| Project/Area Number |
16K10437
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Research Field |
General surgery
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| Research Institution | Osaka General Medical Center (2018-2019)
Fukushima Medical University (2016-2017) |
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Principal Investigator |
Gotoh Mitsukazu 地方独立行政法人大阪府立病院機構大阪急性期・総合医療センター(臨床研究支援センター), 大阪急性期・総合医療センター 総長, 総長 (50162160)
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| Co-Investigator(Kenkyū-buntansha) |
丸橋 繁 福島県立医科大学, 医学部, 教授 (20362725)
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| Project Period (FY) |
2016-04-01 – 2020-03-31
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| Project Status |
Completed (Fiscal Year 2019)
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| Budget Amount *help |
¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000)
Fiscal Year 2018: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000)
Fiscal Year 2017: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
Fiscal Year 2016: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
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| Keywords | 医療の質の評価 / リスクモデル / 消化器外科 / 医療水準評価術式 / 術後合併症 / ACS-NSQIP / NCD / risk calculator |
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| Outline of Final Research Achievements |
The Japanese Society of Gastroenterological Surgery (JSGS) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) have collaboratively developed several clinical projects since 2011 using two nationwide clinical registries with the goal of achieving further improvement of surgical quality in both countries. In this study we have carried out joint projects on 1) the Morbidity-Mortality Study and 2) Cross-national validation study of the ACS NSQIP Risk Calculator. In Morbidity-Mortality Study, postoperative morbidities rather than preoperative comorbidities were responsible for mortality in two major procedures including hepatectomy and pancreaticoduodenectomy. In the calibration study for low anterior resection a lack of calibration with different event rates were improved by simple method of intercept correction, suggesting as a general strategy for cross-national validation of the risk calculator.
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| Academic Significance and Societal Importance of the Research Achievements |
わが国と米国では、手術成績に関わる多くの因子が異なると思われる。年齢構成、健康に関わるライフスタイル（肥満やダイエット等）、手術そのもの、あるいは合併症が起きたときの対応や保険制度等も異なる。その中で、術後死亡に強く関わる因子は、術前因子よりも術後合併症の発生であることが明確になった。また、NSQIPのrisk calculatorではわが国の死亡イベントを高く予測した。この傾向は2011、2012年の集計結果（Medicine (Baltimore). 2015 Dec;94(49):e2194）でも観察されており、それを説明する原因因子の解析は今後の課題となった。
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