Hiromasa Horiguchi - Academia.edu (original) (raw)

Papers by Hiromasa Horiguchi

Respiratory Care, 2016

BACKGROUND: In the course of therapy of patients with COPD, non-pharmacologic treatment, such as ... more BACKGROUND: In the course of therapy of patients with COPD, non-pharmacologic treatment, such as rehabilitation, plays an important role. Although some studies have provided concrete evidence of the effectiveness of rehabilitation in improving functional outcomes in subjects with COPD, evidence of its mortality-reducing effect has been insufficient. In the present study, we examined whether rehabilitation had positive effects on in-hospital mortality of subjects with COPD. METHODS: We used the Japanese Diagnosis Procedure Combination nationwide administrative claims database. This was a retrospective cohort study, and there were 18,037 eligible subjects with COPD from 1,055 hospitals. The main outcome was in-hospital mortality rates. A one-to-one propensity score matching method was used to compare hospital mortality rates after admission between rehabilitation and non-rehabilitation groups. RESULTS: A total of 3,356 pairs of subjects were selected from the rehabilitation and non-rehabilitation groups (n ‫؍‬ 6,712). Subjects in the rehabilitation program showed a reduction in the odds of mortality (odds ratio ‫؍‬ 0.80, 95% CI 0.65-1.00, P ‫؍‬ .045). In the subgroup analyses, the rehabilitation group had a lower in-hospital mortality in the pre-obese subgroup (body mass index 25.0-29.9) than the non-rehabilitation group (P ‫؍‬ .02). Although not significant, the rehabilitation group showed a relatively low in-hospital mortality in the Hugh-Jones dyspnea scale class 5 subgroup (P ‫؍‬ .066). CONCLUSIONS: This large nationwide cohort study showed that rehabilitation indeed contributed to a reduction of in-hospital mortality. These findings underscore the importance of adopting rehabilitation as part of the treatment of COPD.

Background: Laparoscopic gastrectomy (LG) is becoming more widely indicated, although its applica... more Background: Laparoscopic gastrectomy (LG) is becoming more widely indicated, although its application has not been investigated sufficiently in community-based gastrointestinal research because the small number of gastric cancers in western countries might have limited its use. However, concerns have been raised regarding variations in the quality of care with LG. To contribute to improving the efficient utilization of costly surgical innovations, we determined the impact of hospital characteristics on LG care.

Background: Because longer length of hospital stays (LOS) have been recognized to pose a signific... more Background: Because longer length of hospital stays (LOS) have been recognized to pose a significant economic burden on society, attempts to reduce LOS in acute care hospitals have been implemented to improve the efficiency of care. However, few studies have quantitatively measured the inherent effect of LOS on patient functional recovery in acute care settings.

Background: The increasing elderly population will turn increased attention to the functional rec... more Background: The increasing elderly population will turn increased attention to the functional recovery and costs for patients with cerebrovascular disease (CVD). Several functional scales like the Barthel index (BI) have been applied in healthcare research and handled as continuous variables for risk adjustment or main outcomes.

BACKGROUND: In the era of an aging population, stakeholders should recognize the presence of age ... more BACKGROUND: In the era of an aging population, stakeholders should recognize the presence of age disparities for the delivery of acute care. Few studies have assessed the association between resource use as an input and functional recovery as a health outcome among older people. We examined the disparity in care quality for patients aged≥ 60 years with stroke, hip arthropathy or bone injury.

Background: Enteral nutrition (EN) rather than parenteral nutrition (PN) has been advocated in tr... more Background: Enteral nutrition (EN) rather than parenteral nutrition (PN) has been advocated in treatment guidelines for acute pancreatitis (AP) as endorsed in randomized studies or meta-analyses. The findings derived from those studies would recognize the criticism of smaller sample sizes or limited patient case-mixes. To determine the generalizability of those findings, community-based appraisal on the advantages of EN over PN is required.

Background Enhancing CPG acceptance and implementation can play a major role in the development a... more Background Enhancing CPG acceptance and implementation can play a major role in the development and establishment of emergency medicine as a specialty in many parts of the world. A Guideline International Network special interest group established to support collaboration to improve uptake of clinical practice guidelines (CPGs) across the emergency care sector conducted an international survey to identify attributes of guideline likely to enhance their use.

The Department of Health Management and Policy is an endowed department affiliated with the “22nd... more The Department of Health Management and Policy is an endowed department affiliated with the “22nd Century Medical and Research Center,” which is a new center of industry-academia collaboration established by the University of Tokyo Hospital. With donations from Nissay Information Technology Co., Ltd., the Department launched its first courses on April 1, 2005.

International journal of impotence research

We investigated the incidence and clinical features of priapism in Japan, using a national admini... more We investigated the incidence and clinical features of priapism in Japan, using a national administrative claims database, the Diagnosis Procedure Combination database. Priapism patients were identified using the International Classification of Diseases and Related Health Problems, 10th Revision code, N483 (priapism). Verified patient characteristics included age, comorbidities and management of priapism. Among 6.93 million inpatients, 46 patients with priapism were identified. Four had two admissions each for repeated events. The median age was 41.5 years (range, 11-89 years). A total of 21 patients had comorbidities; 3 had haematological malignancies, 4 had haemodialysis, 1 had a renal transplant, 2 had neurological problems, 4 had non-haematological malignancies, 3 had trauma and 6 had psychoses (2 cases had two comorbidities). All patients with non-haematological malignancies were over the age of 70 years, indicating that close attention is required to search for associated malignancies in elderly patients. The medical treatments included 6 vascular embolizations, 11 Winter method surgeries and 18 other operations. The incidence was estimated to be 0.13 (95% confidence interval, 0.097-0.17) per 100,000 person-years. This incidence was lower than that reported in other parts of the world.

The Journal of hospital infection, 2012

Although surgery is considered a risk for Clostridium difficile-associated disease (CDAD), large-... more Although surgery is considered a risk for Clostridium difficile-associated disease (CDAD), large-scale data on outcomes of postsurgical CDAD are rare. Using the Japanese Diagnosis Procedure Combination inpatient database, we analysed factors affecting the occurrence of CDAD and the outcomes of CDAD following digestive tract surgery. We identified patients postoperatively diagnosed with CDAD among patients undergoing oesophagectomy, gastrectomy, and colorectal resection for cancer from 2007 to 2010. We performed logistic regression analyses for the occurrence of CDAD and in-hospital mortality, and multiple linear regressions and one-to-one propensity-matched analyses for postoperative length of stay and total costs, with adjustment for patient backgrounds and hospital factors. Of 143,652 patients undergoing digestive tract surgery, 409 (0.28%) CDAD patients were identified. Higher Charlson comorbidity index, longer preoperative length of stay and non-academic hospitals were significantly associated with higher occurrence of CDAD. In-hospital mortality was higher in the CDAD patients compared with non-CDAD patients [3.4% vs 1.6%; odds ratio: 1.83; 95% confidence interval (CI): 1.07-3.13; P = 0.027]. Attributable postoperative length of stay and total costs related to CDAD were 12.4 days (95% CI: 9.7-15.0; P < 0.001) and US$6,576 (3,753-9,398; P < 0.001) in the linear regressions and 9 days (P < 0.001) and US$6,724 (P < 0.001) in the propensity-matched paired analyses. High mortality, long hospital stay and high costs were associated with postsurgical CDAD. The results indicate the necessity of further CDAD control measures for patients undergoing digestive tract surgery.

Hepatology research : the official journal of the Japan Society of Hepatology, 2012

The present study aimed to conduct a nationwide investigation on the relationship between hospi... more The present study aimed to conduct a nationwide investigation on the relationship between hospital volume and outcomes following liver resection in Japan. We also discuss health policy implications of the results. Using the Japanese Diagnosis Procedure Combination database, we identified 18 046 patients who underwent hepatic resection between July and December 2007-2009. Patients were subdivided into hospital-volume quartiles: very low- (<18/year), low- (18-35), high- (36-70) and very high-volume groups (>70). Multivariate logistic regression analysis for in-hospital mortality within 30 days of surgery was performed to analyze adjusted effects of various factors. Patients in the very high-volume group had a higher Charlson Comorbidity Index (P < 0.001) than those in the very low-volume group. Very low-volume hospitals were significantly less likely to perform extended lobectomy than very high-volume hospitals (5.4% vs 17.6%, P < 0.001). Crude in-hospital mortality within 30 days of surgery was 1.1% (0.6%, 0.8%, 1.9% and 3.0% for limited resection, segmentectomy, lobectomy and extended lobectomy, respectively). With reference to the very low-volume group, risk-adjusted odds ratios (95% confidence intervals) of low-, high- and very high-volume groups for overall mortality were 0.70 (0.48-1.02; P = 0.060), 0.52 (0.34-0.81; P = 0.004) and 0.16 (0.09-0.30; P < 0.001), respectively. There is a linear trend between higher hospital volume and lower in-hospital mortality of liver resection in Japan, particularly for lobectomy and extended lobectomy. Based on these results, regionalization of lobectomy and extended lobectomy in high-volume centers could be effective for reducing postoperative mortality.

Journal of anesthesia, 2012

Remifentanil, a mu-opioid receptor agonist, has important characteristics for neuroanesthesia, bu... more Remifentanil, a mu-opioid receptor agonist, has important characteristics for neuroanesthesia, but data about its effects on postoperative recovery and mortality are currently lacking. Using the Japanese Diagnosis Procedure Combination database in 2007, we selected patients who underwent elective brain tumor resection with open craniotomy under general anesthesia using either remifentanil or fentanyl and divided them into two categories: remifentanil patients and non-remifentanil patients. After propensity score matching for potential confounders, we compared the in-hospital mortality and postoperative length of stay (LOS) between the two groups. For comparison, the same endpoints were evaluated for patients underwent rectal cancer surgery under general anesthesia with intraoperative epidural anesthesia. In patients who underwent brain tumor resection (936 pairs), remifentanil patients had significantly lower in-hospital mortality (1.5 % vs. 3.0 %; P = 0.029). Logistic regression analysis revealed that the odds ratio for use of remifentanil for in-hospital mortality was 0.47 (95 % confidence interval, 0.25-0.91; P = 0.025). Remifentanil patients also showed earlier discharge from hospital (median LOS, 17 vs. 19 days; hazard ratio, 1.19, 95 % confidence interval, 1.08-1.30; P < 0.001). In contrast, in 2,756 pairs of patients undergoing rectal cancer surgery, no significant difference was seen in either in-hospital morality (1.2 % vs. 1.3 %; P = 0.518) or median LOS (19 vs. 19 days; P = 0.148) between the two groups. Our data suggest a possible association between use of remifentanil and better early postoperative recovery for patients undergoing neurosurgery with craniotomy. Further studies, including a randomized controlled trial, are required to confirm the present results.

BMJ open, 2012

Objective: To identify risk factors for inhospital mortality in patients with hip fractures using... more Objective: To identify risk factors for inhospital mortality in patients with hip fractures using the Japanese Diagnosis Procedure Combination (DPC) nationwide administrative claims database.

BMC health services research, 2012

Little is known about the effects of professional staffing on cancer surgical outcomes. The prese... more Little is known about the effects of professional staffing on cancer surgical outcomes. The present study aimed to investigate the association between cancer surgical outcomes and physician/nurse staffing in relation to hospital volume.

BJU international, 2012

Study Type - Prognosis (outcome) Level of Evidence 2b. What&a... more Study Type - Prognosis (outcome) Level of Evidence 2b. What's known on the subject? and What does the study add? Reportedly, Fournier's gangrene has a high mortality rate, ~7.5-40%, and experts recommend early surgical debridement. This study examines 379 patients and shows that an early intervention, i.e. within 2 hospital days could halve the mortality rate compared with later intervention. • To examine how early surgical intervention influenced cases of Fournier's gangrene (FG) fatality. • Patients with FG (defined as an International Classification of Diseases-10 code of M72.6 [necrotizing fasciitis] at the perineum or external genitalia), who received surgical intervention ≤ 5 days after admission, were identified from the Diagnosis Procedure Combination database for the 6-month period July to December, in the years 2007-2010. • Data included age, sex, comorbidities, ambulance use, operations and debridement ranges. • Multivariate logistic regression analysis of mortality was performed to show whether early (≤ 2 hospital days) or delayed (3-5 hospital days) surgical treatment affected FG outcomes. • A total of 302 male and 77 female patients with FG were identified for which the overall case fatality rate was 17.1% (65 cases). • There were no significant differences in patient characteristics between the early operation group (n = 327) and the delayed operation group (n = 52), with the exception of ambulance use (33.3% vs 17.3%, P = 0.020). • Cystostomy, colostomy, orchiectomy/penectomy (male patients only), or debridement ≥ 3000 cm(2) were performed on 42 (8.8%), 56 (11.5%), 46 (10.8%) and 17 (4.4%) patients, respectively. • Multivariate analysis showed that there was a significantly lower case fatality rate among the early operation group (odds ratio [OR] = 0.38; P = 0.031). • Older age (OR 1.80, for 10-year increments), Charlson comorbidity index score (OR = 1.33, for 1-point increments), sepsis or disseminated intravascular coagulation at admission (OR 4.01), and debridement range ≥ 3000 cm(2) (OR 5.22, compared with other operations) were significantly associated with a higher case fatality rate. • Early (≤ 2 hospital days) surgical intervention for FG is significantly associated with lower mortality than delayed (3-5 hospital days) action.

The Journal of emergency medicine, 2013

Journal of intensive care medicine, 2012

Quality improvement initiatives in intensive care units (ICUs) have increased survival rates. Cha... more Quality improvement initiatives in intensive care units (ICUs) have increased survival rates. Changes in functional status following ICU care have been studied, but results are inconclusive because of insufficient consideration of the combinations of critical care procedures used. Using the Japanese administrative database including the Barthel Index (BI) at admission and discharge, we measured the changes in functional status among the adult patients and determined whether longer ICU stay or use of various critical care procedures was associated with functional deterioration. Of the 12 502 528 patients admitted to 1206 hospitals over 5 consecutive years from 2006, we analyzed data from patients aged 15 years or older who survived ICU admission in 320 hospitals. Critical care procedures evaluated were ventilation, blood purification (hemodialysis, hemodiafiltration, or hemadsorption), and cardiac support devices (intra-aortic balloon pump or percutaneous cardiopulmonary support system). Functional outcomes were determined by the difference between BI at admission and at discharge and were divided into improvement, no change, or deterioration. We compared patient characteristics, principal diagnosis, comorbidities, timing of surgical procedure, complications, days in ICU, and use of critical care procedures among the 3 categories. Associations between critical care procedures and functional deterioration were identified using multivariate analysis. Of 234 209 patients with complete BI information, 7137 (3.1%) received blood purification, 27 100 (11.7%) received ventilation, 2888 (1.2%) received blood purification and ventilation, 5613 (2.4%) received a cardiac support device, 247 (0.1%) received a cardiac support device and blood purification, 10 444 (4.5%) received a cardiac support device and ventilation, and 1110 (0.5%) received a cardiac support device, ventilation, and blood purification. Longer use of blood purification or ventilation and a longer ICU stay were associated with functional deterioration. Intensivists should be aware of the effects of critical care procedures on functional deterioration and advance the appropriate use of functional support according to each patient's condition.

The Tohoku journal of experimental medicine, 2012

American journal of disaster medicine, 2012

Public health emergencies like earthquakes and tsunamis underscore the need for an evidence-based... more Public health emergencies like earthquakes and tsunamis underscore the need for an evidence-based approach to disaster preparedness. Using the Japanese administrative database and the geographical information system (GIS), the interruption of hospital-based mechanical ventilation administration by a hypothetical disaster in three areas of the southeastern mainland (Tokai, Tonankai, and Nankai) was simulated and the repercussions on ventilator care in the prefectures adjacent to the damaged prefectures was estimated. Using the database of 2010 including 3,181,847 hospitalized patients among 952 hospitals, the maximum daily ventilator capacity in each hospital was calculated and the number of patients who were administered ventilation on October xx was counted. Using GIS and patient zip code, the straight-line distances among the damaged hospitals, the hospitals in prefectures nearest to damaged prefectures, and ventilated patients' zip codes were measured. The authors simulated that ventilated patients were transferred to the closest hospitals outside damaged prefectures. The increase in the ventilator operating rates in three areas was aggregated. One hundred twenty-four and 236 patients were administered ventilation in the damaged hospitals and in the closest hospitals outside the damaged prefectures of Tokai, 92 and 561 of Tonankai, and 35 and 85 of Nankai, respectively. The increases in the ventilator operating rates among prefectures ranged from 1.04 to 26.33-fold in Tokai; 1.03 to 1.74-fold in Tonankai, and 1.00 to 2.67-fold in Nankai. Administrative databases and GIS can contribute to evidenced-based disaster preparedness and the determination of appropriate receiving hospitals with available medical resources.

Case reports in gastroenterology, 2012

Several studies have regarded proximal gastrectomy (PG) as optimal compared to total gastrectomy ... more Several studies have regarded proximal gastrectomy (PG) as optimal compared to total gastrectomy (TG) for upper stomach cancer. In addition to the traditional outcomes of complication and mortality, change in functional status should be considered as another relevant outcome in aging generations. However, there has been no community-based appraisal of functional outcomes between PG and TG. Using an administrative database, we compared functional outcomes between PG and TG. Among 12,508 patients who survived for ≥15 years and underwent open gastrectomy between 2008 and 2010, we examined patient characteristics, comorbidities, functional status estimated by the Barthel index (BI) at admission and discharge, complications, ICU care, ventilation administration, blood transfusion, operating room time, resumption of oral intake, length of stay and total charges. With reference to distal gastrectomy (DG), we performed multivariate analyses to assess the impacts of PG and TG on complications and BI deterioration. A total of 434 PGs and 4,941 TGs were observed in 148 and 295 hospitals, respectively. Patient characteristics, care process, resumption of oral intake, operating room time, length of stay and total charges were also significantly different among the three gastrectomy types. PG, TG and DG Case 401 were not associated with complications or functional deterioration. Patient characteristics, preoperative blood transfusion and longer operating room time were significantly associated with more complications and BI deterioration. Since patient case mix and longer operating room time were associated with poor outcomes, physicians should recognize the role of PG and might optimally challenge and complete gastrectomies within the appropriate indications.

Respiratory Care, 2016

BACKGROUND: In the course of therapy of patients with COPD, non-pharmacologic treatment, such as ... more BACKGROUND: In the course of therapy of patients with COPD, non-pharmacologic treatment, such as rehabilitation, plays an important role. Although some studies have provided concrete evidence of the effectiveness of rehabilitation in improving functional outcomes in subjects with COPD, evidence of its mortality-reducing effect has been insufficient. In the present study, we examined whether rehabilitation had positive effects on in-hospital mortality of subjects with COPD. METHODS: We used the Japanese Diagnosis Procedure Combination nationwide administrative claims database. This was a retrospective cohort study, and there were 18,037 eligible subjects with COPD from 1,055 hospitals. The main outcome was in-hospital mortality rates. A one-to-one propensity score matching method was used to compare hospital mortality rates after admission between rehabilitation and non-rehabilitation groups. RESULTS: A total of 3,356 pairs of subjects were selected from the rehabilitation and non-rehabilitation groups (n ‫؍‬ 6,712). Subjects in the rehabilitation program showed a reduction in the odds of mortality (odds ratio ‫؍‬ 0.80, 95% CI 0.65-1.00, P ‫؍‬ .045). In the subgroup analyses, the rehabilitation group had a lower in-hospital mortality in the pre-obese subgroup (body mass index 25.0-29.9) than the non-rehabilitation group (P ‫؍‬ .02). Although not significant, the rehabilitation group showed a relatively low in-hospital mortality in the Hugh-Jones dyspnea scale class 5 subgroup (P ‫؍‬ .066). CONCLUSIONS: This large nationwide cohort study showed that rehabilitation indeed contributed to a reduction of in-hospital mortality. These findings underscore the importance of adopting rehabilitation as part of the treatment of COPD.

Background: Laparoscopic gastrectomy (LG) is becoming more widely indicated, although its applica... more Background: Laparoscopic gastrectomy (LG) is becoming more widely indicated, although its application has not been investigated sufficiently in community-based gastrointestinal research because the small number of gastric cancers in western countries might have limited its use. However, concerns have been raised regarding variations in the quality of care with LG. To contribute to improving the efficient utilization of costly surgical innovations, we determined the impact of hospital characteristics on LG care.

Background: Because longer length of hospital stays (LOS) have been recognized to pose a signific... more Background: Because longer length of hospital stays (LOS) have been recognized to pose a significant economic burden on society, attempts to reduce LOS in acute care hospitals have been implemented to improve the efficiency of care. However, few studies have quantitatively measured the inherent effect of LOS on patient functional recovery in acute care settings.

Background: The increasing elderly population will turn increased attention to the functional rec... more Background: The increasing elderly population will turn increased attention to the functional recovery and costs for patients with cerebrovascular disease (CVD). Several functional scales like the Barthel index (BI) have been applied in healthcare research and handled as continuous variables for risk adjustment or main outcomes.

BACKGROUND: In the era of an aging population, stakeholders should recognize the presence of age ... more BACKGROUND: In the era of an aging population, stakeholders should recognize the presence of age disparities for the delivery of acute care. Few studies have assessed the association between resource use as an input and functional recovery as a health outcome among older people. We examined the disparity in care quality for patients aged≥ 60 years with stroke, hip arthropathy or bone injury.

Background: Enteral nutrition (EN) rather than parenteral nutrition (PN) has been advocated in tr... more Background: Enteral nutrition (EN) rather than parenteral nutrition (PN) has been advocated in treatment guidelines for acute pancreatitis (AP) as endorsed in randomized studies or meta-analyses. The findings derived from those studies would recognize the criticism of smaller sample sizes or limited patient case-mixes. To determine the generalizability of those findings, community-based appraisal on the advantages of EN over PN is required.

Background Enhancing CPG acceptance and implementation can play a major role in the development a... more Background Enhancing CPG acceptance and implementation can play a major role in the development and establishment of emergency medicine as a specialty in many parts of the world. A Guideline International Network special interest group established to support collaboration to improve uptake of clinical practice guidelines (CPGs) across the emergency care sector conducted an international survey to identify attributes of guideline likely to enhance their use.

The Department of Health Management and Policy is an endowed department affiliated with the “22nd... more The Department of Health Management and Policy is an endowed department affiliated with the “22nd Century Medical and Research Center,” which is a new center of industry-academia collaboration established by the University of Tokyo Hospital. With donations from Nissay Information Technology Co., Ltd., the Department launched its first courses on April 1, 2005.

International journal of impotence research

We investigated the incidence and clinical features of priapism in Japan, using a national admini... more We investigated the incidence and clinical features of priapism in Japan, using a national administrative claims database, the Diagnosis Procedure Combination database. Priapism patients were identified using the International Classification of Diseases and Related Health Problems, 10th Revision code, N483 (priapism). Verified patient characteristics included age, comorbidities and management of priapism. Among 6.93 million inpatients, 46 patients with priapism were identified. Four had two admissions each for repeated events. The median age was 41.5 years (range, 11-89 years). A total of 21 patients had comorbidities; 3 had haematological malignancies, 4 had haemodialysis, 1 had a renal transplant, 2 had neurological problems, 4 had non-haematological malignancies, 3 had trauma and 6 had psychoses (2 cases had two comorbidities). All patients with non-haematological malignancies were over the age of 70 years, indicating that close attention is required to search for associated malignancies in elderly patients. The medical treatments included 6 vascular embolizations, 11 Winter method surgeries and 18 other operations. The incidence was estimated to be 0.13 (95% confidence interval, 0.097-0.17) per 100,000 person-years. This incidence was lower than that reported in other parts of the world.

The Journal of hospital infection, 2012

Although surgery is considered a risk for Clostridium difficile-associated disease (CDAD), large-... more Although surgery is considered a risk for Clostridium difficile-associated disease (CDAD), large-scale data on outcomes of postsurgical CDAD are rare. Using the Japanese Diagnosis Procedure Combination inpatient database, we analysed factors affecting the occurrence of CDAD and the outcomes of CDAD following digestive tract surgery. We identified patients postoperatively diagnosed with CDAD among patients undergoing oesophagectomy, gastrectomy, and colorectal resection for cancer from 2007 to 2010. We performed logistic regression analyses for the occurrence of CDAD and in-hospital mortality, and multiple linear regressions and one-to-one propensity-matched analyses for postoperative length of stay and total costs, with adjustment for patient backgrounds and hospital factors. Of 143,652 patients undergoing digestive tract surgery, 409 (0.28%) CDAD patients were identified. Higher Charlson comorbidity index, longer preoperative length of stay and non-academic hospitals were significantly associated with higher occurrence of CDAD. In-hospital mortality was higher in the CDAD patients compared with non-CDAD patients [3.4% vs 1.6%; odds ratio: 1.83; 95% confidence interval (CI): 1.07-3.13; P = 0.027]. Attributable postoperative length of stay and total costs related to CDAD were 12.4 days (95% CI: 9.7-15.0; P < 0.001) and US$6,576 (3,753-9,398; P < 0.001) in the linear regressions and 9 days (P < 0.001) and US$6,724 (P < 0.001) in the propensity-matched paired analyses. High mortality, long hospital stay and high costs were associated with postsurgical CDAD. The results indicate the necessity of further CDAD control measures for patients undergoing digestive tract surgery.

Hepatology research : the official journal of the Japan Society of Hepatology, 2012

The present study aimed to conduct a nationwide investigation on the relationship between hospi... more The present study aimed to conduct a nationwide investigation on the relationship between hospital volume and outcomes following liver resection in Japan. We also discuss health policy implications of the results. Using the Japanese Diagnosis Procedure Combination database, we identified 18 046 patients who underwent hepatic resection between July and December 2007-2009. Patients were subdivided into hospital-volume quartiles: very low- (<18/year), low- (18-35), high- (36-70) and very high-volume groups (>70). Multivariate logistic regression analysis for in-hospital mortality within 30 days of surgery was performed to analyze adjusted effects of various factors. Patients in the very high-volume group had a higher Charlson Comorbidity Index (P < 0.001) than those in the very low-volume group. Very low-volume hospitals were significantly less likely to perform extended lobectomy than very high-volume hospitals (5.4% vs 17.6%, P < 0.001). Crude in-hospital mortality within 30 days of surgery was 1.1% (0.6%, 0.8%, 1.9% and 3.0% for limited resection, segmentectomy, lobectomy and extended lobectomy, respectively). With reference to the very low-volume group, risk-adjusted odds ratios (95% confidence intervals) of low-, high- and very high-volume groups for overall mortality were 0.70 (0.48-1.02; P = 0.060), 0.52 (0.34-0.81; P = 0.004) and 0.16 (0.09-0.30; P < 0.001), respectively. There is a linear trend between higher hospital volume and lower in-hospital mortality of liver resection in Japan, particularly for lobectomy and extended lobectomy. Based on these results, regionalization of lobectomy and extended lobectomy in high-volume centers could be effective for reducing postoperative mortality.

Journal of anesthesia, 2012

Remifentanil, a mu-opioid receptor agonist, has important characteristics for neuroanesthesia, bu... more Remifentanil, a mu-opioid receptor agonist, has important characteristics for neuroanesthesia, but data about its effects on postoperative recovery and mortality are currently lacking. Using the Japanese Diagnosis Procedure Combination database in 2007, we selected patients who underwent elective brain tumor resection with open craniotomy under general anesthesia using either remifentanil or fentanyl and divided them into two categories: remifentanil patients and non-remifentanil patients. After propensity score matching for potential confounders, we compared the in-hospital mortality and postoperative length of stay (LOS) between the two groups. For comparison, the same endpoints were evaluated for patients underwent rectal cancer surgery under general anesthesia with intraoperative epidural anesthesia. In patients who underwent brain tumor resection (936 pairs), remifentanil patients had significantly lower in-hospital mortality (1.5 % vs. 3.0 %; P = 0.029). Logistic regression analysis revealed that the odds ratio for use of remifentanil for in-hospital mortality was 0.47 (95 % confidence interval, 0.25-0.91; P = 0.025). Remifentanil patients also showed earlier discharge from hospital (median LOS, 17 vs. 19 days; hazard ratio, 1.19, 95 % confidence interval, 1.08-1.30; P < 0.001). In contrast, in 2,756 pairs of patients undergoing rectal cancer surgery, no significant difference was seen in either in-hospital morality (1.2 % vs. 1.3 %; P = 0.518) or median LOS (19 vs. 19 days; P = 0.148) between the two groups. Our data suggest a possible association between use of remifentanil and better early postoperative recovery for patients undergoing neurosurgery with craniotomy. Further studies, including a randomized controlled trial, are required to confirm the present results.

BMJ open, 2012

Objective: To identify risk factors for inhospital mortality in patients with hip fractures using... more Objective: To identify risk factors for inhospital mortality in patients with hip fractures using the Japanese Diagnosis Procedure Combination (DPC) nationwide administrative claims database.

BMC health services research, 2012

Little is known about the effects of professional staffing on cancer surgical outcomes. The prese... more Little is known about the effects of professional staffing on cancer surgical outcomes. The present study aimed to investigate the association between cancer surgical outcomes and physician/nurse staffing in relation to hospital volume.

BJU international, 2012

Study Type - Prognosis (outcome) Level of Evidence 2b. What&a... more Study Type - Prognosis (outcome) Level of Evidence 2b. What's known on the subject? and What does the study add? Reportedly, Fournier's gangrene has a high mortality rate, ~7.5-40%, and experts recommend early surgical debridement. This study examines 379 patients and shows that an early intervention, i.e. within 2 hospital days could halve the mortality rate compared with later intervention. • To examine how early surgical intervention influenced cases of Fournier's gangrene (FG) fatality. • Patients with FG (defined as an International Classification of Diseases-10 code of M72.6 [necrotizing fasciitis] at the perineum or external genitalia), who received surgical intervention ≤ 5 days after admission, were identified from the Diagnosis Procedure Combination database for the 6-month period July to December, in the years 2007-2010. • Data included age, sex, comorbidities, ambulance use, operations and debridement ranges. • Multivariate logistic regression analysis of mortality was performed to show whether early (≤ 2 hospital days) or delayed (3-5 hospital days) surgical treatment affected FG outcomes. • A total of 302 male and 77 female patients with FG were identified for which the overall case fatality rate was 17.1% (65 cases). • There were no significant differences in patient characteristics between the early operation group (n = 327) and the delayed operation group (n = 52), with the exception of ambulance use (33.3% vs 17.3%, P = 0.020). • Cystostomy, colostomy, orchiectomy/penectomy (male patients only), or debridement ≥ 3000 cm(2) were performed on 42 (8.8%), 56 (11.5%), 46 (10.8%) and 17 (4.4%) patients, respectively. • Multivariate analysis showed that there was a significantly lower case fatality rate among the early operation group (odds ratio [OR] = 0.38; P = 0.031). • Older age (OR 1.80, for 10-year increments), Charlson comorbidity index score (OR = 1.33, for 1-point increments), sepsis or disseminated intravascular coagulation at admission (OR 4.01), and debridement range ≥ 3000 cm(2) (OR 5.22, compared with other operations) were significantly associated with a higher case fatality rate. • Early (≤ 2 hospital days) surgical intervention for FG is significantly associated with lower mortality than delayed (3-5 hospital days) action.

The Journal of emergency medicine, 2013

Journal of intensive care medicine, 2012

Quality improvement initiatives in intensive care units (ICUs) have increased survival rates. Cha... more Quality improvement initiatives in intensive care units (ICUs) have increased survival rates. Changes in functional status following ICU care have been studied, but results are inconclusive because of insufficient consideration of the combinations of critical care procedures used. Using the Japanese administrative database including the Barthel Index (BI) at admission and discharge, we measured the changes in functional status among the adult patients and determined whether longer ICU stay or use of various critical care procedures was associated with functional deterioration. Of the 12 502 528 patients admitted to 1206 hospitals over 5 consecutive years from 2006, we analyzed data from patients aged 15 years or older who survived ICU admission in 320 hospitals. Critical care procedures evaluated were ventilation, blood purification (hemodialysis, hemodiafiltration, or hemadsorption), and cardiac support devices (intra-aortic balloon pump or percutaneous cardiopulmonary support system). Functional outcomes were determined by the difference between BI at admission and at discharge and were divided into improvement, no change, or deterioration. We compared patient characteristics, principal diagnosis, comorbidities, timing of surgical procedure, complications, days in ICU, and use of critical care procedures among the 3 categories. Associations between critical care procedures and functional deterioration were identified using multivariate analysis. Of 234 209 patients with complete BI information, 7137 (3.1%) received blood purification, 27 100 (11.7%) received ventilation, 2888 (1.2%) received blood purification and ventilation, 5613 (2.4%) received a cardiac support device, 247 (0.1%) received a cardiac support device and blood purification, 10 444 (4.5%) received a cardiac support device and ventilation, and 1110 (0.5%) received a cardiac support device, ventilation, and blood purification. Longer use of blood purification or ventilation and a longer ICU stay were associated with functional deterioration. Intensivists should be aware of the effects of critical care procedures on functional deterioration and advance the appropriate use of functional support according to each patient's condition.

The Tohoku journal of experimental medicine, 2012

American journal of disaster medicine, 2012

Public health emergencies like earthquakes and tsunamis underscore the need for an evidence-based... more Public health emergencies like earthquakes and tsunamis underscore the need for an evidence-based approach to disaster preparedness. Using the Japanese administrative database and the geographical information system (GIS), the interruption of hospital-based mechanical ventilation administration by a hypothetical disaster in three areas of the southeastern mainland (Tokai, Tonankai, and Nankai) was simulated and the repercussions on ventilator care in the prefectures adjacent to the damaged prefectures was estimated. Using the database of 2010 including 3,181,847 hospitalized patients among 952 hospitals, the maximum daily ventilator capacity in each hospital was calculated and the number of patients who were administered ventilation on October xx was counted. Using GIS and patient zip code, the straight-line distances among the damaged hospitals, the hospitals in prefectures nearest to damaged prefectures, and ventilated patients' zip codes were measured. The authors simulated that ventilated patients were transferred to the closest hospitals outside damaged prefectures. The increase in the ventilator operating rates in three areas was aggregated. One hundred twenty-four and 236 patients were administered ventilation in the damaged hospitals and in the closest hospitals outside the damaged prefectures of Tokai, 92 and 561 of Tonankai, and 35 and 85 of Nankai, respectively. The increases in the ventilator operating rates among prefectures ranged from 1.04 to 26.33-fold in Tokai; 1.03 to 1.74-fold in Tonankai, and 1.00 to 2.67-fold in Nankai. Administrative databases and GIS can contribute to evidenced-based disaster preparedness and the determination of appropriate receiving hospitals with available medical resources.

Case reports in gastroenterology, 2012

Several studies have regarded proximal gastrectomy (PG) as optimal compared to total gastrectomy ... more Several studies have regarded proximal gastrectomy (PG) as optimal compared to total gastrectomy (TG) for upper stomach cancer. In addition to the traditional outcomes of complication and mortality, change in functional status should be considered as another relevant outcome in aging generations. However, there has been no community-based appraisal of functional outcomes between PG and TG. Using an administrative database, we compared functional outcomes between PG and TG. Among 12,508 patients who survived for ≥15 years and underwent open gastrectomy between 2008 and 2010, we examined patient characteristics, comorbidities, functional status estimated by the Barthel index (BI) at admission and discharge, complications, ICU care, ventilation administration, blood transfusion, operating room time, resumption of oral intake, length of stay and total charges. With reference to distal gastrectomy (DG), we performed multivariate analyses to assess the impacts of PG and TG on complications and BI deterioration. A total of 434 PGs and 4,941 TGs were observed in 148 and 295 hospitals, respectively. Patient characteristics, care process, resumption of oral intake, operating room time, length of stay and total charges were also significantly different among the three gastrectomy types. PG, TG and DG Case 401 were not associated with complications or functional deterioration. Patient characteristics, preoperative blood transfusion and longer operating room time were significantly associated with more complications and BI deterioration. Since patient case mix and longer operating room time were associated with poor outcomes, physicians should recognize the role of PG and might optimally challenge and complete gastrectomies within the appropriate indications.