National Clinical Database (NCD) in Japan for gastroenterological surgery: Brief introduction

Japan's National Clinical Database (NCD) is a large‐scale nationwide web‐based data entry system for surgical procedures that was established in 2010 with major support from the Japan Surgical Society (JSS), the Japanese Society of Gastroenterological Surgery (JSGS), and eight other professional surgical societies.

Data entry began in 2011 and has grown considerably in annual volume: data were collected on 1 172 579 surgical cases in the first year and on 1 717 186 cases in 2015. Coverage is estimated to be about 95% currently, as almost all surgical cases carried out in Japan are thought to be included in the NCD. Its successful growth is mainly as a result of the work of participating hospitals’ data managers who are responsible for forwarding their data to the NCD office through the Internet. Data sets are evaluated annually by the JSGS using a web‐based management system to assure data traceability and the results are published annually (in Japanese); this management system also validates data consistency through random inspections of participating hospitals. The number of participating hospitals is also increasing; as of 1 May 2017, the total has reached 4967.

The NCD collects valuable data about operations of various types. In the NCD's gastroenterological surgery section, data input is required on eight major procedures: esophagectomy, distal gastrectomy, total gastrectomy, right hemicolectomy, low anterior resection, hepatectomy, pancreaticoduodenectomy, and surgery to treat acute diffuse peritonitis. With the collaboration of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) established in the 1990s, Japan's NCD has striven to develop its own standardized surgical database for quality improvement. Table 1 shows year‐by‐year trends in the eight reportable procedures beginning in 2011. Operative mortality and morbidity risk models based on year 2011 NCD data for those procedures have already been developed and published. Mortality rates for the eight reportable procedures are at acceptably low levels.

Table 1.

Frequency of eight major gastroenterological surgery procedures in Japan (2011‐2015)

Procedure	2011	2012	2013	2014	2015
Esophagectomy	4916	5946	5694	6091	6058
Distal gastrectomy	34 160	38 750	39 957	38 584	37 822
Total gastrectomy	18 652	21 122	19 035	19 071	18 696
Right hemicolectomy	17 890	21 034	21 814	22 446	22 851
Low anterior resection	16 984	20 321	21 096	21 861	22 496
Hepatectomy	7434	8239	7937	7666	7439
Pancreaticoduodenectomy	8305	9329	10 068	10 400	10 577
Acute diffuse peritonitis surgery	7753	9177	10 447	12 085	13 030

The NCD's huge stock of data also provides important information about operations that has never before been available. Clinical studies using the NCD's data have published findings on such topics as: feedback implementation for quality improvement of cancer treatment;1 association between the participation of board‐certified surgeons and operative mortality;2 and the impact of hospital volume on risk‐adjusted mortality.3 Large‐scale surveys have also compared the effect of body mass index on surgical outcomes in gastroenterological and cardiovascular surgery.4

In summary, the NCD is a gateway to national‐level data on surgical outcomes in Japan and is a key to establishing future advances in gastroenterological surgery.

DISCLOSURE

Conflict of Interest: Authors declare no conflicts of interest for this article.