Volume- and quality-controlled certification system promotes centralization of complex hepato-pancreatic-biliary surgery

Yoshihiro Mise, Shinya Hirakawa, Hisateru Tachimori, Yoshihiro Kakeji, Yuko Kitagawa, Shohei Komatsu, Atsushi Nanashima, Masafumi Nakamura, Itaru Endo, Akio Saiura

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Centralization of complex surgeries has made little progress when it only considers the minimum number of surgical procedures. We aim to assess the impact of certification system of Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) on centralization and surgical quality of advanced hepato-pancreatic-biliary (HPB) surgery. Methods: The National Clinical Database was used to review 20 111 patients who underwent pancreatoduodenectomy (PD) and 9666 who underwent advanced hepatectomy defined as hepatectomy of more than one section during 2019 and 2020. JSHPBS certifies hospitals based on the annual number of advanced HPB surgeries and the surgical quality. Minimum numbers of surgeries for board-certified A and B institutions are 50 and 30, respectively. Short-term outcomes were compared among institutions. Results: In 2020, 69.4% (7007/10090) and 72.9% (3433/4710) of patients underwent PD and advanced hepatectomy at board-certified institutions. In-hospital mortality rates after PD was 0.9% at certified A institutions, 1.4% at B institutions, and 2.7% at non-certified institutions (p <.001). The odds ratio (OR) of risk-adjusted mortality after PD compared with non-certified institutions was 0.39 (confidence interval [CI]: 0.30–0.50, p <.001) at certified A institutions, and 0.54 at certified B institutions (CI: 0.40–0.73, p <.001). In-hospital mortality rates after advanced hepatectomy was 1.7% at certified A institutions, 2.3% at B institutions, and 3.2% at non-certified institutions (p <.001). The OR of risk-adjusted mortality after advanced hepatectomy compared with non-certified institutions was 0.57 at certified A institutions (CI: 0.41–0.78, p <.001). Conclusion: The volume- and quality-controlled certification system of JSHBPS reduces surgical mortality after advanced HPB surgeries.

Original languageEnglish
Pages (from-to)851-862
Number of pages12
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Issue number7
Publication statusPublished - 2023 Jul
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Hepatology


Dive into the research topics of 'Volume- and quality-controlled certification system promotes centralization of complex hepato-pancreatic-biliary surgery'. Together they form a unique fingerprint.

Cite this