go [verfasserIn] Gotoh, Mitsukazu [verfasserIn] Mori, Masaki [verfasserIn] |
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E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2016 |
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| Übergeordnetes Werk: |
Enthalten in: Gastric Cancer - Springer-Verlag, 2002, 20(2016), 3 vom: 23. Aug., Seite 496-507 |
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| Übergeordnetes Werk: |
volume:20 ; year:2016 ; number:3 ; day:23 ; month:08 ; pages:496-507 |
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| DOI / URN: |
10.1007/s10120-016-0634-0 |
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SPR00934506X |
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| 520 | |a Background Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan. Methods We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013. Results Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set. Conclusions In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. This risk model could help to tailor perioperative management and improve clinical outcomes for patients who undergo distal gastrectomy. | ||
| 650 | 4 | |a Gastric cancer |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Distal gastrectomy |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Morbidity |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Mortality |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Japanese National Clinical Database |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Miyata, Hiroaki |e verfasserin |4 aut | |
| 700 | 1 | |a Konno, Hiroyuki |e verfasserin |4 aut | |
| 700 | 1 | |a Saze, Zenichiro |e verfasserin |4 aut | |
| 700 | 1 | |a Hirahara, Norimichi |e verfasserin |4 aut | |
| 700 | 1 | |a Kikuchi, Hirotoshi |e verfasserin |4 aut | |
| 700 | 1 | |a Wakabayashi, Go |e verfasserin |4 aut | |
| 700 | 1 | |a Gotoh, Mitsukazu |e verfasserin |4 aut | |
| 700 | 1 | |a Mori, Masaki |e verfasserin |4 aut | |
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10.1007/s10120-016-0634-0 doi (DE-627)SPR00934506X (SPR)s10120-016-0634-0-e DE-627 ger DE-627 rakwb eng Kunisaki, Chikara verfasserin aut Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan. Methods We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013. Results Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set. Conclusions In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. This risk model could help to tailor perioperative management and improve clinical outcomes for patients who undergo distal gastrectomy. Gastric cancer (dpeaa)DE-He213 Distal gastrectomy (dpeaa)DE-He213 Morbidity (dpeaa)DE-He213 Mortality (dpeaa)DE-He213 Japanese National Clinical Database (dpeaa)DE-He213 Miyata, Hiroaki verfasserin aut Konno, Hiroyuki verfasserin aut Saze, Zenichiro verfasserin aut Hirahara, Norimichi verfasserin aut Kikuchi, Hirotoshi verfasserin aut Wakabayashi, Go verfasserin aut Gotoh, Mitsukazu verfasserin aut Mori, Masaki verfasserin aut Enthalten in Gastric Cancer Springer-Verlag, 2002 20(2016), 3 vom: 23. Aug., Seite 496-507 (DE-627)SPR009286586 nnns volume:20 year:2016 number:3 day:23 month:08 pages:496-507 https://dx.doi.org/10.1007/s10120-016-0634-0 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER AR 20 2016 3 23 08 496-507 |
| spelling |
10.1007/s10120-016-0634-0 doi (DE-627)SPR00934506X (SPR)s10120-016-0634-0-e DE-627 ger DE-627 rakwb eng Kunisaki, Chikara verfasserin aut Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan. Methods We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013. Results Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set. Conclusions In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. This risk model could help to tailor perioperative management and improve clinical outcomes for patients who undergo distal gastrectomy. Gastric cancer (dpeaa)DE-He213 Distal gastrectomy (dpeaa)DE-He213 Morbidity (dpeaa)DE-He213 Mortality (dpeaa)DE-He213 Japanese National Clinical Database (dpeaa)DE-He213 Miyata, Hiroaki verfasserin aut Konno, Hiroyuki verfasserin aut Saze, Zenichiro verfasserin aut Hirahara, Norimichi verfasserin aut Kikuchi, Hirotoshi verfasserin aut Wakabayashi, Go verfasserin aut Gotoh, Mitsukazu verfasserin aut Mori, Masaki verfasserin aut Enthalten in Gastric Cancer Springer-Verlag, 2002 20(2016), 3 vom: 23. Aug., Seite 496-507 (DE-627)SPR009286586 nnns volume:20 year:2016 number:3 day:23 month:08 pages:496-507 https://dx.doi.org/10.1007/s10120-016-0634-0 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER AR 20 2016 3 23 08 496-507 |
| allfields_unstemmed |
10.1007/s10120-016-0634-0 doi (DE-627)SPR00934506X (SPR)s10120-016-0634-0-e DE-627 ger DE-627 rakwb eng Kunisaki, Chikara verfasserin aut Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan. Methods We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013. Results Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set. Conclusions In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. This risk model could help to tailor perioperative management and improve clinical outcomes for patients who undergo distal gastrectomy. Gastric cancer (dpeaa)DE-He213 Distal gastrectomy (dpeaa)DE-He213 Morbidity (dpeaa)DE-He213 Mortality (dpeaa)DE-He213 Japanese National Clinical Database (dpeaa)DE-He213 Miyata, Hiroaki verfasserin aut Konno, Hiroyuki verfasserin aut Saze, Zenichiro verfasserin aut Hirahara, Norimichi verfasserin aut Kikuchi, Hirotoshi verfasserin aut Wakabayashi, Go verfasserin aut Gotoh, Mitsukazu verfasserin aut Mori, Masaki verfasserin aut Enthalten in Gastric Cancer Springer-Verlag, 2002 20(2016), 3 vom: 23. Aug., Seite 496-507 (DE-627)SPR009286586 nnns volume:20 year:2016 number:3 day:23 month:08 pages:496-507 https://dx.doi.org/10.1007/s10120-016-0634-0 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER AR 20 2016 3 23 08 496-507 |
| allfieldsGer |
10.1007/s10120-016-0634-0 doi (DE-627)SPR00934506X (SPR)s10120-016-0634-0-e DE-627 ger DE-627 rakwb eng Kunisaki, Chikara verfasserin aut Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan. Methods We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013. Results Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set. Conclusions In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. This risk model could help to tailor perioperative management and improve clinical outcomes for patients who undergo distal gastrectomy. Gastric cancer (dpeaa)DE-He213 Distal gastrectomy (dpeaa)DE-He213 Morbidity (dpeaa)DE-He213 Mortality (dpeaa)DE-He213 Japanese National Clinical Database (dpeaa)DE-He213 Miyata, Hiroaki verfasserin aut Konno, Hiroyuki verfasserin aut Saze, Zenichiro verfasserin aut Hirahara, Norimichi verfasserin aut Kikuchi, Hirotoshi verfasserin aut Wakabayashi, Go verfasserin aut Gotoh, Mitsukazu verfasserin aut Mori, Masaki verfasserin aut Enthalten in Gastric Cancer Springer-Verlag, 2002 20(2016), 3 vom: 23. Aug., Seite 496-507 (DE-627)SPR009286586 nnns volume:20 year:2016 number:3 day:23 month:08 pages:496-507 https://dx.doi.org/10.1007/s10120-016-0634-0 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER AR 20 2016 3 23 08 496-507 |
| allfieldsSound |
10.1007/s10120-016-0634-0 doi (DE-627)SPR00934506X (SPR)s10120-016-0634-0-e DE-627 ger DE-627 rakwb eng Kunisaki, Chikara verfasserin aut Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan. Methods We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013. Results Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set. Conclusions In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. This risk model could help to tailor perioperative management and improve clinical outcomes for patients who undergo distal gastrectomy. Gastric cancer (dpeaa)DE-He213 Distal gastrectomy (dpeaa)DE-He213 Morbidity (dpeaa)DE-He213 Mortality (dpeaa)DE-He213 Japanese National Clinical Database (dpeaa)DE-He213 Miyata, Hiroaki verfasserin aut Konno, Hiroyuki verfasserin aut Saze, Zenichiro verfasserin aut Hirahara, Norimichi verfasserin aut Kikuchi, Hirotoshi verfasserin aut Wakabayashi, Go verfasserin aut Gotoh, Mitsukazu verfasserin aut Mori, Masaki verfasserin aut Enthalten in Gastric Cancer Springer-Verlag, 2002 20(2016), 3 vom: 23. Aug., Seite 496-507 (DE-627)SPR009286586 nnns volume:20 year:2016 number:3 day:23 month:08 pages:496-507 https://dx.doi.org/10.1007/s10120-016-0634-0 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER AR 20 2016 3 23 08 496-507 |
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Enthalten in Gastric Cancer 20(2016), 3 vom: 23. Aug., Seite 496-507 volume:20 year:2016 number:3 day:23 month:08 pages:496-507 |
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Kunisaki, Chikara @@aut@@ Miyata, Hiroaki @@aut@@ Konno, Hiroyuki @@aut@@ Saze, Zenichiro @@aut@@ Hirahara, Norimichi @@aut@@ Kikuchi, Hirotoshi @@aut@@ Wakabayashi, Go @@aut@@ Gotoh, Mitsukazu @@aut@@ Mori, Masaki @@aut@@ |
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<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">SPR00934506X</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20201124064144.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">201005s2016 xx |||||o 00| ||eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1007/s10120-016-0634-0</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)SPR00934506X</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(SPR)s10120-016-0634-0-e</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="100" ind1="1" ind2=" "><subfield code="a">Kunisaki, Chikara</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2016</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Background Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan. Methods We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013. Results Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set. Conclusions In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. 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Kunisaki, Chikara |
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Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer Gastric cancer (dpeaa)DE-He213 Distal gastrectomy (dpeaa)DE-He213 Morbidity (dpeaa)DE-He213 Mortality (dpeaa)DE-He213 Japanese National Clinical Database (dpeaa)DE-He213 |
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Kunisaki, Chikara Miyata, Hiroaki Konno, Hiroyuki Saze, Zenichiro Hirahara, Norimichi Kikuchi, Hirotoshi Wakabayashi, Go Gotoh, Mitsukazu Mori, Masaki |
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modeling preoperative risk factors for potentially lethal morbidities using a nationwide japanese web-based database of patients undergoing distal gastrectomy for gastric cancer |
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Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer |
| abstract |
Background Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan. Methods We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013. Results Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set. Conclusions In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. This risk model could help to tailor perioperative management and improve clinical outcomes for patients who undergo distal gastrectomy. |
| abstractGer |
Background Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan. Methods We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013. Results Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set. Conclusions In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. This risk model could help to tailor perioperative management and improve clinical outcomes for patients who undergo distal gastrectomy. |
| abstract_unstemmed |
Background Most risk models for mortality and morbidity after distal gastrectomy have been created based on relatively small retrospective studies, and a model originating from nationwide database has been lacking. This study aimed to identify preoperative risk factors that predict the postoperative morbidities closely associated with mortality in gastric cancer patients undergoing distal gastrectomy, using data from the National Clinical Database (NCD), a nationwide web-based database in Japan. Methods We analyzed records from the NCD for 65,906 patients who underwent distal gastrectomy in 1,986 hospitals during 2011 and 2012. Using 80 % of these patients, we identified independent preoperative predictors for morbidities closely related with mortality. These risk factors were then validated using the remaining 20 % of patients from 2011 to 2012 and the further 35,575 records from 2013. Results Operative mortality was 1.07 % and overall morbidity was 14.2 % for the development data set. We selected eight morbidities that were closely associated with postoperative mortality, and then identified between 13 and 25 independent preoperative risk factors for each of the eight morbidities. Of these, old age, female gender, and poor ADL were the factors most frequently associated with the morbidities. The C-indices for each morbidity from the 2011 to 2012 validation data set were favorable as follows: unplanned intubation (0.797), pneumonia (0.784), systemic sepsis (0.748), renal failure (0.832), cardiac events (0.728), large blood transfusions (0.700), central nervous system (CNS) events (0.779), and anastomotic leakage (0.658). Similar C-indices were obtained for each mortality using the 2013 validation data set. Conclusions In this study, we successfully constructed an acceptable risk model using preoperative risk factors to predict eight postoperative morbidities highly associated with mortality in gastric cancer patients. This risk model could help to tailor perioperative management and improve clinical outcomes for patients who undergo distal gastrectomy. |
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Miyata, Hiroaki Konno, Hiroyuki Saze, Zenichiro Hirahara, Norimichi Kikuchi, Hirotoshi Wakabayashi, Go Gotoh, Mitsukazu Mori, Masaki |
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