山本 博之 (ヤマモト ヒロユキ)

Yamamoto, Hiroyuki

写真a

所属(所属キャンパス)

医学部 医療政策・管理学教室 (信濃町)

職名

専任講師(有期)

HP

 

研究分野 【 表示 / 非表示

  • 疫学・予防医学 (臨床疫学)

  • 生命・健康・医療情報学

  • 病院・医療管理学

  • 腎臓内科学

 

論文 【 表示 / 非表示

  • Certified thoracic surgeons in Japan: a national database survey on risk-adjusted mortality associated with lung resection

    Miyazaki T., Fukuchi E., Yamamoto H., Miyata H., Tanaka F., Okada M., Suzuki K., Yoshino I., Endo S., Sato Y., Chida M., Nagayasu T.

    Surgery Today (Surgery Today)  2021年

    研究論文(学術雑誌), 共著, 査読無し,  ISSN  09411291

     概要を見る

    © 2021, Springer Nature Singapore Pte Ltd. Purpose: We investigated the association between the number of certified general thoracic surgeons (GTSs) and the mortality after lung cancer surgery, based on the data from the National Clinical Database (NCD). Methods: We analyzed the characteristics and operative and postoperative data of 120,946 patients who underwent lung cancer surgery in one of the 905 hospitals in Japan. The number of GTSs in each hospital was categorized as 0, 1–2, or 3 or more. Multivariable analysis was applied to adjust the patients’ preoperative risk factors, as identified in a previous study. We calculated 95% confidence intervals (CI) for the mortality rate based on the odds ratios (ORs). Results: The patients’ characteristics were distributed almost uniformly regardless of the number of GTSs. Crude mortality according to the number of GTSs of 0, 1–2, or 3 or more was 0.9%, 0.8%, and 0.7%, respectively (p = 0.03). However, after adjustment, the ORs for 1–2 and 3 or more GTSs (reference: 0) were 0.86 (p = 0.23, 95% CI: 0.67–1.10) and 0.84 (p = 0.18, 95% CI: 0.64–1.09), respectively. The number of GTSs did not have a significant association with mortality. Similar results were observed for patients in the lobectomy cohort. Conclusion: Low surgical mortality was consistent, regardless of the number of GTSs in each hospital.

  • Incidence of adverse cardiovascular events in type 2 diabetes mellitus patients after initiation of the glucose‐lowering agents: A population‐based community study from the Shizuoka Kokuho Database

    Shun Kohsaka, Hiraku Kumamaru, Shiori Nishimura, Satoshi Shoji, Eiji Nakatani, Nao Ichihara, Hiroyuki Yamamoto, Yoshiki Miyachi, Hiroaki Miyata

    Journal of Diabetes Investigation (Wiley)  2020年12月

    研究論文(学術雑誌), 共著, 査読無し,  ISSN  2040-1116

     概要を見る

    © 2020 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd Aims/Introduction: Increased incidence of hospitalization for heart failure (HHF) among patients with diabetes is increasingly being reported. We investigated the incidence of adverse cardiovascular events including HHF among patients with type 2 diabetes mellitus, and the potential clinical improvement with sodium–glucose cotransporter 2 inhibitors (SGLT2i) using a contemporary administrative claims database from a large governmental district of Japan. Materials and Methods: We included initiators of any oral glucose-lowering drugs between 2013 and 2018. We estimated the 5-year cumulative incidence of hospitalization for HF, myocardial infarction and stroke, treating death as a competing risk. We evaluated the possible impact of introducing SGLT2i to the potential recipients of the drug, using the inclusion criteria from Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) and Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE-TIMI 58) trials, assuming the same risk reduction as theirs. Results: Among 23,340 drug initiators (54.0% men, and 6.4% aged >85 years), the 5-year cumulative incidence was 5.4% (95% confidence interval 4.9–5.9%) for HHF, 1.9% (95% confidence interval 1.7–2.2%) for myocardial infarction admission and 6.1% (95% confidence interval 5.7–6.6%) for stroke admission. Among 6,192 patients with laboratory test data, 651 (10.5%) and 2,680 (43.3%) patients met the EMPA-REG-like and DECLARE-like criteria, respectively. The 5-year cumulative incidence among the 2,849 patients meeting either of the criteria was estimated to decrease from 97.1 to 75.6 events through 75% adoption of SGLT2i. Conclusions: The incidence of HHF was similar to that of stroke. A significant portion of our cohort met the inclusion criteria for major randomized clinical trials for SGLT2i, and estimated reduction in the HHF events was substantial.

  • Effect of hospital and surgeon procedure volumes on the incidence of intraoperative conversion during off-pump coronary artery bypass grafting.

    Chikara Ueki, Hiroyuki Yamamoto, Noboru Motomura, Hiroaki Miyata, Ryuzo Sakata, Hiroshi Tsuneyoshi

    Seminars in thoracic and cardiovascular surgery (Seminars in Thoracic and Cardiovascular Surgery)  2020年11月

    研究論文(学術雑誌), 共著, 査読無し,  ISSN  10430679

     概要を見る

    Intraoperative conversion to cardiopulmonary bypass with its subsequent high mortality is a major concern associated with off-pump coronary artery bypass grafting (OPCAB). The impact of procedure volume on the incidence of intraoperative conversion, however, is poorly defined. This study therefore evaluated the effect of procedure volume on the incidence of conversion in OPCAB using nationwide data. We analyzed 31,361 patients who underwent primary, non-emergent, isolated OPCAB during 2013-2016 reported in the Japan Cardiovascular Surgery Database. Hospitals (n=548) and surgeons (n=1315) were divided into tertile categories (low, medium, high volumes) based on the total number of isolated coronary artery bypass grafting (CABG). Hierarchical logistic regression analysis, including 22 preoperative factors and hospital and surgeon CABG volumes, was used to assess the relation between procedure volume and the risk of conversion due to bleeding/hemodynamic instability. There were 797 (2.5%) intraoperative conversions due to bleeding/hemodynamic instability. Risk-adjusted odds ratios (ORs) for conversion were significantly lower in some combined hospital/surgeon CABG volume categories than in the reference category. Hospital/surgeon volumes and their OR (95% confidence interval) were as follows: low/low 1.00 (reference); medium/low 0.62 (0.39-0.96); high/low 0.47 (0.27-0.81); high/high 0.58 (0.38-0.89). There was a lower risk of conversion in medium- and high-volume than low-volume hospitals, especially among low-volume surgeons. Procedure volume is associated with the incidence of conversion during OPCAB. Among low-volume surgeons, hospital CABG volume significantly reduces conversion in a volume-dependent manner. These findings will be useful for safety training of OPCAB surgeons.

  • Association between Preoperative HbA1c Levels and Complications after Esophagectomy: Analysis of 15 801 Esophagectomies from the National Clinical Database in Japan.

    Akihiko Okamura, Hiroyuki Yamamoto, Masayuki Watanabe, Hiroaki Miyata, Shingo Kanaji, Kinji Kamiya, Yoshihiro Kakeji, Yuichiro Doki, Yuko Kitagawa

    Annals of surgery 2020年11月

    研究論文(学術雑誌), 共著, 査読無し

     概要を見る

    OBJECTIVE: To elucidate the association between preoperative hemoglobin A1c (HbA1c) levels and short-term outcomes after oncologic esophagectomy. SUMMARY BACKGROUND DATA: Although diabetes mellitus (DM) is associated with an increased risk of postoperative morbidity in several types of surgery, the association of DM with short-term outcomes after esophagectomy has shown conflicting results. METHODS: We analyzed 15801 patients who underwent oncologic esophagectomy between 2015 and 2017 from the National Clinical Database. We evaluated the associations between preoperative HbA1c levels and short-term outcomes, using multivariable logistic regression and restricted cubic spline models. RESULTS: The cohort included 12074, 1361, 1097, 909, and 360 patients with HbA1c levels of ≤5.9%, 6.0%-6.4%, 6.5%-6.9%, 7.0%-7.9%, and ≥8.0%, respectively. There were value-dependent associations between HbA1c values and odds ratios (ORs) for anastomotic leakage (AL), surgical site infections (SSIs), pneumonia, and composite outcomes. Compared with the HbA1c category of ≤5.9%, the categories of 7.0%-7.9% and ≥8.0% were at higher risk for AL (P <0.001 and 0.031, respectively), the category of ≥8.0% was at higher risk for SSIs (P = 0.001), the categories of 6.5%-6.9% and 7.0%-7.9% were at higher risk for pneumonia (P = 0.016 and 0.002, respectively), and the categories of 7.0-7.9 and ≥ 8.0% were at higher risk for composite outcomes (P < 0.001 and 0.001, respectively). CONCLUSIONS: Preoperative HbA1c levels are associated with the risk of postoperative complications following esophagectomy, and the threshold values differed among the outcomes. Preoperative HbA1c is useful in predicting the risk of postoperative complications.

  • Thoracic and cardiovascular surgeries in Japan during 2018 : Annual report by the Japanese Association for Thoracic Surgery.

    Hideyuki Shimizu, Morihito Okada, Yasushi Toh, Yuichiro Doki, Shunsuke Endo, Hirotsugu Fukuda, Yasutaka Hirata, Hisashi Iwata, Junjiro Kobayashi, Hiraku Kumamaru, Hiroaki Miyata, Noboru Motomura, Shoji Natsugoe, Soji Ozawa, Yoshikatsu Saiki, Aya Saito, Hisashi Saji, Yukio Sato, Tsuyoshi Taketani, Kazuo Tanemoto, Akira Tangoku, Wataru Tatsuishi, Hiroyuki Tsukihara, Masayuki Watanabe, Hiroyuki Yamamoto, Kenji Minatoya, Kohei Yokoi, Yutaka Okita, Masanori Tsuchida, Yoshiki Sawa

    General thoracic and cardiovascular surgery (General Thoracic and Cardiovascular Surgery)  69 ( 1 ) 179 - 212 2020年10月

    研究論文(学術雑誌), 共著, 査読無し,  ISSN  1863-6705

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KOARA(リポジトリ)収録論文等 【 表示 / 非表示

総説・解説等 【 表示 / 非表示

  • NCD24,233例を用いた、術前治療が胸腔鏡下食道切除術の短期成績に与える影響の研究結果とその課題

    吉田 直矢, 山本 博之, 宮田 裕章, 馬場 祥史, 長井 洋平, 馬場 秀夫

    日本外科学会定期学術集会抄録集 ((一社)日本外科学会)  119回   SF - 072 2019年04月

    その他記事, 共著

  • National Clinical Databaseにおけるデータの質検証結果報告(2014-2015年症例)

    高橋 新, 福地 絵梨子, 隈丸 拓, 一原 直昭, 山本 博之, 平原 憲道, 宮田 裕章

    日本医師事務作業補助研究会全国大会集録 ((NPO)日本医師事務作業補助研究会)  7回   50 - 50 2017年11月

    その他記事, 共著,  ISSN  2187-7939

  • National Clinical Database(NCD)自施設データ活用におけるダウンロードデータの特徴と注意点

    高橋 新, 福地 絵梨子, 隈丸 拓, 一原 直昭, 山本 博之, 平原 憲道, 宮田 裕章

    診療情報管理 (日本診療情報管理学会)  29 ( 2 ) 207 - 207 2017年08月

    その他記事, 共著,  ISSN  1883-7972

競争的資金等の研究課題 【 表示 / 非表示

  • 大規模データベースを用いた慢性腎臓病・透析症例の周術期リスクと管理戦略の検討

    2019年04月
    -
    2021年03月

    文部科学省・日本学術振興会, 科学研究費助成事業, 山本 博之, 若手研究, 補助金,  代表