Validation of the board certification system for expert surgeons (hepato-biliary-pancreatic field) using the data of the National Clinical Database of Japan: part 2 – Pancreatoduodenectomy

Fumihiko Miura, Masakazu Yamamoto, Mitsukazu Gotoh, Hiroyuki Konno, Jiro Fujimoto, Katsuhiko Yanaga, Norihiro Kokudo, Hiroki Yamaue, Go Wakabayashi, Yasuyuki Seto, Michiaki Unno, Hiroaki Miyata, Norimichi Hirahara, Masaru Miyazaki

Research output: Contribution to journalArticlepeer-review

31 Citations (Scopus)


Background: Data of pancreatoduodenectomy (PD) cases from the National Clinical Database (NCD) were analyzed in order to validate the board certification system established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS). Methods: Board-certified A training institutions and board-certified B training institutions were required to perform at least 50 and 30 high-level hepato-biliary-pancreatic (HBP) surgeries per year, respectively. Records of 17,563 patients who had undergone PD during 2011 and 2012 were retrospectively analyzed according to the category of the board-certified institution and with or without participation of board-certified instructors or expert surgeons. Results: Operative mortality rates after PDs performed at certified A institutions, certified B institutions, and non-certified institutions were 1.5%, 3.0%, and 3.9%, respectively (P < 0.001). The operative mortality rates after PDs performed with participation of certified instructors or expert surgeons were better than those without (2.2% vs. 3.8%, P < 0.001). A multiple logistic regression model showed that cutoffs of high-level HBP surgeries performed per year at hospitals that predicted 30-day mortality after PDs were 10 and 50, and that those that predicted operative mortality were 10 and 70. Conclusions: The requirements for board-certified institutions, instructors, and expert surgeons to perform PD were appropriate. The requirements for board-certified A institutions were close to the identified cutoffs. Further analyses are necessary to elucidate the implications of the board certification system.

Original languageEnglish
Pages (from-to)353-363
Number of pages11
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Issue number6
Publication statusPublished - 2016 Jun 1


  • Board certification
  • Centralization
  • Hepatectomy
  • Hepato-biliary-pancreatic surgery
  • High-volume hospital
  • Pancreatoduodenectomy

ASJC Scopus subject areas

  • Surgery
  • Hepatology


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