Recombinant Human Soluble Thrombomodulin Contributes to a Reduction In-Hospital Mortality of Acute Cholangitis with Disseminated Intravascular Coagulation: A Propensity Score Analyses of a Japanese Nationwide Database

Tarasawa, Kunio; Fujimori, Kenji; Fushimi, Kiyohide

doi:10.1620/tjem.252.53

Cited by 11 publications

(14 citation statements)

References 25 publications

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“…This retrospective observational study used the inpatient data from Diagnosis Procedure Combination (DPC) database (Murata et al 2011;Murata et al 2012;Murata et al 2014;Tarasawa et al 2020). The DPC database includes discharge and administrative claims data for all inpatients discharged from more than 1,000 participating hospitals.…”

Section: Design and Data Sourcementioning

confidence: 99%

“…The DPC database includes discharge and administrative claims data for all inpatients discharged from more than 1,000 participating hospitals. It covers 92 % of all tertiary-care emergency hospitals in Japan A c c e p t e d M a n u s c r i p t (Murata et al 2012;Tarasawa et al 2020). This database is used widely in medical and health research (Fujimori et al 2021a;Fujimori et al 2021b;Tomioka et al 2019).…”

Section: Design and Data Sourcementioning

confidence: 99%

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Risk Factors with 30-Day Readmission and the Impact of Length of Hospital Stay on It in Patients with Heart Failure: A Retrospective Observational Study Using a Japanese National Database

Miyazaki

Tarasawa

Fushimi

et al. 2023

Tohoku J. Exp. Med.

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Heart failure is a major disease, and its 30-day readmission, readmission within 30-day after discharge, negatively impacts patients and society. Thus, we need to stratify the risk and prevent readmission. We aimed to investigate risk factors associated with 30day readmission and examine the impact of length of hospital stay (LOS) on 30-day readmission. Using the Diagnosis-Procedure-Combination database from April 2018 to March 2021, we conducted multiple logistic regression to investigate risk factors with 30day readmission. Also, we conducted subgroup analysis in the short LOS group. To examine the association between LOS and 30-day readmission, we performed propensity score matching between the short and middle LOS groups. As a result, we categorized 10,283 patients and 169,842 patients into the readmission group and the no-readmission group. We identified the following factors as the risk of readmission: short LOS, female, smoking, older age, lower body mass index, lower barthel index, artificial ventilator, betablockers, thiazides, tolvaptan, loop diuretics, carperitides, class Ⅲ antiarrhythmic agents, myocardial infarction, diabetes, renal disease, atrial fibrillation, dilated cardiomyopathy, and discharge to home. As a subgroup analysis in the short LOS group, we revealed that the short LOS group risk factors differed from overall. After propensity score matching in the short LOS group and middle LOS group, 37,199 pairs were matched, and we revealed that shorter LOS increases the risk of readmission. These results demonstrated that shortened LOS increases 30-day readmission, and risk factors are unique to each LOS.We suggest stratifying the readmission risk and being careful with early discharge.

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Section: Design and Data Sourcementioning

confidence: 99%

Section: Design and Data Sourcementioning

confidence: 99%

Risk Factors with 30-Day Readmission and the Impact of Length of Hospital Stay on It in Patients with Heart Failure: A Retrospective Observational Study Using a Japanese National Database

Miyazaki

Tarasawa

Fushimi

et al. 2023

Tohoku J. Exp. Med.

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“…Further, our study included a large patient population as compared with previous studies. Recently, Tarasawa et al 21 reported a propensity score analysis of rhTM use for acute cholangitis with DIC using a Japanese Nationwide Database. In their study, 2865 patients were divided into rhTM (n = 1636) and control groups (n = 1229).…”

Section: Discussionmentioning

confidence: 99%

Clinical impact of recombinant thrombomodulin administration on disseminated intravascular coagulation due to severe acute cholangitis (Recover‐AC study)

Ogura

Eguchi

Nakahara

et al. 2021

J Hepato Biliary Pancreat

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Background and Aim Recombinant thrombomodulin (rhTM) is potentially effective in the treatment of disseminated intravascular coagulation (DIC). Several studies related to drugs for the treatment of acute cholangitis have shown negative results in improvement of overall survival (OS) with rhTM. The aim of this multicenter study was to evaluate the clinical effectiveness of rhTM in patients with acute cholangitis and sepsis‐induced DIC who underwent biliary drainage. Methods A total of 284 consecutive patients, who were complicated with sepsis‐induced DIC due to severe acute cholangitis, were included (rhTM group, n = 173; non‐rhTM, n = 111) in this study. The primary outcome was the DIC resolution rate at 7 days after starting treatment. The 28‐day survival rate was secondarily evaluated. Results DIC scores in the rhTM group improved significantly compared with the non‐rhTM group on day 7 (P = .020). According to multivariate analysis, etiology of cholangitis (malignant, HR 2.28), rhTM (non‐administration, HR 4.13), and DIC score (≥5, HR 2.46) were significant factors associated with failed DIC resolution on day 7. Propensity score matching created 103 matched pairs. Survival rate at day 28 was significantly higher in rhTM group (94.3%) compared with non‐rhTM group (82.6%; P = .048) after propensity score matching. rhTM (non‐administration, HR 2.870), DIC score (≥5, HR 2.751), and APACHE II score (≥20, HR 9.310) were significant factors associated with decreasing survival rate at day 28. Conclusion In conclusion, rhTM seemed to improve patient survival, but future studies should only include patients with benign or malignant disease and should be performed according to APACHE II scores.

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“…In addition, analytical studies using this DPC data have been published from various perspectives. (Tarasawa et al 2020;Fujimori et al 2021a, Fujimori et al 2021bFujimori et al 2021c ;Noda et al 2021;Moroi et al 2022) On the other hand, the Japanese National Data Base (NDB) is also managed by the MHLW. NDB focused on the "Act on Securing Medical Care for the Elderly" that collects receipt information from insurers.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Effect of Postoperative Pain Management after Robot-Assisted Radical Prostatectomy: A Study on Reducing Hospital Length of Stay and Medical Costs Using Japanese Nationwide Database

Mizuta

Tarasawa

Fushimi

et al. 2023

Tohoku J. Exp. Med.

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Prostate cancer has a high incidence rate. Many articles reported its usefulness with the advent of robotic surgery in 2001. However, epidural analgesia is declining due to the spread of minimally invasive treatment. There have been no studies using nationwide databases on the impact of epidural analgesia use on length of hospital stay and medical costs. Therefore, we used a Japanese national inpatient database from April 2016 to March 2020. The study population included 46,166 patients. We compared a postoperative analgesia management group using epidural analgesia (EA Group: 5,354) and a group not using epidural analgesia (non-EA Group: 40,812). We found significant differences among the two groups regarding the length of stay, Days from Surgery to Discharge, and Inpatient cost of surgery to discharge. Hospital length of stay and postoperative hospital stay was statistically shorter in the EA group than in the non-EA group (11.3 ±2.8 days vs. 12.1 ± 3.1 days, p-value <0.001 and 8.9 ±2.5days vs. 9.3 ±2.7days, p-value <0.001) respectively, and medical costs were also significantly lower in the EA group (￥284,566 vs. ￥294,277, p-value <0.001). Also, the ADL assessment at discharge determined a considerably higher score in the EA group than in the non-EA groups. Epidural analgesia for postoperative pain management largely depends on each medical institution's treatment A c c e p t e d M a n u s c r i p t 4 policy. However, epidural analgesia is declining due to the spread of minimally invasive treatment. Therefore, epidural analgesia should be reconsidered because it can reduce hospital stays and hospitalization costs.

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Recombinant Human Soluble Thrombomodulin Contributes to a Reduction In-Hospital Mortality of Acute Cholangitis with Disseminated Intravascular Coagulation: A Propensity Score Analyses of a Japanese Nationwide Database

Cited by 11 publications

References 25 publications

Risk Factors with 30-Day Readmission and the Impact of Length of Hospital Stay on It in Patients with Heart Failure: A Retrospective Observational Study Using a Japanese National Database

Risk Factors with 30-Day Readmission and the Impact of Length of Hospital Stay on It in Patients with Heart Failure: A Retrospective Observational Study Using a Japanese National Database

Clinical impact of recombinant thrombomodulin administration on disseminated intravascular coagulation due to severe acute cholangitis (Recover‐AC study)

Effect of Postoperative Pain Management after Robot-Assisted Radical Prostatectomy: A Study on Reducing Hospital Length of Stay and Medical Costs Using Japanese Nationwide Database

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