Annual report by The Japanese Association for Thoracic Surgery: Committee for Scientific Affair.
S. Endo and S. Natsugoe equally contributed.
The Japanese Association for Thoracic Surgery has conducted annual surveys of thoracic surgery throughout Japan since 1986 to determine the statistics regarding the number of procedures according to operative category. Here, we have summarized the results from our annual survey of thoracic surgery performed during 2015.
As has been done so far, thoracic surgery was classified into three categories—cardiovascular, general thoracic, and esophageal surgery—and the patient data were examined and analyzed for each group. Access to the computerized data is offered to all members of this Association. We honor and value all member’s continued professional support and contributions (Tables 1, 2).
Table 1 Questionnaires sent out and received back by the end of December 2015
Sent out
Returned
Response rate
(A) Cardiovascular surgery
–
568
–
(B) General thoracic surgery
736
714
97.0%
(C) Esophageal surgery
610
571
93.6%
Table 2 Categories subclassified according to the number of operations performed
Number of operations performed
Category
General thoracic surgery
0
12
1–24
66
25–49
120
50–99
190
100–149
138
150–199
80
≧ 200
108
Total
714
Number of operations performed
Esophageal surgery
0
81
1–4
151
5–9
101
10–19
102
20–29
46
30–39
29
40–49
13
≧ 50
48
Total
571
Anzeige
The incidence of hospital mortality was added to the survey to determine the nationwide status, which has contributed to the Japanese surgeons to understand the present status of thoracic surgery in Japan and to make progress to improve operative results by comparing their work with those of others. The Association was able to gain a better understanding of present problems as well as future prospects, which has been reflected to its activity including education of its members.
Thirty-day mortality (so-called “operative mortality”) is defined as death within 30 days of operation regardless of the patient’s geographic location and even after the patient had been discharged from the hospital. Hospital mortality is defined as death within any time interval after an operation if the patient had not been discharged from the hospital.
Hospital-to-hospital transfer in the categories of esophageal surgery is not considered discharge: transfer to a nursing home or a rehabilitation unit is considered hospital discharge unless the patient subsequently dies of complications of the operation. On the contrary, hospital-to-hospital transfer after 30 days of operation in the categories of cardiovascular surgery and general thoracic surgery is considered discharge because data of national clinical database (NCD) 2015 were used in this category and hospital-to-hospital transfer after 30 days of operation is considered discharge in NCD.
Abstract of the survey
All data regarding cardiovascular surgery and thoracic surgery were obtained from NCD, whereas data regarding esophageal surgery were collected from survey questionnaire by The Japanese Association for Thoracic Surgery forms because NCD of esophageal surgery does not include non-surgical cases (i.e., patients with adjuvant chemotherapy or radiation alone). Based on the change in data aggregation, there are several differences between this 2015 annual report and previous annual reports: the number of institutions decreased in each category from 578 (2014) to 568 (2015) in cardiovascular, from 762 to 714 in general thoracic and from 626 to 571 in esophageal surgery. Because more than two departments in the same institute registered their data to NCD individually, we cannot calculate correct number of institutes in this survey. Then, the response rate is not indicated in the category of cardiovascular surgery (Table 1), and the number of institutions classified by the operation number is also not calculated in the category of cardiovascular surgery (Table 2).
Anzeige
2015 Final report
(A) Cardiovascular surgery
First, we are very pleased with our colleague’s (member’s) cooperation to our survey of cardiovascular surgery, which definitely enhances the quality of this annual report. We are truly grateful again for the enormous effort put into completing the NCD at each participating institution.
Figure 1 shows the development of cardiovascular surgery in Japan over the last 29 years. Aneurysm surgery includes only operations for thoracic and thoracoabdominal aortic aneurysm. Extra-anatomic bypass surgery for thoracic aneurysm and pacemaker implantation were totally excluded from the survey since 2015. The number of assist device implantation operations is not included in the total number of surgical operations, while it remained in the survey. A total of 69,512 cardiovascular operations were performed at 561 institutions during 2015 alone and included 44 heart transplantations, which were re-started in 1999.
The number of operations for congenital heart disease (9054 cases) decreased in 2.3% compared with that of 2014 (9269 cases) [1], and 2.5% decrease when compared with the data of 10 years ago (9287 cases in 2005) [2]. The number of operations for adult heart disease (19,820 cases in valvular heart disease, 15,103 ischemic heart disease, 17,444 cases in thoracic aortic aneurysm and 1897 cases for other procedures) decreased compared with those of 2014 (9.7, 3.4, 0.3 and 10.4%, respectively).
During the last 10 years, the numbers of operations for adult heart disease increased constantly except for that for ischemic heart disease (39.1% increase in valvular heart disease, 23.5% decrease in ischemic heart disease, 101.1% increase in thoracic aortic aneurysm, and 56.5% increase in other procedures compared those of 2005 [2]). The concomitant coronary artery bypass grafting procedure (CABG) is not included in ischemic heart disease but included in other categories such as valvular heart disease and thoracic aneurysm in our study, then, the number of CABG still remained over 20,000 cases per year (20,785 cases) in 2015. Data for individual categories are summarized in Tables 3, 4, 5, 6, 7, 8 and 9.
Table 3
Congenital (total 9269)
(1) CPB (+) (total 6710)
Neonate
Infant
1–17 years
≧ 18 years
Total
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
PDA
3
0
0
0
8
0
0
0
4
0
0
0
10
0
0
0
25
0
0
0
Coarctation (simple)
13
0
0
0
14
0
0
0
14
0
0
0
12
0
0
0
53
0
0
0
+ VSD
54
0
0
0
42
0
0
1 (2.4)
14
0
0
0
0
0
0
0
110
0
0
1 (0.9)
+ DORV
1
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
+ AVSD
4
0
0
1 (25.0)
3
0
0
1 (33.3)
0
0
0
0
0
0
0
0
7
0
0
2 (28.6)
+ TGA
2
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
+ SV
0
0
0
0
2
0
0
0
1
0
0
0
0
0
0
0
3
0
0
0
+ Others
7
0
0
0
9
1 (11.1)
0
1 (11.1)
9
1 (11.1)
0
1 (11.1)
3
0
0
0
28
2 (7.1)
0
2 (7.1)
Interrupt. of Ao (simple)
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
+ VSD
27
0
0
0
34
0
0
1 (2.9)
11
0
0
0
1
0
0
0
73
0
0
1 (1.4)
+ DORV
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ Truncus
3
0
0
0
5
0
0
1 (20.0)
2
0
0
0
0
0
0
0
10
0
0
1 (10.0)
+ TGA
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
+ Others
1
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
Vascular ring
0
0
0
0
6
0
0
0
2
0
0
0
0
0
0
0
8
0
0
0
PS
2
0
0
0
26
0
0
0
79
0
0
0
14
0
0
0
121
0
0
0
PA ∙ IVS or critical PS
14
0
0
1 (7.1)
52
0
0
0
66
0
0
0
4
0
0
0
136
0
0
1 (0.7)
TAPVR
123
12 (9.8)
0
23 (18.7)
75
1 (1.3)
0
5 (6.7)
7
0
0
0
4
0
0
0
209
13 (6.2)
0
28 (13.4)
PAPVR ± ASD
1
0
0
0
4
0
0
0
58
0
0
0
17
1 (5.9)
0
1 (5.9)
80
1 (1.3)
0
1 (1.3)
ASD
8
0
0
0
77
0
0
0
655
0
0
1 (0.2)
291
0
0
0
1031
0
0
1 (0.1)
Cor triatriatum
1
0
0
0
7
0
0
0
2
0
0
0
0
0
0
0
10
0
0
0
AVSD (partial)
0
0
0
0
14
0
0
1 (7.1)
36
0
0
0
6
0
0
0
56
0
0
1 (1.8)
AVSD (complete)
6
0
0
0
94
1 (1.1)
0
4 (4.3)
97
5 (5.2)
0
7 (7.2)
6
0
0
0
203
6 (3.0)
0
11 (5.4)
+ TOF or DORV
2
0
0
0
6
0
0
0
24
1 (4.2)
0
2 (8.3)
5
0
0
1 (20.0)
37
1 (2.7)
0
3 (8.1)
+ Others
1
0
0
0
2
0
0
0
2
0
0
0
0
0
0
0
5
0
0
0
VSD (subarterial)
4
0
0
0
113
0
0
0
189
0
0
0
18
0
0
0
324
0
0
0
VSD (perimemb./muscular)
14
0
0
0
849
2 (0.2)
0
4 (0.5)
340
0
0
0
50
1 (2.0)
0
1 (2.0)
1253
3 (0.2)
0
5 (0.4)
VSD (type unknown)
0
0
0
0
0
0
0
0
0
21
0
21
0
0
0
VSD + PS
0
0
0
0
40
0
0
0
19
0
0
0
0
0
0
0
59
0
0
0
DCRV ± VSD
0
0
0
0
9
0
0
0
30
0
0
0
7
0
0
0
46
0
0
0
Aneurysm of sinus Valsalva
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
4
0
0
0
TOF
12
1 (8.3)
0
2 (16.7)
144
2 (1.4)
0
2 (1.4)
194
2 (1.0)
0
2 (1.0)
33
2 (6.1)
0
2 (6.1)
383
7 (1.8)
0
8 (2.1)
PA + VSD
10
0
0
2 (20.0)
69
3 (4.3)
0
5 (7.2)
132
4 (3.0)
0
6 (4.5)
17
0
0
0
228
7 (3.1)
0
13 (5.7)
DORV
30
2 (6.7)
0
2 (6.7)
121
3 (2.5)
0
5 (4.1)
146
4 (2.7)
0
5 (3.4)
13
0
0
0
310
9 (2.9)
0
12 (3.9)
TGA (simple)
100
3 (3.0)
0
7 (7.0)
7
0
0
0
5
1 (20.0)
0
1 (20.0)
1
0
0
0
113
4 (3.5)
0
8 (7.1)
+ VSD
42
2 (4.8)
0
4 (9.5)
29
1 (3.4)
0
1 (3.4)
24
0
0
1 (4.2)
3
1 (33.3)
0
1 (33.3)
98
4 (4.1)
0
7 (7.1)
VSD + PS
0
0
0
0
3
0
0
0
4
0
0
0
0
0
0
0
7
0
0
0
Corrected TGA
0
0
0
0
9
1 (11.1)
0
1 (11.1)
37
1 (2.7)
0
2 (5.4)
17
0
0
0
63
2 (3.2)
0
3 (4.8)
Truncus arteriosus
9
3 (33.3)
0
3 (33.3)
15
1 (6.7)
0
1 (6.7)
14
0
0
4 (28.6)
0
0
0
0
38
4 (10.5)
0
8 (21.1)
SV
21
2 (9.5)
0
3 (14.3)
184
3 (1.6)
0
7 (3.8)
194
3 (1.5)
0
6 (3.1)
15
0
0
0
414
8 (1.9)
0
16 (3.9)
TA
8
0
0
0
34
0
0
1 (2.9)
48
0
0
0
6
0
0
0
96
0
0
1 (1.0)
HLHS
34
2 (5.9)
0
5 (14.7)
132
6 (4.5)
0
10 (7.6)
57
2 (3.5)
0
3 (5.3)
1
0
0
0
224
10 (4.5)
0
18 (8.0)
Aortic valve lesion
5
0
0
0
24
1 (4.2)
0
1 (4.2)
107
0
0
2 (1.9)
28
0
0
0
164
1 (0.6)
0
3 (1.8)
Mitral valve lesion
3
1 (33.3)
0
1 (33.3)
45
2 (4.4)
0
3 (6.7)
67
0
0
0
19
0
0
1 (5.3)
134
3 (2.2)
0
5 (3.7)
Ebstein
8
2 (25.0)
0
3 (37.5)
25
0
0
0
27
0
0
0
14
0
0
0
74
2 (2.7)
0
3 (4.1)
Coronary disease
1
0
0
0
8
0
0
0
25
0
0
0
7
0
0
0
41
0
0
0
Others
11
3 (27.3)
0
4 (36.4)
37
2 (5.4)
0
3 (8.1)
45
1 (2.2)
0
1 (2.2)
56
0
0
0
149
6 (4.0)
0
8 (5.4)
Conduit failure
0
0
0
0
5
0
0
0
20
0
0
0
8
0
0
0
33
0
0
0
Redo (excluding conduit failure)
3
0
0
1 (33.3)
69
0
0
3 (4.3)
98
1 (1. 0)
0
3 (3.1)
48
0
1 (2.1)
0
218
1 (0.5)
1 (0.5)
7 (3.2)
Total
588
33 (5.6)
0
62 (10.5)
2457
30 (1.2)
0
62 (2.5)
2905
26 (0.9)
0
47 (1.6)
760
5 (0.7)
1 (0.1)
7 (0.9)
6710
94 (1.4)
1 (0.0)
178 (2.7)
(), % mortality
CPB cardiopulmonary bypass, PDA patient ductus arteriosus, VSD ventricular septal defect, DORV double-outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of great arteries, SV single ventricle, Interrupt. of Ao interruption of aorta, PS pulmonary stenosis, PA-IVS pulmonary atresia with intact ventricular septum, TAPVR total anomalous pulmonary venous return, PAPVR partial anomalous pulmonary venous return, ASD atrial septal defect, TOF tetralogy of Fallot, DCRV double-chambered right ventricle, TA tricuspid atresia, HLHS hypoplastic left heart syndrome, RV-PA right ventricle-pulmonary artery
(2) CPB (−) (total 2344)
Neonate
Infant
1–17 years
≧ 18 years
Total
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
PDA
347
5 (1.4)
0
17 (4.9)
182
1 (0.5)
0
4 (2.2)
45
0
0
0
6
0
0
0
580
6 (1.0)
0
21 (3.6)
Coarctation (simple)
21
0
0
0
21
0
0
0
2
0
0
0
2
0
0
0
46
0
0
0
+ VSD
41
1 (2.4)
0
2 (4.9)
20
0
0
0
1
0
0
0
0
0
0
0
62
1 (1.6)
0
2 (3.2)
+ DORV
2
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
3
0
0
0
+ AVSD
6
0
0
1 (16.7)
0
0
0
0
1
0
0
0
0
0
0
0
7
0
0
1 (14.3)
+ TGA
2
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
+ SV
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
+ Others
12
1 (8.3)
0
1 (8.3)
5
0
0
0
1
0
0
0
0
0
0
0
18
1 (5.6)
0
1 (5.6)
Interrupt. of Ao (simple)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ VSD
26
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
32
0
0
0
+ DORV
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
+ Truncus
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
+ TGA
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
+ Others
2
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
4
0
0
0
Vascular ring
4
0
0
0
14
0
0
0
4
0
0
0
0
0
0
0
22
0
0
0
PS
8
0
0
0
9
0
0
0
0
0
0
0
0
0
0
0
17
0
0
0
PA ∙ IVS or critical PS
33
1 (3.0)
0
2 (6.1)
35
0
0
0
8
0
0
0
0
0
0
0
76
1 (1.3)
0
2 (2.6)
TAPVR
5
0
0
0
5
0
0
1 (20.0)
2
0
0
0
1
0
0
0
13
0
0
1 (7.7)
PAPVR ± ASD
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
ASD
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
2
0
0
0
Cor triatriatum
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
AVSD (partial)
2
0
0
1 0
3
0
0
0
0
0
0
0
0
0
0
0
5
0
0
1 (20.0)
AVSD (complete)
39
0
0
2 (5.1)
66
2 (3.0)
0
2 (3.0)
6
0
0
0
2
0
0
0
113
2 (1.8)
0
4 (3.5)
+ TOF or DORV
1
0
0
0
4
0
0
0
1
0
0
0
0
0
0
0
6
0
0
0
+ Others
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
VSD (subarterial)
3
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
VSD (perimemb./muscular)
66
0
0
0
156
0
0
1 (0.6)
4
0
0
0
0
0
0
0
226
0
0
1 (0.4)
VSD + PS
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
DCRV ± VSD
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
2
0
0
0
Aneurysm of sinus valsalva
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOF
17
0
0
0
71
0
0
0
8
0
0
0
1
0
0
0
97
0
0
0
PA + VSD
16
0
0
1 (6.3)
61
2 (3.3)
0
3 (4.9)
35
0
0
0
0
0
0
0
112
2 (1.8)
0
4 (3.6)
DORV
50
2 (4.0)
0
2 (4.0)
76
0
0
1 (1.3)
8
0
0
0
2
0
0
0
136
2 (1.5)
0
3 (2.2)
TGA (simple)
6
0
0
0
3
0
0
0
0
0
0
0
3
0
0
0
12
0
0
0
+ VSD
10
0
0
0
9
0
0
0
2
0
0
0
0
0
0
0
21
0
0
0
VSD + PS
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
Corrected TGA
2
0
0
0
9
0
0
0
20
0
0
0
6
0
0
0
37
0
0
0
Truncus arteriosus
20
0
0
0
6
0
0
0
2
0
0
1 (50.0)
0
0
0
0
28
0
0
1 (3.6)
SV
76
2 (2.6)
0
6 (7.9)
66
1 (1.5)
0
3 (4.5)
17
0
0
0
4
0
0
0
163
3 (1.8)
0
9 (5.5)
TA
10
0
0
0
16
0
0
0
5
0
0
0
3
0
0
0
34
0
0
0
HLHS
109
2 (1.8)
0
9 (8.3)
34
0
0
0
14
0
0
0
0
0
0
0
157
2 (1.3)
0
9 (5.7)
Aortic valve lesion
8
1 (12.5)
0
2 (25.0)
3
0
0
0
2
0
0
0
1
0
0
0
14
1 (7.1)
0
2 (14.3)
Mitral valve lesion
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
Ebstein
2
0
0
0
8
0
0
0
1
0
0
0
1
0
0
0
12
0
0
0
Coronary disease
0
0
0
0
0
0
0
0
4
1 (25.0)
0
1 (25.0)
0
0
0
0
4
1 (25.0)
0
1 (25.0)
Others
10
2 (20.0)
0
4 (40.0)
14
2 (14.3)
0
2 (14.3)
16
0
0
0
1
0
0
0
41
4 (9.8)
0
6 (14.6)
Conduit failure
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
Redo (excluding conduit failure)
21
1 (4.8)
0
1 (4.8)
71
0
0
1 (1.4)
104
1 (1.0)
0
2 (1.9)
14
0
0
0
210
2 (1.0)
0
4 (1.9)
Total
991
18 (1.8)
0
51 (5.1)
986
8 (0.8)
0
18 (1.8)
319
2 (0.6)
0
4 (1.3)
48
0
0
0
2344
28 (1.2)
0
73 (3.1)
(), % mortality
CPB cardiopulmonary bypass, PDA patient ductus arteriosus, VSD ventricular septal defect, DORV double-outlet right ventricle, AVSD atrioventricular septal defect, TGA transposition of great arteries, SV single ventricle, Interrupt. of Ao interruption of aorta, PS pulmonary stenosis, PA-IVS pulmonary atresia with intact ventricular septum, TAPVR total anomalous pulmonary venous return, PAPVR partial anomalous pulmonary venous return, ASD atrial septal defect, TOF tetralogy of Fallot, DCRV double-chambered right ventricle, TA tricuspid atresia, HLHS hypoplastic left heart syndrome, RV-PA right ventricle-pulmonary artery
(3) Main procedure
Neonate
Infant
1–17 years
≧ 18 years
Total
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
Hospital
After discharge
1
SP Shunt
135
3 (2.2)
0
7 (5.2)
364
5 (1.4)
0
8 (2.2)
63
1 (1.6)
0
1 (1.6)
4
0
0
0
566
9 (1.6)
0
16 (2.8)
2
PAB
415
7 (1.7)
0
22 (5.3)
324
1 (0.3)
0
3 (0.9)
17
0
0
0
2
0
0
0
758
8 (1.1)
0
25 (3.3)
3
Bidirectional Glenn or hemi-Fontan ± α
0
0
0
0
263
2 (0.8)
0
5 (1.9)
99
0
0
1 (1.0)
2
0
0
0
364
2 (0.5)
0
6 (1.6)
4
Damus–Kaye–Stansel operation
4
1 (25.0)
0
1 (25.0)
31
1 (3.2)
0
2 (6.5)
11
1 (9.1)
0
1 (9.1)
2
1 (50.0)
0
1 (50.0)
48
4 (8.3)
0
5 (10.4)
5
PA reconstruction/repair(including redo)
15
1 (6.7)
0
3 (20.0)
92
3 (3.3)
0
6 (6.5)
104
0
0
1 (1.0)
5
0
0
0
216
4 (1.9)
0
10 (4.6)
6
RVOT reconstruction/repair
5
1 (20.0)
0
1 (20.0)
161
2 (1.2)
0
3 (1.9)
308
5 (1.6)
0
6 (1.9)
33
0
0
0
507
8 (1.6)
0
10 (2.0)
7
Rastelli procedure
1
0
0
0
30
2 (6.7)
0
2 (6.7)
100
4 (4.0)
0
5 (5.0)
5
0
0
0
136
6 (4.4)
0
7 (5.1)
8
Arterial switch procedure
155
5 (3.2)
0
11 (7.1)
28
2 (7.1)
0
2 (7.1)
6
1 (16.7)
0
1 (16.7)
0
0
0
0
189
8 (4.2)
0
14 (7.4)
9
Atrial switch procedure
0
0
0
0
2
0
0
0
1
0
0
0
0
0
0
0
3
0
0
0
10
Double switch procedure
0
0
0
0
2
1 (50.0)
0
1 (50.0)
8
0
0
1 (12.5)
0
0
0
0
10
1 (10.0)
0
2 (20.0)
11
Repair of anomalous origin of CA
0
0
0
0
5
0
0
0
10
0
0
0
0
0
0
0
15
0
0
0
12
Closure of coronary AV fistula
0
0
0
0
2
0
0
0
7
1 (14.3)
0
1 (14.3)
8
0
0
0
17
1 (5.9)
0
1 (5.9)
13
Fontan/TCPC
0
0
0
0
0
0
0
0
347
3 (0.9)
0
9 (2.6)
23
0
0
0
370
3 (0.8)
0
9 (2.4)
14
Norwood procedure
29
2 (6.9)
0
4 (13.8)
110
7 (6.4)
0
16 (14.5)
6
1 (16.7)
0
1 (16.7)
0
0
0
0
145
10 (6.9)
0
21 (14.5)
15
Ventricular septation
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16
Left side AV valve repair (including Redo)
3
0
0
0
48
1 (2.1)
0
1 (2.1)
53
0
0
0
14
0
0
0
118
1 (0.8)
0
1 (0.8)
17
Left side AV valve replace (including Redo)
0
0
0
0
8
1 (12.5)
0
2 (25.0)
33
0
0
1 (3.0)
14
0
0
1 (7.1)
55
1 (1.8)
0
4 (7.3)
18
Right side AV valve repair (including Redo)
7
2 (28.6)
0
3 (42.9)
22
0
0
0
41
0
0
2 (4.9)
29
0
0
0
99
2 (2.0)
0
5 (5.1)
19
Right side AV valve replace (including Redo)
0
0
0
0
1
0
0
0
7
0
0
0
16
0
0
0
24
0
0
0
20
Common AV valve repair(including Redo)
3
0
0
0
14
0
0
2 (14.3)
19
2 (10.5)
0
2 (10.5)
2
0
0
0
38
2 (5.3)
0
4 (10.5)
21
Common AV valve replace(including Redo)
0
0
0
0
7
1 (14.3)
0
1 (14.3)
8
0
0
1 (12.5)
1
0
0
0
16
1 (6.3)
0
2 (12.5)
22
Repair of supra-aortic stenosis
1
0
0
0
10
1 (10.0)
0
1 (10.0)
17
0
0
0
1
0
0
0
29
1 (3.4)
0
1 (3.4)
23
Repair of subaortic stenosis (including Redo)
0
0
0
0
4
0
0
0
34
0
0
0
5
0
0
0
43
0
0
0
24
Aortic valve plasty ± VSD closure
2
0
0
0
12
0
0
0
24
0
0
1 (4.2)
2
0
0
0
40
0
0
1 (2.5)
25
Aortic valve replacement
0
0
0
0
1
0
0
0
26
0
0
0
23
0
0
0
50
0
0
0
26
AVR with annular enlargement
0
0
0
0
0
0
0
0
13
1 (7.7)
0
1 (7.7)
1
0
0
0
14
1 (7.1)
0
1 (7.1)
27
Aortic root replacement (except Ross)
0
0
0
0
0
0
0
0
12
0
0
1 (8.3)
6
0
0
0
18
0
0
1 (5.6)
28
Ross procedure
0
0
0
0
2
1 (50.0)
0
1 (50.0)
12
0
0
0
0
0
0
0
14
1 (7.1)
0
1 (7.1)
Total
775
22 (2.8)
0
52 (6.7)
1543
31 (2.0)
0
56 (3.6)
1386
20 (1.4)
0
37 (2.7)
198
1 (0.5)
0
2 (1.0)
3902
74 (1.9)
0
147 (3.8)
(), % mortality
SP systemic pulmonary, PAB pulmonary artery banding, PA pulmonary artery, RVOT right ventricular outflow tract, CA coronary artery, AV fistula arteriovenous fistula, TCPC total cavopulmonary connection, AV valve atrioventricular valve, VSD ventricular septal defect, AVR aortic valve replacement
CABG coronary artery bypass grafting, A aortic valve, M mitral valve, T tricuspid valve, P pulmonary valve; number of redo cases is included in total case number of 21,939
LMT includes LMT alone or LMT with other branch diseases
(b) Off-pump CABG (total 8685)
(The present section also includes cases of planned off-pump CABG in which, during surgery, the change is made to an on-pump CABG or on-pump beating-heart procedure)
Acute, within 2 weeks from the onset of myocardial infarction
(C) TMLR (total 0)
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Isolated
0
0
0
0
with CABG
0
0
0
0
Total
0
0
0
0
TMLR transmyocardial laser revascularization
(3) Operation for arrhythmia (total 5765)
Cases
30-day mortality
Hospital mortality
Concomitant operation
Isolated
Congenital
Valve
IHD
Others
Multiple combination
Hospital
After discharge
2 categories
3 categories
Maze
3795
73 (1.9)
1 (0.03)
108 (2.8)
80
180
3338
607
290
636
49
For WPW
2
0
0
0
0
0
2
0
0
0
0
For ventricular tachyarrhythmia
40
1 (2.5)
0
2 (5.0)
2
0
15
24
8
8
1
Others
1928
35 (1.8)
0
68 (3.5)
122
82
1531
400
214
384
30
Total
5765
109 (1.9)
1 (0.02)
178 (3.1)
204
262
4886
1031
512
1028
80
() % mortality
Except for 106 isolated cases, all remaining 3749 cases are doubly allocated, one for this subgroup and the other for the subgroup corresponding to the concomitant operations
In 2015, 6894 open-heart operations for congenital heart disease were performed with overall hospital mortality of 2.7%. The number of operations for congenital heart disease decreased gradually throughout these 10 years (maximum 7386 cases in 2006), and overall hospital mortality showed plateau around 3.0%. In detail, the most common disease was ventricular septal defect (1253 cases), for the first time since the inauguration of this survey. Atrial septal defect (ASD), which had been the most common disease, was the “second” common one (1031 cases) in 2015. It was mainly due to the development of catheter device for ASD closure commercially available in Japan since 2005. In the last 10 years, hospital mortality for complex congenital heart disease was as follows (2005 [2], 2010 [3], and 2015): complete atrio-septal defect (4.7, 4.2 and 1.7%), tetralogy of Fallot (1.6, 0.8 and 1.3%), transposition of the great arteries with intact septum (6.2, 4.1 and 6.6%) and with ventricular septal defect (15.9, 7.3 and 3.9%), single ventricle (5.3, 7.5 and 4.3%), and hypoplastic left heart syndrome (24.4, 13.1 and 9.8%). Right heart bypass surgery is now commonly performed (364 bidirectional Glenn procedures excluding 48 Damus–Kaye–Stansel procedures and 370 Fontan type procedures including total cavopulmonary connection) with acceptable hospital mortality (1.6 and 2.4%). Norwood type I procedure was performed in 145 cases with relatively low hospital mortality rate of 14.5%.
The number of operations for valvular heart disease has constantly increased until 2014 (21,939 cases) [1], and that was 19,820 cases in 2015. The hospital mortality of primary single valve placement was 2.8 and 8.7% for the aortic and the mitral position, while that for primary mitral valve repair was 1.7%. Hospital mortality rate for redo valve surgery was 5.7% in aortic and 7.1% in mitral positions, respectively. Finally, overall hospital mortality did not show dramatic improvement during the last 10 years (3.6% in 2005 [2], 3.1% in 2010 [3], and 4.0% in 2015), which might be partially due to the recent progression of age of the patients. Repair of the valve became a popular procedure (377 cases in the aortic, 6417 cases in the mitral, and 4942 cases in the tricuspid), and mitral valve repair constituted 32.4% of all valvular operations and 65.0% of all mitral valve procedures, which are similar to those of the last 5 years. Aortic and mitral valve replacements with bioprosthesis were performed in 6704 cases and 789 cases, respectively. The ratio of bioprosthesis was 76.4% at the aortic and 23.8% at the mitral position. This ratio of the aortic bioprosthesis increased dramatically from 30 to 40% in the early 2000s [4, 5] to more than 70% recent 5 years. CABG as a concomitant procedure was performed in 20.8% of operations for all valvular heart disease (14.4% in 2005 [2] and 17.3% in 2010 [3]).
Isolated CABG was performed in 13,830 cases which were only 75.4% of that of 10 years ago (2005 [2]). Among these, off-pump CABG was intended in 8685 cases (63.0%) with a success rate of 97.2%, so final success rate of off-pump CABG was 61.1%. The percentage of intended off-pump CABG reached 60.3% in 2004 [4] and then was kept over 60% until now. In 13,830 isolated CABG patients, 96.8% of them received at least one arterial graft, while all arterial graft CABGs were performed only in 22.9% of them. The operative and hospital mortality rates associated with primary elective CABG procedures in 11,266 cases were 0.8 and 1.5%, respectively. Similar data analysis of CABG including primary/redo and elective/emergency data was begun in 2003 [5], and the operative and hospital mortality rates associated with primary elective CABG procedures in 2003 were 1.0 and 1.5%, respectively, so operative results of primary CABG have been stable. Hospital mortality of primary emergency CABG in 2367 cases was still high and was 7.4%. The result of conversion from off-pump CABG rate was 2.8% and hospital mortality in that was 11.3%. A total of 1273 patients underwent surgery for complications of myocardial infarction, including 272 operations for left ventricular aneurysm, ventricular septal perforation or cardiac rupture and 340 operations for ischemic mitral regurgitation.
Operations for arrhythmia were performed mainly as a concomitant procedure in 5765 cases associated with 49.5% increase comparing with that of 2014. The hospital mortality of arrhythmia surgery including 3795 MAZE procedures was 3.1%. MAZE procedure has become quite popular procedure (2497 cases in 2005 [2] and 3591 cases in 2010 [3]).
Anzeige
Operations for thoracic aortic dissection were performed in 8691 cases and this increased by 12.4% this year compared with those of last year. For 6575 Stanford type A acute aortic dissections, hospital mortality remained high and was 9.9%. Operations for a non-dissected thoracic aneurysm were carried out in 9226 cases (decreased by 5.6%), with overall hospital mortality of 6.0%. The hospital mortality associated with unruptured aneurysm was 4.5%, and that of ruptured aneurysm was 24.2%, which remains markedly high.
The number of stent graft procedures remarkably increased recently. A total of 2521 patients with aortic dissection underwent stent graft placement: thoracic endovascular aortic repair (TEVAR) in 1650 cases and open stent grafting in 871 cases. The number of TEVAR for type B chronic aortic dissections increased from 835 cases in 2014 to 1065 cases in 2015. The hospital mortality rates associated with TEVAR for type B aortic dissection were 8.9% in acute cases and 2.6% for chronic cases, respectively.
A total of 3935 patients with non-dissected aortic aneurysm underwent stent graft placement: TEVAR in 2912 cases (17.3% decrease compared with that in 2014) and open stent grafting in 937 cases (155% increase compared with that in 2014). The reason of striking increase of open stent grafting might be due to commercial availability since 2014. The hospital mortality rates for TEVAR and open stenting were as follows: TEVAR (3.2% for unruptured, 21.7% for ruptured aneurysm,) and open stenting (7.2% for unruptured and 25.6% for ruptured.)
In summary, the total cardiovascular operations decreased during 2015 by 2933 cases with steadily constant results in almost all categories. The main reason why the number of operations decreased in 2015 was the number of extra-anatomical bypass operations in thoracic aortic aneurysm and the number of trans-venous pacemaker implantations was excluded from the total number of cardiovascular operations in association with the change of data aggregation as was referred to earlier.
Anzeige
(B) General thoracic surgery
The 2015 survey of general thoracic surgery comprised 736 surgical units, and most data were submitted using the web-based collection system of the national clinical database (NCD) [1]. In total, 79,775 operations were reported by general thoracic surgery departments in 2015—1.8 times the number of operations in 2001 and 2705 more operations than in 2014 (Fig. 2).
Fig. 2
General thoracic surgery
×
In 2015, 40,302 operations for primary lung cancer were performed (Table 10), and the number has increased every year. The 2015 value is 2.1 times that of 2001. Operations for lung cancer were 50.5% of all procedures in general thoracic surgery.
Table10 Total entry cases of General Thoracic Surgery during 2015
Cases
%
Benign pulmonary tumor
2161
2.7
Primary lung cancer
40,302
50.5
Other primary malignant pulmonary tumor
385
0.5
Metastatic pulmonary tumor
8226
10.3
Tracheal tumor
166
0.2
Mesothelioma
635
0.8
Chest wall tumor
677
0.8
Mediastinal tumor
4813
6.0
Thymectomy for MG without thymoma
164
0.2
Inflammatory pulmonary disease
2265
2.8
Empyema
2739
3.4
Bullous disease excluding pneumothorax
416
0.5
Pneumothorax
14,728
18.5
Chest wall deformity
174
0.2
Diaphragmatic hernia including traumatic
36
0.0
Chest trauma excluding diaphragmatic hernia
388
0.5
Lung transplantation
63
0.1
Others
1437
1.8
Total
79,775
100.0
The number of video-assisted thoracic surgery (VATS) procedures in the NCD unexpectedly increased in 2014; however, the exact number of such procedures was not published. The increase was attributed to the use of a non-standard definition of VATS for the NCD registry until 2013. The NCD registry previously included VATS procedures utilizing a skin incision longer than 8 cm and/or a minithoracotomy (hybrid) approach, which are traditionally not regarded as VATS procedures. In this report, the traditional VATS definition is used to describe the number of VATS procedures in the NCD. The number of VATS operations for benign pulmonary tumor, primary lung cancer, and the total number of VATS operation in 2014 and 2015 are shown in Tables 11, 12, 14, 17, 18, 19, 20, 21, 22, 23, 24, 26, 27, 28, and 30, respectively.
Table11 1. Benign pulmonary tumor
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
Hamartoma
478
0
0
0
469
454
Sclerosing hemangioma
125
0
0
0
118
96
Papilloma
20
0
0
0
19
16
Mucous gland adenoma bronchial
5
0
0
0
5
7
Fibroma
166
0
0
0
162
128
Lipoma
10
0
0
0
8
6
Neurogenic tumor
15
0
0
0
13
16
Clear cell tumor
4
0
0
0
4
2
Leiomyoma
10
0
0
0
10
16
Chondroma
6
0
0
0
6
4
Inflammatory myofibroblastic tumor
3
0
0
0
3
1
Pseudolymphoma
23
0
0
0
22
31
Histiocytosis
20
0
0
0
19
22
Teratoma
8
0
0
0
5
0
Others
1268
1 (0.1)
0
3 (0.2)
1200
1266
Total
2161
1 (0.0)
0
3 (0.1)
2063
2065
( ) Mortality %
*Unpublished reference data
Table12 2. Primary malignant pulmonary tumor
Cases
Hospital
After discharge
Hospital mortality
By VATS
2015
2014*
2. Primary malignant pulmonary tumor
Lung cancer
40,687
129 (0.3)
45 (0.1)
275 (0.7)
26,188
24,306
Adenocarcinoma
28,206
47 (0.2)
21 (0.1)
87 (0.3)
Squamous cell carcinoma
7651
60 (0.8)
15 (0.2)
132 (1.7)
Large cell carcinoma
744
5 (0.7)
1 (0.1)
14 (1.9)
(LCNEC)
465
2 (0.4)
0
10 (2.2)
Small cell carcinoma
707
6 (0.8)
0
11 (1.6)
Adenosquamous carcinoma
583
3 (0.5)
1 (0.2)
6 (1.0)
Carcinoma with pleomorphic, sarcomatoid or sarcomatous elements
473
3 (0.6)
5 (1.1)
7 (1.5)
Carcinoid
237
1 (0.4)
0
1 (0.4)
Carcinomas of salivary gland type
35
0
0
0
Unclassified
54
1 (1.9)
0
2 (3.7)
Multiple lung cancer
1245
3 (0.2)
0
11 (0.9)
Others
367
0
2 (0.5)
2 (0.5)
Wedge resection
5810
10 (0.2)
4 (0.1)
25 (0.4)
4917
4359
Segmental excision
4230
10 (0.24)
1 (0.0)
17 (0.4)
2950
2836
(Sleeve segmental excision)
11
0
0
0
7
7
Lobectomy
29,323
96 (0.3)
33 (0.1)
206 (0.7)
18,078
16,676
(Sleeve lobectomy)
541
4 (0.7)
2 (0.4)
12 (2.2)
75
69
Pneumonectomy
533
7 (1.3)
6 (1.1)
13 (2.4)
55
48
(Sleeve pneumonectomy)
10
0
0
1 (10.0)
0
0
Other bronchoplasty
43
2 (4.7)
1 (2.3)
4 (9.3)
5
5
Pleuropneumonectomy
3
0
0
0
0
0
Others
351
4 (1.1)
0
8 (2.3)
183
202
Unknown
9
0
0
0
Sarcoma
47
0
0
2 (4.3)
AAH
109
0
0
0
Others
229
0
0
0
( ) Mortality %
*Unpublished reference data
Table13 Details of lung cancer operation
Cases
c-Stage (TNM)
Ia
24,563
Ib
7631
IIa
3012
IIb
1777
IIIa
2504
IIIb
160
IV
480
NA
175
Total
40,302
Sex
Male
24,882
Female
15,420
NA
0
Total
40,302
Cause of death
Cardiovascular
21
Pneumonia
40
Pyothorax
5
Bronchopleural fistula
17
Respiratory failure
31
Pulmonary embolism
5
Interstitial pneumonia
99
Brain infarction or bleeding
19
Others
75
Unknown
6
Total
318
p-Stage
0 (pCR)
418
Ia
21,131
Ib
7928
IIa
3280
IIb
2088
IIIa
4020
IIIb
194
IV
1027
NA
216
Total
40,302
Age
< 20
49
20–29
32
30–39
234
40–49
1066
50–59
3716
60–69
13,276
70–79
16,954
80–89
4912
≥ 90
62
NA
1
Total
40,302
Table14 3. Metastatic pulmonary tumor
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
3. Metastatic pulmonary tumor
8226
13 (0.2)
5 (0.1)
25 (0.3)
7593
7424
Colorectal
3886
2 (0.1)
3 (0.1)
6 (0.2)
3589
3618
Hepatobiliary/pancreatic
352
0
1 (0.3)
1 (0.3)
327
332
Uterine
475
0
0
0
446
363
Mammary
474
1 (0.2)
0
1 (0.2)
448
420
Ovarian
74
0
0
0
71
56
Testicular
65
0
0
1 (1.5)
58
77
Renal
653
0
0
0
627
589
Skeletal
118
0
0
0
107
135
Soft tissue
249
1 (0.4)
0
2 (0.8)
219
212
Otorhinolaryngological
460
0
0
2 (0.4)
425
385
Pulmonary
480
3 (0.6)
0
5 (1.0)
394
407
Others
940
6 (0.6)
1 (0.1)
7 (0.7)
882
830
( ) Mortality %
*Unpublished reference data
Table15 4. Tracheal tumor
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
4. Tracheal tumor
166
4 (2.4)
3 (1.8)
6 (3.6)
A. Primary malignant tumor
Histological classification
Squamous cell carcinoma
17
1 (5.9)
1 (5.9)
1 (5.9)
Adenoid cystic carcinoma
21
0
0
0
Mucoepidermoid carcinoma
4
0
0
0
Others
17
0
0
0
Total
59
1 (1.7)
1 (1.7)
1 (1.7)
B. Metastatic/invasive malignant tumor
E.g., invasion of thyroid cancer
68
3 (4.4)
2 (2.9)
5 (7.4)
C. Benign tracheal tumor
Histological classification
Papilloma
1
0
0
0
Adenoma
3
0
0
0
Neurofibroma
0
0
0
0
Chondroma
0
0
0
0
Leiomyoma
4
0
0
0
Others
31
0
0
0
Histology unknown
0
0
0
0
Total
39
0
0
0
Operation
Sleeve resection with reconstruction
13
0
0
1 (7.7)
Wedge with simple closure
2
0
0
0
Wedge with patch closure
0
0
0
Total laryngectomy with tracheostomy
0
0
0
0
Others
1
0
0
0
Unknown
0
0
0
0
Total
16
0
0
1 (6.3)
( ) Mortality %
Table16 5. Tumor of pleural origin
5. Tumor of pleural origin
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Histological classification
Solitary fibrous tumor
116
0
0
0
Diffuse malignant pleural mesothelioma
280
4 (1.4)
3 (1.1)
9 (3.2)
Localized malignant pleural mesothelioma
36
0
0
0
Others
203
1 (0.5)
0
3 (1.5)
Total
635
5 (0.8)
3 (0.5)
12 (1.9)
Operative procedure
Extrapleural pneumonectomy
80
1 (1.3)
0
4 (5.0)
Total pleurectomy
89
2 (2.2)
0
4 (4.5)
Others
111
1 (0.9)
3 (2.7)
1 (0.9)
Total
280
4 (1.4)
3 (1.1)
9 (3.2)
( ) Mortality %
Table17 6. Chest wall tumor
6. Chest wall tumor
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
Primary malignant tumor
130
0
0
0
54
57
Metastatic malignant tumor
195
0
1 (0.5)
1 (0.5)
62
81
Benign tumor
352
0
0
1 (0.3)
264
274
Total
677
0
1 (0.1)
2 (0.3)
380
412
( ) Mortality %
*Unpublished reference data
Table18 7. Mediastinal tumor
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
7. Mediastinal tumor
4813
3 (0.1)
3 (0.06)
9 (0.2)
3369
3208
Thymoma*
1912
2 (0.1)
0
3 (0.2)
1127
1016
Thymic cancer
336
0
0
1 (0.3)
167
143
Thymus carcinoid
30
0
0
0
20
15
Germ cell tumor
107
0
0
0
58
56
Benign
82
0
0
0
47
47
Malignant
25
0
0
0
11
9
Neurogenic tumor
424
0
1 (0.2)
0
397
440
Congenital cyst
1026
0
0
0
924
811
Goiter
84
1 (1.2)
1 (1.2)
1 (1.2)
24
19
Lymphatic tumor
186
0
0
2 (1.1)
141
155
Excision of pleural recurrence of thymoma
27
0
0
0
23
31
Thymolipoma
15
0
0
0
10
9
Others
666
0
1 (0.2)
2 (0.3)
478
513
( ) Mortality %
*Unpublished reference data
Table19 8. Thymectomy for myasthenia gravis
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
8. Thymectomy for myasthenia gravis
474
3 (0.6)
0
4 (0.8)
248
269
With thymoma
310
2 (0.6)
0
3 (1.0)
152
161
( ) Mortality %
*Unpublished reference data
Table 20 9. Operations for non-neoplastic disease
(A) Inflammatory pulmonary disease
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
22,183
175 (0.8)
33 (0.1)
428 (1.9)
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
(A) Inflammatory pulmonary disease
2265
8 (0.4)
3 (0.1)
24 (1.1)
2004
1958
Tuberculous infection
68
0
0
0
57
60
Mycobacterial infection
503
0
0
0
449
435
Fungal infection
309
5 (1.6)
0
7 (2.3)
236
249
Bronchiectasis
67
0
0
3 (4.5)
49
54
Tuberculous nodule
106
0
1 (0.9)
0
103
120
Inflammatory pseudo tumor
776
0
1 (0.1)
1 (0.1)
734
508
Interpulmonary lymph node
56
0
0
0
56
59
Others
380
3 (0.8)
1 (0.3)
13 (3.4)
320
473
( ) Mortality %
*Unpublished reference data
Table 21 9. Operations for non-neoplastic disease
(B) Empyema
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
Acute empyema
1999
45 (2.3)
8 (0.4)
131 (6.6)
1657
1574
With fistula
466
27 (5.8)
3 (0.6)
77 (16.5)
275
274
Without fistula
1516
18 (1.2)
5 (0.3)
52 (3.4)
1369
1279
Unknown
17
0
0
2 (11.8)
13
21
Chronic empyema
740
10 (1.4)
2 (0.3)
53 (7.2)
404
368
With fistula
325
5 (1.5)
1 (0.3)
33 (10.2)
126
132
Without fistula
367
5 (1.4)
1 (0.3)
18 (4.9)
248
214
Unknown
48
0
0
2 (4.2)
30
22
Total, %
2739
55 (2.0)
10 (0.4)
184 (6.7)
2061
1942
( ) Mortality %
*Unpublished reference data
Table 22 9. Operations for non-neoplastic disease
(C) Descending necrotizing mediastinitis
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
(C) Descending necrotizing mediastinitis
98
2 (2.0)
0
8 (8.2)
70
80
( ) Mortality %
*Unpublished reference data
Table 23 9. Operations for non-neoplastic disease
(D) Bullous disease
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
(D) Bullous disease
416
1 (0.2)
0
2 (0.5)
393
366
Emphysematous bulla
330
1 (0.3)
0
2 (0.6)
314
288
Bronchogenic cyst
16
0
0
0
14
15
Emphysema with volume reduction surgery
21
0
0
0
20
23
Others
49
0
0
0
45
40
LVRS lung volume reduction surgery
( ) Mortality %
Table 24 9. Operations for non-neoplastic disease
(E) Pneumothorax
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
14,728
95 (0.6)
17 (0.1)
120 (0.8)
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
Spontaneous pneumothorax
Operative procedure
Bullectomy
3118
6 (0.2)
1 (0.0)
9 (0.3)
3122
3380
Bullectomy with additional procedure
7805
4 (0.05)
3 (0.04)
8 (0.1)
7713
7453
Coverage with artificial material
7409
3 (0.04)
3 (0.0)
7 (0.1)
7327
7059
Parietal pleurectomy
35
0
0
0
33
52
Coverage and parietal pleurectomy
109
1 (0.9)
0
1 (0.9)
105
94
Others
252
0
0
0
248
248
Others
888
4 (0.5)
2 (0.2)
8 (0.9)
799
836
Unknown
5
0
0
0
5
8
Total
11,816
14 (0.1)
6 (0.05)
25 (0.2)
11,639
11,679
Secondary pneumothorax
Associated disease
COPD
1981
33 (1.7)
6 (0.3)
61 (3.1)
1912
1696
Tumorous disease
123
2 (1.6)
3 (2.4)
5 (4.1)
114
79
Catamenial
137
0
0
0
132
146
LAM
50
0
0
0
50
42
Others (excluding pneumothorax by trauma)
560
16 (2.9)
2 (0.4)
29 (5.2)
509
544
Unknown
0
0
0
0
0
0
Operative procedure
Bullectomy
436
11 (2.5)
2 (0.5)
17 (3.9)
422
383
Bullectomy with additional procedure
1665
21 (1.3)
4 (0.2)
42 (2.5)
1616
1416
Coverage with artificial material
1560
21 (1.3)
4 (0.3)
41 (2.6)
1516
1335
Parietal pleurectomy
10
0
0
0
9
7
Coverage and parietal pleurectomy
37
0
0
0
34
16
Others
58
0
0
1 (1.7)
57
58
Others
748
19 (2.5)
5 (0.7)
36 (4.8)
678
690
Unknown
2
0
0
0
1
5
Total
2851
51 (1.8)
11 (0.4)
95 (3.3)
2717
2507
( ) Mortality %
*Unpublished reference data
Table 25 9. Operations for non-neoplastic disease
(F) Chest wall deformity
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
(F) Chest wall deformity
174
0
0
0
Funnel chest
167
0
0
0
Others
7
0
0
0
( ) Mortality %
Table 26 9. Operations for non-neoplastic disease
(G) Diaphragmatic hernia
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
(G) Diaphragmatic hernia
36
0
0
0
22
24
Congenital
3
0
0
0
3
8
Traumatic
12
0
0
0
7
3
Others
21
0
0
0
12
13
( ) Mortality %
*Unpublished reference data
Table 27 9. Operations for non-neoplastic disease
(H) Chest trauma
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
(H) Chest trauma
388
17 (4.4)
0
26 (6.7)
243
239
( ) Mortality %
*Unpublished reference data
Table 28 9. Operations for non-neoplastic disease
(I) Other respiratory surgery
Cases
30-day mortality
Hospital mortality
By VATS
Hospital
After discharge
2015
2014*
(I) Other respiratory surgery
1339
27 (2.0)
3 (0.2)
64 (4.8)
953
957
Arteriovenous malformation*
82
0
0
0
77
70
Pulmonary sequestration
90
0
0
0
73
89
Postoperative bleeding > air leakage
385
11 (2.9)
0
27 (7.0)
273
255
Chylothorax
64
2 (3.1)
0
2 (3.1)
55
52
Others
718
14 (1.9)
3 (0.4)
35 (4.9)
475
491
( ) Mortality %
*Unpublished reference data
Table 29
10. Lung transplantation
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
Single lung transplantation from brain-dead donor
23
1 (4.3)
0
2 (8.7)
Bilateral lung transplantation from brain-dead donor
There were 2161 operations for benign pulmonary tumors in 2015, which was similar to the number in 2014 (Table 11). Hamartoma was the most frequent diagnosis in operations for benign pulmonary tumors. VATS was performed in 2063 patients (95.5%). Additional information on primary malignant pulmonary tumors is shown in Tables 12 and 13. With regard to lung cancer subtype, adenocarcinoma was by far the most frequent diagnosis (70.0% of all lung cancer operations), followed by squamous cell carcinoma (19.0%). Sublobar resection was performed in 10,040 lung cancer cases (24.9% of all cases) and lobectomy was performed in 29,323 cases (72.8% of all cases). Sleeve lobectomy was performed in 541 cases, and pneumonectomy was required in 533 cases (1.3% of all cases). VATS lobectomy for lung cancer was performed in 18,078 cases (61.7%). The number of VATS procedures for primary lung cancer was slightly higher than in 2014.
Anzeige
In total, 129 patients died before hospital discharge within 30 days after lung cancer surgery, and 45 patients died after discharge within 30 days after lung cancer surgery. Therefore, 174 patients died within 30 days after lung cancer surgery (30-day mortality rate, 0.43%). In total, 277 patients died before discharge (hospital mortality rate, 0.69%), and the 30-day mortality rate, by procedure, was 0.26% for segmentectomy, 0.44% for lobectomy, and 2.44% for pneumonectomy. Interstitial pneumonia was the leading cause of death after lung cancer surgery, followed by pneumonia, respiratory failure, and cardiovascular events, as was the case in 2014.
Operations for metastatic pulmonary tumors are shown in Table 14; 8226 such operations were performed in 2015, an increase from the previous year. Colorectal cancer was the most frequent diagnosis (47.2% of all cases).
There were 127 operations for malignant tracheal tumor in 2015, but only 16 patients were treated with curative intent (Table 15).
There were 635 pleural tumors in 2015 (Table 16). Diffuse malignant pleural mesothelioma was the most frequent histologic diagnosis. Total pleurectomy was performed in 89 cases and extrapleural pneumonectomy in 80 cases. The hospital mortality rate was 4.5% after total pleurectomy and 5.0% after extrapleural pneumonectomy.
In total, 677 chest wall tumors were resected in 2015 (Table 17); 352 (52.0%) were benign. Among the 325 malignant chest wall tumors, 195 (60.0%) were metastatic tumors.
Mediastinal tumors were resected in 4813 patients, a slight increase from the previous year (Table 18). Thymic epithelial tumor—including 1912 thymomas, 336 thymic carcinomas, and 30 thymic neuroendocrine carcinomas—was the most frequent mediastinal tumor type in 2015.
Thymectomy for myasthenia gravis was performed in 474 cases (Table 19); 310 cases were associated with thymoma and the remaining cases were not associated with thymoma.
There were 2265 cases of lung resection for inflammatory lung diseases (Table 20); 34.2% of the cases were inflammatory tumors of unknown origin, 22.2% were atypical mycobacterium infections, and 13.6% were fungal infections.
The 2739 operations for empyema (Table 21) comprised 1999 cases (73.0%) of acute empyema and 740 cases of chronic empyema. Bronchopleural fistula was reported in 466 patients (23.3%) with acute empyema and 325 patients (43.9%) with chronic empyema. The hospital mortality rate was 16.5% in patients with acute empyema with fistula.
There were 98 operations for descending necrotizing mediastinitis (Table 22). The hospital mortality rate was 8.2%.
There were 416 operations for bullous diseases (Table 23). Lung volume reduction surgery was performed in only 21 patients.
The NCD showed 14,728 operations for spontaneous pneumothorax (Table 24). The 11,816 operations for primary pneumothorax comprised 3118 patients (26.4%) who underwent bullectomy only and 7805 patients (66.1%) who underwent an additional procedure. There were 2851 operations for secondary pneumothorax. COPD was by far the most prevalent associated disease (69.5%). The hospital mortality rate for secondary pneumothorax associated with COPD was 3.1%.
The 2015 survey reported 174 operations for chest wall deformity (Table 25). However, this might be an underestimate, because the Nuss procedure was more likely to have been performed in centers not associated with JATS.
Diaphragmatic hernia was treated surgically in 36 patients (Table 26). This figure might be an underestimate, as some procedures might have been classified as gastrointestinal surgery.
The survey reported 388 procedures for chest trauma excluding iatrogenic injuries (Table 27). The hospital mortality rate was 6.7%.
Table 28 shows operations for other diseases, including 82 cases of arteriovenous malformation and 90 cases of pulmonary sequestration.
A total of 63 lung transplantations were performed in 2015 (Table 29): 47 patients received lung transplants from brain-dead donors and 16 received transplants from living-related donors. The number of lung transplantation procedures has remained constant for several years.
The number of VATS procedures has increased annually, reaching 60,735 in 2015 (Table 30).
The details of tracheobronchoplasty, pediatric surgery, and combined resection of neighboring organs are shown in Tables 31, 32, 33 and 34.
Table31 12. Tracheobronchoplasty
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
12. Tracheobronchoplasty
703
9 (1.3)
5 (0.7)
21 (3.0)
Trachea
29
2 (6.9)
0
2 (6.9)
Sleeve resection with reconstruction
16
0
0
0
Wedge with simple closure
5
0
0
0
Wedge with patch closure
0
0
0
0
Total laryngectomy with tracheostomy
0
0
0
0
Others
8
2 (25.0)
0
2 (25.0)
Carinal reconstruction
33
0
1 (3.0)
0
Sleeve pneumonectomy
11
0
0
1 (9.1)
Sleeve lobectomy
536
5 (0.9)
2 (0.4)
13 (2.4)
Sleeve segmental excision
17
0
0
0
Bronchoplasty without lung resection
14
0
0
0
Others
63
2 (3.2)
2 (3.2)
5 (7.9)
( ) Mortality %
Table32 13. Pediatric surgery
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
13. Pediatric surgery
359
4 (1.1)
0
6 (1.7)
( ) Mortality %
Table33 14. Combined resection of neighboring organ(s)
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
14.Combined resection of neighboring organ(s)
1451
7 (0.5)
3 (0.2)
22 (1.5)
Organ resected
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
A. Primary lung cancer
Aorta
8
0
0
0
Superior vena cava
24
0
0
0
Brachiocephalic vein
17
1 (5.9)
0
1 (5.9)
Pericardium
127
1 (0.8)
2 (1.6)
8 (6.3)
Pulmonary artery
129
1 (0.8)
0
2 (1.6)
Left atrium
27
0
0
1 (3.7)
Diaphragm
71
0
0
1 (1.4)
Chest wall (including ribs)
360
3 (0.8)
1 (0.3)
8 (2.2)
Vertebra
11
0
0
1 (9.1)
Esophagus
6
0
0
0
Total
780
6 (0.8)
3 (0.4)
22 (2.8)
B. Mediastinal tumor
Aorta
3
0
0
0
Superior vena cava
72
0
0
1 (1.4)
Brachiocephalic vein
92
0
0
0
Pericardium
355
1 (0.3)
0
2 (0.6)
Pulmonary artery
2
0
0
0
Left atrium
0
0
0
0
Diaphragm
34
0
0
0
Chest wall (including ribs)
7
0
0
0
Vertebra
3
0
0
0
Esophagus
5
0
0
0
Lung
530
1 (0.2)
0
2 (0.4)
Total
1103
2 (0.2)
0
5 (0.5)
( ) Mortality %
Table34 15. Operation of lung cancer invading the chest wall of the apex
Cases
30-day mortality
Hospital mortality
Hospital
After discharge
15.Operation of lung cancer invading the chest wall of the apex
741
2 (0.3)
4 (0.5)
7 (0.9)
( ) Mortality %
Includes tumors invading the anterior apical chest wall and posterior apical chest wall (superior sulcus tumor, so-called Pancoast type)
(C) Esophageal surgery
During 2015 alone, a total of 12,732 patients with esophageal diseases were registered from 571 institutions (response rate: 93.6%) affiliated to the Japanese Association for Thoracic Surgery and/or to the Japan Esophageal Society. Among these institutions, those where 20 or more patients underwent esophageal surgeries within the year of 2015 were 136 institutions (23.8%), which shows no definite shift of esophageal operations to high-volume institutions when compared to the data of 2014 (22.1%) (Table 35). Of 2991 patients with a benign esophageal disease, 1619 (54.1%) patients underwent surgery, and 77 (2.6%) patients underwent endoscopic resection, while 1295 (43.3%) patients did not undergo any surgical treatment (Table 36). Of 10,288 patients with a malignant esophageal tumor, 8106 (78.8%) patients underwent resection, esophagectomy for 6151 (59.8%) and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for 1955 (19.0%), while 2182 (21.2%) patients did not undergo any resection (Tables 37, 38). The patients registered, particularly those undergoing non-surgical therapy for a malignant esophageal disease, have been increasing since 1990 (Fig. 3).
Table35 Distribution of number of esophageal operations in 2015 in each institution
Annual trend of in-patients with esophageal diseases. EMR endoscopic mucosal resection (including endoscopic submucosal)
×
Among benign esophageal diseases (Table 36), hiatal hernia, esophageal varices, esophagitis (including reflux esophagitis) and achalasia were the most common conditions in Japan. On the other hand, spontaneous rupture of the esophagus, benign esophageal tumors and congenital esophageal atresia were common diseases which were surgically treated as well as the above-mentioned diseases. The thoracoscopic and/or laparoscopic procedures have been widely adopted for benign esophageal diseases, in particular achalasia, hiatal hernia and benign tumors. Open surgery was performed in 1072 (66.2%) patients with a benign esophageal disease, with 30-day mortality in 7 (0.7%), while thoracoscopic and/or laparoscopic surgery was performed for 547 (33.8%) patients, with none of the 30-day mortality. The difference in these death rates between open and scopic surgery seems to be related to the conditions requiring open surgery.
The majority of malignant diseases were carcinomas (Table 37). Among esophageal carcinomas, the incidence of squamous cell carcinoma was 90.1%, while that of adenocarcinomas including Barrett cancer was 7.2%. The resection rate for patients with a squamous cell carcinoma was 77.9%, while that for patients with an adenocarcinoma was 88.9%.
According to location, cancer in the thoracic esophagus was the most common (Table 38). Of the 4137 patients (40.2% of total esophageal malignancies) having superficial esophageal cancers within mucosal and submucosal layers, 6151 (59.8%) patients underwent esophagectomy, while 1955 (19.0%) patients underwent EMR or ESD. The 30-day mortality rate and hospital mortality rate after esophagectomy for patients with a superficial cancer were 0.5 and 1.7% (141/6151), respectively.
Multiple primary cancers were observed in 1816 (17.7%) of all the 10,288 patients with esophageal cancer. Synchronous cancer was found in 960 (9.3%) patients, while metachronous cancer was observed in 856 (8.3%) patients. The stomach is the commonest site for both synchronous and metachronous malignancy followed by head and neck cancer (Table 38).
Among esophagectomy procedures, transthoracic esophagectomy through right thoracotomy was the most commonly adopted for patients with a superficial cancer as well as for those with an advanced cancer (Table 39). Transhiatal esophagectomy commonly performed in Western countries was adopted in only 2.8% of patients having a superficial cancer who underwent esophagectomy and in 1.4% of those having an advanced cancer in Japan. The thoracoscopic and/or laparoscopic esophagectomy were adopted for 1036 patients (51.3%) with a superficial cancer, and for 1734 patients (42.0%) with an advanced cancer. The number of cases of thoracoscopic and/or laparoscopic surgery for superficial or advanced cancer has been increasing for these several years (Fig. 4).
(2) Transthoracic (rt.) esophagectomy and reconstruction
1709
7 (0.4)
12 (0.7)
27 (1.6)
1194
3 (0.3)
8 (0.7)
14 (1.2)
(3) Transthoracic (lt.) esophagectomy and reconstruction
27
0
0
0
3
0
0
0
(4) Cervical esophageal resection and reconstruction
31
1 (3.2)
1 (3.2)
2 (6.5)
15
0
1 (6.7)
1 (6.7)
(5) Two-stage operation
41
1 (2.4)
0
2 (4.9)
23
1 (4.3)
0
1 (4.3)
(6) Others
135
0
1 (0.7)
1 (0.7)
49
0
0
0
(7) Not specified
19
0
0
0
7
0
0
0
Advanced cancer (T2–T4)
Esophagectomy
4130
29 (0.7)
56 (1.4)
106 (2.6)
1734
12 (0.7)
25 (1.4)
42 (2.4)
3
(1) Transhiatal esophagectomy
57
1 (1.8)
1 (1.8)
3 (5.3)
12
0
0
0
(2) Transthoracic (rt.) esophagectomy and reconstruction
3500
26 (0.7)
46 (1.3)
85 (2.4)
1607
11 (0.7)
22 (1.4)
38 (2.4)
(3) Transthoracic (lt.) esophagectomy and reconstruction
105
0
0
1 (1.0)
12
0
0
0
(4) Cervical esophageal resection and reconstruction
137
0
3 (2.2)
8 (5.8)
23
0
2 (8.7)
2 (8.7)
(5) Two-stage operation
71
1 (1.4)
4 (5.6)
6 (8.5)
16
0
0
0
(6) Others/not specified
206
1 (0.5)
2 (1.0)
3 (1.5)
58
1 (1.7)
1 (1.7)
2 (3.4)
(7) Not specified
54
0
0
0
6
0
0
0
(Depth not specified)
2
0
1
1
0
0
0
0
0
Combined resection of other organs
351
7 (2.0)
4 (1.1)
15 (4.3)
(1) Aorta
3
0
0
0
(2) Trachea, bronchus
15
0
0
0
(3) Lung
67
3 (4.5)
0
4 (6.0)
(4) Others
266
4 (1.5)
4 (1.5)
11 (4.1)
Unknown
0
0
0
0
Salvage surgery
264
4 (1.5)
11 (4.2)
21 (8.0)
58
1 (1.7)
1 (1.7)
3 (5.2)
29
Fig. 4
Annual trend of video-assisted esophagectomy for esophageal malignancy
×
Combined resection of the neighboring organs during resection of an esophageal cancer was performed in 351 patients (Tables 39, 40). Resection of the aorta together with esophagectomy was performed in three cases. Tracheal and/or bronchial resection combined with esophagectomy was performed in 15 patients, with the both of 30-day mortality rate and the hospital mortality rate at 0%. Lung resection combined with esophagectomy was performed in 67 patients, with the 30-day mortality rate at 4.5% and the hospital mortality rate at 6.0%.
Table40 Mortality after combined resection of the neighboring organs
Year
Esophagectomy
Combined resection
Aorta
Tracheobronchus
Lung
Others
a
b
c (%)
a
b
c (%)
a
b
c (%)
a
b
c (%)
a
b
c (%)
1996
4194
120
2.86
7
3
42.86
24
0
0.00
50
2
4.00
78
4
5.13
1997
4441
127
2.86
1
0
0.00
34
5
14.71
56
1
1.79
94
3
3.19
1998
4878
136
2.79
4
0
0.00
29
0
0.00
74
1
1.35
128
2
1.56
1999
5015
116
2.31
5
0
0.00
23
2
8.70
68
0
0.00
122
1
0.82
2000
5350
81
1.51
2
0
0.00
23
2
8.70
69
0
0.00
96
1
1.04
2001
5521
110
1.99
1
0
0.00
26
1
3.85
83
3
3.61
99
2
2.02
2002
4904
66
1.35
3
1
33.33
20
2
10.00
63
0
0.00
63
1
1.59
2003
4639
45
0.97
0
0
0.00
24
2
8.33
58
0
0.00
88
1
1.14
2004
4739
64
1.35
2
0
0.00
17
0
0.00
59
5
8.47
119
2
1.68
2005
5163
52
1.01
1
0
0.00
11
1
9.09
67
1
1.49
73
1
1.37
2006
5236
63
1.20
0
0
0.00
17
0
0.00
62
2
3.23
122
3
2.46
2007
4990
60
1.20
0
0
0.00
25
1
4.00
44
1
2.27
138
2
1.45
2008
5124
63
1.23
0
0
0.00
17
1
5.88
48
1
2.08
185
0
0.00
2009
5260
63
1.20
0
0
0.00
19
2
10.53
58
2
3.45
211
3
1.42
2010
5180
45
0.87
2
0
0.00
33
0
0.00
58
0
0.00
245
5
2.04
2011
5430
38
0.70
4
0
0.00
26
0
0.00
41
0
0.00
179
5
2.79
2012
6055
47
0.78
2
0
0.00
23
1
4.35
69
0
0.00
240
1
0.42
2013
5824
41
0.70
2
0
0.00
44
0
0.00
77
1
1.30
156
3
1.92
2014
6244
47
0.75
2
0
0.00
24
0
0.00
77
3
3.90
227
3
1.32
2015
6151
39
0.63
3
0
0.00
15
0
0.00
67
3
4.48
266
4
1.50
Total
1,04,338
1423
1.36
41
4
9.76
273
20
7.33
1248
26
2.08
2929
47
1.60
a Number of patients who underwent the operation
b Number of patients died within 30 days after operation
c % ratio of b/a, i.e., direct operative mortality
Salvage surgery after definitive (chemo-)radiotherapy was performed in 264 patients, with the 30-day mortality rate at 1.5% and with the hospital mortality rate at 8.0% (Table 39).
Lastly, in spite of the efforts of the Committee to cover wider patient populations to this annual survey, the majority of the institutions which responded to the questionnaire were the departments of thoracic or esophageal surgery. It should be noted that larger number of patients with esophageal diseases should have been treated medically and endoscopically. We should continue our effort for complete survey through more active collaboration with the Japan Esophageal Society and other related societies.
Acknowledgements
On behalf of The Japanese Association for Thoracic Surgery, the authors thank the Heads of the Affiliate and Satellite Institutes of Thoracic Surgery for their cooperation, and the Councilors of the Japan Esophageal Society.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Mit der Zeitschrift Die Chirurgie erhalten Sie zusätzlich Online-Zugriff auf weitere 43 chirurgische Fachzeitschriften, CME-Fortbildungen, Webinare, Vorbereitungskursen zur Facharztprüfung und die digitale Enzyklopädie e.Medpedia.
Bis 30. April 2024 bestellen und im ersten Jahr nur 199 € zahlen!
In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.
Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.
Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.
Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.
Update Chirurgie
Bestellen Sie unseren Fach-Newsletterund bleiben Sie gut informiert.
Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.
Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.
