General Thoracic and Cardiovascular Surgery https://doi.org/10.1007/s11748-020-01298-2 ANNUAL REPORT Thoracic and cardiovascular surgeries in Japan during 2017 Annual report by the Japanese Association for Thoracic Surgery Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery1 · Hideyuki Shimizu2 · Morihito Okada3 · Akira Tangoku4 · Yuichiro Doki5 · Shunsuke Endo6 · Hirotsugu Fukuda7 · Yasutaka Hirata8 · Hisashi Iwata9 · Junjiro Kobayashi10 · Hiraku Kumamaru11 · Hiroaki Miyata12 · Noboru Motomura13 · Shoji Natsugoe14 · Soji Ozawa15 · Yoshikatsu Saiki16 · Aya Saito13 · Hisashi Saji17 · Yukio Sato18 · Tsuyoshi Taketani19 · Kazuo Tanemoto20 · Wataru Tatsuishi21 · Yasushi Toh22 · Hiroyuki Tsukihara8 · Masayuki Watanabe23 · Hiroyuki Yamamoto12 · Kohei Yokoi24 · Yutaka Okita25 © The Author(s) 2020 The Japanese Association for Thoracic Surgery has con- defined as death within any time interval following surgery ducted annual surveys of thoracic surgery throughout Japan if the patient has not been discharged from hospital. since 1986 to determine statistics pertaining to the number Hospital-to-hospital transfer in the category of esopha- of procedures performed, based on surgical category. geal surgery is not considered a form of discharge; transfer Herein, we summarize the results of the association’s to a nursing home or a rehabilitation unit is considered annual survey of thoracic surgery performed in 2017. hospital discharge, unless the patient subsequently dies Adhering to the norm to date, thoracic surgery was because of complications from surgery. Contrastingly, classified into three categories: cardiovascular, general hospital-to-hospital transfer 30 days following surgery in thoracic, and esophageal surgeries. Patient data were the categories of cardiovascular and general thoracic sur- examined and analyzed for each group. Access to com- gery is considered discharge, as data related to the National puterized data is available to all members of the associa- Clinical Database (NCD 2017) were employed in this tion. We honor and value all members’ continued category, and hospital-to-hospital transfer 30 days follow- professional support and contributions (Tables 1, 2). ing surgery is considered discharge according to the NCD. Incidence of hospital mortality was included in the survey to determine nationwide status, which has con- Survey abstract tributed to Japanese surgeons’ understanding of the present status of thoracic surgery in Japan, while helping to effect All data pertaining to cardiovascular and thoracic surgeries were progress for improving operative results by enabling them obtained from the NCD, whereas data regarding esophageal to compare their work with that of others. In this way, the surgery were collected from a survey questionnaire derived association has been able to gain a better understanding of from the Japanese Association for Thoracic Surgery documen- present problems and future prospects, which is reflected in tation. The reason for this was that NCD information regarding its activities and the education of its members. esophageal surgery does not include non-surgical cases (i.e., Thirty-day mortality (so-called operative mortality)is patients with adjuvant chemotherapy or radiation only). defined as death within 30 days of surgery, regardless of Because of changes in data collection related to car- the patient’s geographic location, including after the diovascular surgery (initially self-reported using question- patient is discharged from hospital. Hospital mortality is naire sheets in each participating institution up to 2014, then by downloading an automatic package from the Japanese Cardiovascular Surgery Database (JCVSD), a Morihito Okada and Akira Tangoku have equally contributed to this cardiovascular sub-section of the NCD), the response rate work. is not available and is, therefore, not indicated in the car- & Hideyuki Shimizu diovascular surgery category (Table 1). Additionally, the [email protected] number of institutions (based on surgery count) was not Extended author information available on the last page of the article calculated in the cardiovascular surgery category (Table 2). 123 General Thoracic and Cardiovascular Surgery Table 1 Number of institutions involved in the survey Final report: 2017 Questionnaires (A) Cardiovascular surgery Sent out Responded Response rate (%) (A) Cardiovascular surgery –– – We are extremely pleased with the cooperation of our (B) General thoracic surgery 740 678 91.6 colleagues (members) in terms of completing the cardio- (C) Esophageal surgery 568 523 92.1 vascular surgery survey, thereby undoubtedly improving the quality of this annual report. We are truly grateful for the significant efforts made by all within each participating Table 2 Categories subclassified according to the number of opera- institution in completing the JCVSD/NCD. tions performed Figure 1 illustrates the development of cardiovascular sur- Category gery in Japan over the past 30 years. Aneurysm surgery Number of operations performed General thoracic surgery includes only surgeries for thoracic and thoracoabdominal 06aortic aneurysms. Extra-anatomic bypass surgery for thoracic 1–24 28 aneurysm and pacemaker implantation has been excluded from 25–49 72 the survey since 2015. The number of assist device implanta- 50–99 167 tion surgeries is not included in the total number of surgical 100–149 129 procedures but was nonetheless included in the survey. 150–199 100 A total of 70,078 cardiovascular surgeries including 56 heart transplants were performed in 2017, an increase of ≥200 176 3.3% compared with that in the 2016 survey results (n= Total 678 67,867). The number of cardiovascular surgeries is con- Number of operations performed Esophageal surgery tinuously increasing, despite an apparent decrease in 2015, 076likely due to major changes in data collection and aggre- 1–4 114 gation approaches. 5–9 96 When compared with data for 2016 [1] and 2007 [2], the 10–19 98 number of surgeries in 2017 for congenital heart disease 20–29 47 increased by 7.1% (9368 vs. 8744) and 0.2%, respectively; 30–39 26 procedures for valvular heart disease increased by 0.2% 40–49 21 (23,312 vs. 23,254) and 53.2%, respectively; surgery for ≥50 45 thoracic aortic aneurysm increased by 8.7% (20,746 vs. Total 523 19,078) and 114.6%, respectively; ischemic heart proce- dures decreased by 6.6% (13,898 vs. 14,874) and 23.6%, Cardiovascular Surgery 80000 70000 60000 50000 Other 40000 Aneurysm IHD 30000 Number of Number of cases Valve 20000 Congenital 10000 0 2012 2013 2014 2015 1992 1993 1994 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 1986 1987 1988 1989 1990 1991 1996 1997 1998 1999 2016 2017 Calendar Year Fig. 1 Cardiovascular surgery. IHD ischemic heart disease 123 General Thoracic and Cardiovascular Surgery Table 3 Congenital (total; 9368) (1) CPB (?) (total; 7072) Neonate Infant 1–17 years ≥ 18 years Total Cases 30-Day mortality Hospital Cases 30-Day mortality Hospital Cases 30-Day mortality Hospital Cases 30-Day mortality Hospital Cases 30-Day mortality Hospital mortality mortality mortality mortality mortality Hospital After Hospital After Hospital After Hospital After Hospital After discharge discharge discharge discharge discharge PDA 10 0 0 40 0 0 00 0 0 140 0 0 190 0 0 Coarctation 7 0 0 0 11 0 0 0 13 0 0 0 4 0 0 0 35 0 0 0 (simple) ?VSD 49 0 0 1 (2.0) 51 2 (3.9) 0 3 (5.9) 13 0 0 0 0 0 0 0 113 2 (1.8) 0 4 (3.5) ?DORV 2 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 ?AVSD 2 0 0 1 (50.0) 3 0 0 0 1 0 0 0 0 0 0 0 6 0 0 1 (16.7) ?TGA 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 ?SV 20 0 0 00 0 0 10 0 0 00 0 0 30 0 0 ?Others 5 0 0 0 7 0 0 0 8 0 0 0 2 0 0 0 22 0 0 0 Interrupt. of 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 Ao (simple) ?VSD 27 0 0 1 (3.7) 23 0 0 1 (4.3) 12 0 0 0 0 0 0 0 62 0 0 2 (3.2) ?DORV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ?Truncus 4 0 0 0 2 0 0 0 5 0 0 0 0 0 0 0 11 0 0 0 ?TGA 00 0 0 00 0 0 00 0 0 00 0 0 00 0 0 ?Others 1 0 0 0 2 0 0 0 2 0 0 0 0 0 0 0 5 0 0 0 Vascular ring 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 PS 5 0 0 0 25 0 0 0 77 1 (1.3) 0 1 (1.3) 26 0 0 0 133 1 (0.8) 0 1 (0.8) PA・IVS or 15 1 (6.7) 0 1 (6.7) 66 0 0 2 (3.0) 48 0 0 1 (2.1) 2 0 0 0 131 1 (0.8) 0 4 (3.1) critical PS TAPVR 112 6 (5.4) 0 9 (8.0) 59 1 (1.7) 0 3 (5.1) 17 0 0 1 (5.9) 1 0 0 0 189 7 (3.7) 0 13 (6.9) PAPVR ± ASD 0 0 0 0 5 0 0 0 38 0 0 0 22 0 0 0 65 0 0 0 ASD 1 0 0 0 73 0 0 0 583 0 0 0 761 7 (0.9) 0 7 (0.9) 1418 7 (3.7) 0 7 (0.5) Cor triatriatum 1 0 0 0 8 0 0 0 6 0 0 0 4 0 0 0 19 0 0 0 AVSD (partial) 1 0 0 0 7 0 0 1 (14.3) 42 0 0 0 6 0 0 0 56 0 0 1 (1.8) AVSD (complete) 8 0 0 0 117 3 (2.6) 0 4 (3.4) 94 2 (2.1) 0 2 (2.1) 3 0 0 0 222 5 (2.3) 0 6 (2.7) ?TOF or DORV 2 1 (50.0) 0 1 (50.0) 9 0 0 0 14 1 (7.1) 0 1 z(7.1) 0 0 0 0 25 2 (8.0) 0 2 (8.0) ?Others 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 VSD (subarterial) 3 0 0 0 106 0 0 0 142 0 0 0 14 0 0 0 265 0 0 0 VSD 17 0 0 0 729 1 (0.1) 0 1 (0.1) 325 0 0 1 (0.3) 21 0 0 0 1092 1 (0.1) 0 2 (0.2) (perimemb./ muscular) VSD (type unknown) 0 0 0 0 5 3 0 123 2 (1.6) 0 2 (1.6) 131 2 (1.5) 0 2 (1.5) 123 VSD ? PS 0 0 0 0 32 0 1 (3.1) 0 21 0 0 0 1 0 0 0 54 0 1 (1.9) 0 123 Table 3 continued Neonate Infant 1–17 years ≥ 18 years Total Cases 30-Day mortality Hospital Cases 30-Day mortality Hospital Cases 30-Day mortality Hospital Cases 30-Day mortality Hospital Cases 30-Day mortality Hospital mortality mortality mortality mortality mortality Hospital After Hospital After Hospital After Hospital After Hospital After discharge discharge discharge discharge discharge DCRV ±