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Mortality after common rectal surgery in Japan

The most recent issue of the Diseases of the Colon & Rectum evaluates Japanese national standards of clinical care for rectal surgery.

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The health-care system, homogenous ethnicity, and operative strategy for lower rectal cancer surgery in Japan are to some extent unique compared to those in Western countries.

The National Clinical Database is a newly established nationwide, large-scale surgical database in Japan.

Dr Nagahide Matsubara and colleagues illuminated Japanese national standards of clinical care and provide a basis for efforts to optimize patient care.

The research team used this database to construct a risk model for a common procedure in colorectal surgery—low anterior resection for lower rectal cancer.

Data from the National Clinical Database on patients who underwent low anterior resection during 2011 were analyzed.

The postoperative incidence of anastomotic leakage was 10%
Diseases of the Colon & Rectum

Multiple logistic regression analyses were performed to generate predictive models of 30-day mortality and operative mortality.

Receiver-operator characteristic curves were generated, and the concordance index was used to assess the model’s discriminatory ability.

During the study period, data from 16,695 patients who had undergone low anterior resection were collected.

The research team found that mean age was 66 years, and 65% were male, of which 1% required an emergency procedure.

The researchers found that the raw 30-day mortality was 0.4%, and operative mortality was 0.9%.

The team found that the postoperative incidence of anastomotic leakage was 10%.

The team showed that independent risk factors for both 30-day, and operative mortality included BMI greater than 30 kg/m2, previous peripheral vascular disease, preoperative transfusions, and disseminated cancer.

The team noted that concordance indices were 0.77 for operative mortality, and 0.75 for 30-day mortality.

Dr Matsubara's team concludes, "This is the first report of risk stratification on low anterior resection, as representative of rectal surgery, with the use of the large-scale national surgical database that we have recently established in Japan."

"The resulting risk models for 30-day, and operative mortality from rectal surgery may provide important insights into the delivery of health care for patients undergoing GI surgery worldwide."

Dis Colon Rectum 2014: 57(9): 1075–1081
20 August 2014

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