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Impact of a board certification system and adherence to the clinical practice guidelines for gastric cancer on risk-adjusted surgical mortality after distal and total gastrectomy in Japan: a questionnaire survey of departments registered in the National Clinical Database

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Abstract

Purpose

The relationship between board certification, clinical guideline implementation, and quality of gastric cancer surgery remains unclear.

Methods

A web-based questionnaire survey was administered to departments registered in the National Clinical Database (NCD) of Japan between October 2014 and January 2015. Quality indicators (QIs) based on the Donabedian model were evaluated. Structural QIs (e.g., affiliations with academic societies and board certifications) and process QIs (adherence to clinical practice guidelines for gastric cancer) were assessed using risk-adjusted odds ratios (AORs) for surgical mortality. Multivariable logistic regression models with a generalized estimating equation were used.

Results

A total of 835 departments performing 40,992 distal gastrectomies and 806 departments performing 19,618 total gastrectomies responded. Some certified institutions and physicians showed significant associations, with lower AORs for surgical mortality. Important process QIs included pre- and postoperative abdominal CT scanning, endoscopic resection based on progression, curative resection with D2 dissection for advanced gastric cancer, laparoscopic surgery, and HER2 testing for patients with unresectable recurrent gastric cancer.

Conclusions

Multiple structural and process QIs are associated with surgical mortality after gastrectomy in Japan. Measuring and visualizing QIs may enhance healthcare improvements.

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Acknowledgements

The authors thank all the departments and societies related to the NCD for their participation in this study. This study was conducted as part of “a study on the utilization of high-accuracy organ cancer registration in clinical practice guidelines and medical specialist training” supported by a Health and Labour Sciences Research Grant (Clinical Cancer Research) to M. Gotoh. The authors also thank Drs. M. Mori, K. Sugihara, K. Hirata, M. Nagino, Y. Kitagawa, T. Ohta, H. Konno, N. Kokudo, T. Sobue, K. Kotake, M. Yamamoto, M. Tanaka, T. Shimosegawa, M. Sato, and H. Tokuda for their cooperation. The authors also wish to acknowledge Ms. Chieko Fujimura, Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Japan, and Ms. Hitomi Okamoto, National Clinical Database, Japan, for their valuable assistance with the administration and database information.

Funding

This work was supported by a grant from the Ministry of Health, Labour, and Welfare of Japan (201221064A) and by a grant from the Japan Society for the Promotion of Science (19K09111).

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Authors and Affiliations

  1. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hiroyuki Yamamoto & Hiroaki Miyata

  2. Japanese Gastric Cancer Association, Kyoto, Japan

    Atsushi Nashimoto, Isao Miyashiro & Yasuhiro Kodera

  3. The Japanese Society of Gastroenterological Surgery, Axior Mita 6F, 3-1-17, Minato-Ku, Tokyo, 108-0073, Japan

    Atsushi Nashimoto, Isao Miyashiro, Yasushi Toh, Mitsukazu Gotoh, Yasuhiro Kodera, Yoshihiro Kakeji & Yasuyuki Seto

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  1. Hiroyuki Yamamoto
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Correspondence to Mitsukazu Gotoh.

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Conflict of interest

Hiroaki Miyata and Hiroyuki Yamamoto are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo, a social collaboration department supported by grants from the National Clinical Database, Johnson & Johnson K.K., and Nipro Co. The other authors declare no conflicts of interest in association with the present study.

Ethical approval

This study was approved by the Ethics Committee of Fukushima Medical University (No. 1057).

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Yamamoto, H., Nashimoto, A., Miyashiro, I. et al. Impact of a board certification system and adherence to the clinical practice guidelines for gastric cancer on risk-adjusted surgical mortality after distal and total gastrectomy in Japan: a questionnaire survey of departments registered in the National Clinical Database. Surg Today 54, 459–470 (2024). https://doi.org/10.1007/s00595-023-02753-2

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