ArticleSurgery today2021
Estimates of the effects of centralization policy for surgery in Japan: does centralization affect the quality of healthcare for esophagectomies?
Article in Surgery today, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effect of Anastomotic Leak on Long-Term Survival After Esophagectomy: Multivariate Meta-analysis and Restricted Mean Survival Times Examination.Annals of surgical oncology · 2023Pooled it
- Unveiling the Chasm in Japanese robot-assisted surgery diffusion: the interplay of surgical volume and intra-specialty spillover.Journal of robotic surgery · 2026Article
- Inter-institutional heterogeneity in high-volume esophageal cancer centers: an ancillary study of JCOG1109 (JCOG2308A).Esophagus : official journal of the Japan Esophageal Society · 2026Article
- Regional and patient characteristic disparities in the outcomes of minimally invasive surgery for colorectal cancer in Japan.Annals of gastroenterological surgery · 2025Article
- Association between the COVID-19 pandemic and short-term outcomes after esophagectomy for esophageal cancer in facilities with and without board-certified esophageal surgeons: a nationwide retrospective cohort study.Esophagus : official journal of the Japan Esophageal Society · 2025Article
- Outcome research on esophagectomy analyzed using nationwide databases in Japan: evidences generated from real-world data.Esophagus : official journal of the Japan Esophageal Society · 2024Review
- Requirements for hospitals in Japan to have low operative mortality and failure-to-rescue rates.Annals of gastroenterological surgery · 2024Article
- Analysis of the short-term outcomes after esophagectomy for esophageal cancer during the COVID-19 pandemic using data from a nationwide Japanese database.Esophagus : official journal of the Japan Esophageal Society · 2023Article
Corrections and comments
- Erratum issued
Authors and funding
7 authors.
Funding
Abstract
purposeThis study compared the quality of healthcare before and after implementation of a policy restructuring the healthcare delivery system and estimated the impact of centralization.
methodsWe used the National Clinical Database to study patients undergoing esophagectomies from 2011 to 2016. We compared the effect of centralization based on the patient background, surgical mortality, and year of surgery. Difference-in-difference methods based on the generalized estimating equation logistic regression model were used for before-and-after comparisons after adjusting for patient-level expected surgical mortality.
resultsIn total, 34,640 cases were identified. More cases with risk factors were noted in ultra-low-volume hospitals, where 38.4% of cases in underpopulated areas were treated, than in higher volume facilities, and the operative mortality, readmission within 30 days and length of stay were worse among patients treated in these hospitals. In centralized prefectures, the number of cases per hospital increased over time (7.2 in 2011 to 9.5 in 2016) while the crude operative mortality tended to decrease (3.4% in 2011 to 1.8% in 2016). The difference-in-difference estimator was 0.856 (95% confidence interval: 0.639-1.147, p = 0.298).
conclusionThe centralization of ultra-low-volume hospitals did not lead to a deterioration in the quality of care but rather an improving trend.
Indexed as
Identifiers
33660105What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.