研究者総覧

笹渕 裕介 (ササブチ ユウスケ)

  • データサイエンスセンター 講師
Last Updated :2021/11/23

研究者情報

学位

  • 公衆衛生学修士(東京大学)

ホームページURL

J-Global ID

研究キーワード

  • 麻酔科学   集中治療   臨床疫学   

研究分野

  • ライフサイエンス / 医療管理学、医療系社会学

経歴

  • 2017年04月 - 現在  自治医科大学データサイエンスセンター講師
  • 2016年04月 - 2017年03月  東京大学ヘルスサービスリサーチ講座特任助教

学歴

  • 2013年04月 - 2015年03月   東京大学大学院   医学系研究科   公共健康医学専攻
  •         - 2003年03月   山梨医科大学   医学部   医学科

研究活動情報

論文

  • Masaaki Sakuraya, Takuo Yoshida, Yusuke Sasabuchi, Shodai Yoshihiro, Shigehiko Uchino
    BMC cardiovascular disorders 21 1 423 - 423 2021年09月 
    PURPOSE: This study sought to describe the epidemiology of anticoagulation therapy for critically ill patients with new-onset atrial fibrillation (NOAF) according to CHA2DS2-VASc and HAS-BLED scores and to assess the efficacy of early anticoagulation therapy. METHOD: Adult patients who developed NOAF during intensive care unit stay were included. We compared the patients who were treated with and without anticoagulation therapy within 48 h from AF onset. The primary outcome was a composite outcome that included mortality and ischemic stroke during the period until hospital discharge. RESULTS: In total, 308 patients were included in this analysis. Anticoagulants were administered to 95 and 33 patients within 48 h and after 48 h from NOAF onset, respectively. After grouping the patients into four according to their CHA2DS2-VASc and HAS-BLED bleeding scores, we found that the proportion of anticoagulation therapy administered was similar among all groups. After adjustment using a multivariable Cox regression model, we noted that early anticoagulation therapy did not decrease the composite outcome (adjusted hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.47‒1.23). However, in patients without rhythm control drugs, early anticoagulation was significantly associated with better outcomes (adjusted HR 0.46; 95% CI; 0.22‒0.87, P = 0.041). CONCLUSIONS: We found that clinical prediction scores were supposedly not used in the decision to implement anticoagulation therapy and that early anticoagulation therapy did not improve clinical outcomes in critically ill patients with NOAF. Trial registration UMIN-CTR UMIN000026401. Registered 5 March 2017.
  • Takashi Chinen, Yusuke Sasabuchi, Kazuhiko Kotani, Hironori Yamaguchi
    BMC family practice 22 1 162 - 162 2021年07月 
    BACKGROUND: Primary care physicians have diverse responsibilities. To collaborate with cancer specialists efficiently, they should prioritise roles desired by other collaborators rather than roles based on their own beliefs. No previous studies have reported the priority of roles such clinic-based general practitioners are expected to fulfil across the cancer care continuum. This study clarified the desired roles of clinic-based general practitioners to maximise person-centred cancer care. METHODS: A web-based multicentre questionnaire in Japan was distributed to physicians in 2019. Physician roles within the cancer care continuum were divided into 12 categories, including prevention, diagnosis, surgery, follow-up with cancer survivors, chemotherapy, and palliative care. Responses were evaluated by the proportion of three high-priority items to determine the expected roles of clinic-based general practitioners according to responding physicians in similarly designated roles. RESULTS: Seventy-eight departments (25% of those recruited) from 49 institutions returned questionnaires. Results revealed that some physicians had lower expectations for clinic-based general practitioners to diagnose cancer, and instead expected them to provide palliative care. However, some physicians expected clinic-based general practitioners to be involved in some treatment and survivorship care, though the clinic-based general practitioners did not report the same priority. CONCLUSION: Clinic-based general practitioners prioritised involvement in prevention, diagnoses, and palliative care across the cancer continuum, although lower expectations were placed on them than they thought. Some additional expectations of their involvement in cancer treatment and survivorship care were unanticipated by them. These gaps represent issues that should be addressed.
  • Kaito Nakamura, Hiroyuki Ohbe, Kei Ikeda, Kazuaki Uda, Hiroki Furuya, Shunsuke Furuta, Mikio Nakajima, Yusuke Sasabuchi, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga, Hiroshi Nakajima
    Seminars in arthritis and rheumatism 51 5 977 - 982 2021年07月 
    OBJECTIVES: We aimed to investigate the effect of intravenous cyclophosphamide (CYC) as the initial therapy in patients with acute exacerbation of rheumatoid arthritis-related interstitial lung disease. METHODS: This was a retrospective observational study. Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018, we identified patients with acute exacerbation of rheumatoid arthritis-related interstitial lung disease (RA-ILD) who received high-dose methylprednisolone within 3 days after admission. RA-ILD was defined as having either the diagnosis of RA-ILD or the diagnoses of both RA and ILD, based on the ICD-10 codes recorded by attending physicians. Patients were divided into two groups: those receiving intravenous CYC within 3 days after admission (CYC group) and those who did not (control group). One-to-four propensity-score matching analyses were performed. RESULTS: A total of 6130 eligible patients were included. After propensity score matching, 129 patients in the CYC group and 516 patients in the control group were further analyzed. 90-day in-hospital mortality, defined as all-cause mortality during hospitalization within 90 days after admission, was not significantly different between the CYC and control groups (50.4% versus 42.2%, hazard ratio 1.20, 95% confidence interval 0.91-1.58). A larger proportion of patients in the CYC group received platelet transfusion than that in the control group (7.0% versus 2.3%, odds ratio 3.05, 95% confidence interval 1.20-7.73). CONCLUSION: In this retrospective database study, the initial therapy with CYC did not show a survival benefit in patients with acute exacerbation of RA-ILD. CYC was associated with a larger proportion of platelet transfusion.
  • Takeshi Kitamura, Mikio Nakajima, Iwanari Kawamura, Richard H Kaszynski, Hiroyuki Ohbe, Yusuke Sasabuchi, Hiroki Matsui, Kiyohide Fushimi, Seiji Fukamizu, Hideo Yasunaga
    Heart and vessels 36 7 1009 - 1015 2021年07月 
    Intracardiac echocardiography (ICE) utilized in conjunction with three-dimensional (3-D) mapping systems could enhance ventricular tachycardia (VT) ablation procedures. ICE has been increasingly used in VT ablation; however, the safety and effectiveness of VT ablation under the combined use of ICE remains unclear. The present study aimed to analyze the safety and short-term effects of VT ablation with or without ICE. We retrospectively enrolled patients who underwent initial VT ablation with a combination of ICE and a 3-D mapping system within 3 days of hospitalization and discharged from April 2011 to March 2017 using a nationwide Japanese inpatient database. Following enrollment, we conducted a propensity score-matching analysis to compare safety (in-hospital complications) and effectiveness (readmission within 30 days after discharge due to cardiovascular disease and readmissions within 30 days for repeat VT ablations) between patients who underwent VT ablation with (ICE group) and without ICE (non-ICE group). 3-D mapping systems were applied to both groups. We identified 5,804 eligible patients (1,272 and 4,532 patients in the ICE and non-ICE groups, respectively). One-to-one propensity score matching created a total of 1,147 pairs between the ICE and non-ICE groups. The ICE group showed a significantly lower prevalence of cardiac tamponade than the non-ICE group. There were no significant differences observed between the two groups regarding other outcomes concerning safety and effectiveness. Ventricular tachycardia ablation with ICE used in combination with a 3-D mapping system may reduce cardiac tamponade; however, no additional clinical advantages were noted in terms of safety and effectiveness.
  • Hiroyuki Ohbe, Yusuke Sasabuchi, Ryosuke Kumazawa, Hiroki Matsui, Hideo Yasunaga
    Journal of epidemiology 2021年04月 
    BACKGROUND: Detailed data on intensive care unit (ICU) occupancy in Japan are lacking. Using a nationwide inpatient database in Japan, we aimed to assess ICU bed occupancy to guide critical care utilization planning. METHODS: We identified all ICU patients admitted from January 1, 2015 to December 31, 2018 to ICU-equipped hospitals participating in the Japanese Diagnosis Procedure Combination inpatient database. We assessed the trends in daily occupancy by counting the total number of occupied ICU beds on a given day divided by the total number of licensed ICU beds in the participating hospitals. We also assessed ICU occupancy for patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies. RESULTS: Over the 4 study years, 1,379,618 ICU patients were admitted to 495 hospitals equipped with 5,341 ICU beds, accounting for 75% of all ICU beds in Japan. Mean ICU occupancy on any given day was 60%, with a range of 45.0% to 72.5%. Mean ICU occupancy did not change over the 4 years. Mean ICU occupancy was about 9% higher on weekdays than on weekends and about 5% higher in the coldest season than in the warmest season. For patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies, mean ICU occupancy was 24%, 0.5%, and 30%, respectively. CONCLUSION: Only one-fourth of ICU beds were occupied by mechanically ventilated patients, suggesting that the critical care system in Japan has substantial surge capacity under normal temporal variation to care for critically ill patients.
  • Takuo Yoshida, Shigehiko Uchino, Yusuke Sasabuchi, Michihito Kyo, Takashi Igarashi, Haruka Inoue
    International journal of cardiology. Heart & vasculature 33 100742 - 100742 2021年04月 
    Background: Sustained new-onset atrial fibrillation (AF) in the intensive care unit has been reported to be associated with poor outcomes. However, in critical illness, whether rhythm-control therapy can achieve sinus rhythm (SR) restoration is unknown. This study aimed to assess the impact of rhythm-control therapy on SR restoration for new-onset AF in critically ill patients. Methods: This post-hoc analysis of a prospective multicenter observational study involving 32 Japan intensive care units compared patients with and without rhythm-control therapy for new-onset atrial fibrillation (AF) and conducted a multivariable analysis using Cox proportional hazards regression analysis including rhythm-control therapy as a time-varying covariate for SR restoration. Results: Of 423 new-onset AF patients, 178 patients (42%) underwent rhythm-control therapy. Among those patients, 131 (31%) underwent rhythm-control therapy within 6 h after AF onset. Magnesium sulphate was the most frequently used rhythm-control drug. The Cox proportional hazards model for SR restoration showed that rhythm-control therapy had a significant positive association with SR restoration (adjusted hazard ratio: 1.46; 95% confidence interval: 1.16-1.85). However, the rhythm-control group had numerically higher hospital mortality than the non-rhythm-control group (31% vs. 23%, p = 0.09). Conclusions: Rhythm-control therapy for new-onset AF in critically ill patients was associated with SR restoration. However, patients with rhythm-control therapy had poorer prognosis, possibly due to selection bias. These findings may provide important insight for the design and feasibility of interventional studies assessing rhythm-control therapy in new-onset AF.
  • Toru Takiguchi, Hiroyuki Ohbe, Mikio Nakajima, Yusuke Sasabuchi, Takashi Tagami, Hiroki Matsui, Kiyohide Fushimi, Shoji Yokobori, Hideo Yasunaga
    Journal of critical care 62 276 - 282 2021年04月 
    PURPOSE: Whether intermittent or continuous neuromuscular-blocking agents (NMBAs) would be appropriate during target temperature management (TTM) after cardiac arrest remains unclear. MATERIALS AND METHODS: In this retrospective cohort study, we utilized the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018 and identified patients who received NMBAs during TTM after cardiac arrest on the day of admission. We compared the in-hospital mortality between the propensity-score-matched intermittent and continuous NMBA groups. RESULTS: We identified 5584 eligible patients; 1488 received intermittent NMBAs and 4096 received continuous NMBAs. After propensity score matching, there was no significant difference in the in-hospital mortality between the intermittent and continuous NMBA groups (32.9% vs. 33.1%; odds ratio, 0.98; 95% confidence interval, 0.82-1.18). In subgroup analyses, in-hospital mortality of the continuous NMBA group was significantly higher than that of the intermittent NMBA group in patients aged ≥65 years (p for interaction = 0.021). CONCLUSIONS: This large retrospective study did not suggest that intermittent NMBAs may be inferior to continuous NMBAs in terms of mortality reduction in the overall population receiving TTM for cardiac arrest. However, continuous NMBAs may be inferior to intermittent NMBAs for reducing mortality in elderly patients.
  • Hiroyuki Ohbe, Masao Iwagami, Yusuke Sasabuchi, Hideo Yasunaga
    Heart (British Cardiac Society) 2021年02月 
    OBJECTIVE: Current data suggest that a history of traumatic open skin wounds may be a risk factor for infectious endocarditis, with limited evidence. We tested the hypothesis that traumatic skin wound is a risk factor for infectious endocarditis. METHODS: Using the Japan Medical Data Center (JMDC) database (4 650 927 people aged 20-64 years, 2012-2018) and the Kumamoto database (493 414 people aged ≥65 years, 2012-2017), we conducted nested case-control and self-controlled case series (SCCS) analyses. RESULTS: In the JMDC database, 544 cases hospitalised for infective endocarditis (IE) were matched with 2091 controls; 2.8% of cases and 0.5% of controls were exposed to traumatic skin wounds in the previous 1-4 weeks, with an adjusted OR of 4.31 (95% CI 1.74 to 10.7). In the Kumamoto database, 4.0% (27/670) of cases and 1.1% (29/2581) of controls were exposed to traumatic skin wounds in the previous 1-4 weeks, with an adjusted OR of 4.15 (95% CI 2.04 to 8.46). In the SCCS, the incidence rate ratios for IE were 2.61 (95% CI 1.67 to 4.09), 1.73 (95% CI 1.01 to 2.94), 1.19 (95% CI 0.63 to 2.27) and 1.52 (95% CI 0.82 to 2.74) for the Kumamoto database and 3.78 (95% CI 2.07 to 6.92), 1.58 (95% CI 0.64 to 3.89), 1.60 (95% CI 0.65 to 3.94) and 1.29 (95% CI 0.47 to 3.53) for the JMDC database at 1-4, 5-8, 9-12 and 13-16 weeks after traumatic skin wound, respectively, compared with the baseline period. CONCLUSIONS: This study suggests that traumatic skin wound is a risk factor for IE 1-4 weeks after the wound.
  • Yusuke Sasabuchi, Sachiko Ono, Satoru Kamoshita, Tomoe Tsuda, Akiyoshi Kuroda
    JOURNAL OF PARENTERAL AND ENTERAL NUTRITION 2020年11月 
    Background In patients receiving parenteral nutrition (PN), the association between nutrition achievement in accordance with nutrition guidelines and outcomes remains unclear. Our purpose was to assess the association between nutrition achievement and clinical outcomes, including in-hospital mortality, activity of daily living (ADL), and readmission.Methods In this retrospective cohort study, data were extracted from an inpatient medical-claims database at 380 acute care hospitals. This study included patients who underwent central venous catheter insertion between January 2009 and December 2018. Patients were classified into 3 groups: (1) target-not-achieved; (2) target-partially-achieved; and (3) target-achieved. The target doses of energy, amino acids, and lipid were defined as >= 20 kcal/kg/day, >= 1.0 g/kg/day, and >= 2.5 g/day, respectively. To examine the effect of nutrition achievement on outcomes, a multivariable logistic regression analysis was performed.Results A total of 54,687 patients were included; of these, 21,383 patients were in the target-not-achieved group, 29,610 patients were in the target-partially-achieved group, and 3694 patients were in the target-achieved group. The adjusted odds ratio (OR) (95% CI) for in-hospital mortality was 0.69 (0.66-0.72) in the target-partially-achieved group and 0.47 (0.43-0.52) in the target-achieved group with reference to the target-not-achieved group. The adjusted ORs for deteriorated ADL was 0.93 (0.85-1.01) in the target-partially-achieved group and 0.77 (0.65-0.92) in the target-achieved group with reference to the target-not-achieved group. Readmission was not associated with nutrition achievement.Conclusion In-hospital mortality was lower and deteriorated ADL was suppressed in patients whose PN management was in accordance with the nutrition guidelines.
  • Mitsunori Nakano, Naoyuki Kimura, Takao Nonaka, Makiko Mieno, Keisuke Tanno, Yusuke Sasabuchi, Yuichiro Kitada, Daijiro Hori, Koichi Yuri, Harunobu Matsumoto, Atsushi Yamaguchi, Kazushige Hanaoka
    SURGERY TODAY 50 10 1213 - 1222 2020年10月 
    Purpose We investigated the etiology and impact on outcomes of polycystic kidney disease in patients with abdominal aortic aneurysm. Methods Eight-hundred patients who underwent open (n = 603) or endovascular aortic repair (n = 197) were divided into three groups: no cyst (n = 204), non-polycystic kidney (n = 503), and polycystic kidney (>= 5 cysts in the bilateral kidneys, n = 93). The characteristics and outcomes were compared among the groups. Results In the polycystic kidney group, the age was increased and the proportions of patients with male sex, hypertension, and estimated glomerular filtration rate < 30 mL/min/1.73 m(2) were greater. The overall hospital mortality rates were similar. The incidence of acute kidney injury after elective open aortic repair was increased in the polycystic kidney group (12%, 17%, and 29%, P = 0.020). In the polycystic kidney group, 80 patients did not have renal enlargement or a family history of renal disease, while 13 (corresponding to 1.6% [13/800] of the overall patients), had renal enlargement, suggesting the possibility of hereditary polycystic kidney disease. Conclusions In our cohort, 1.6% of the patients with abdominal aortic aneurysm who underwent surgery were at risk of hereditary polycystic kidney disease. Polycystic kidney disease was associated with acute kidney injury after open aortic repair.
  • Takuo Yoshida, Shigehiko Uchino, Yusuke Sasabuchi
    JOURNAL OF CRITICAL CARE 59 136 - 142 2020年10月 
    Purpose: Epidemiological information is lacking after identification of new-onset atrial fibrillation (AF) in critically ill patients. This study aimed to describe the clinical course after the identification of new-onset AF.Materials and methods: This prospective cohort study enrolled adult patients with new-onset AF in 32 Japanese ICUs during 2017-2018. We collected data on patient comorbidities, physiological information before and at the AF onset, interventions for AF cardiac rhythm transition, adverse events and in-hospital death and stroke.Results: We included 423 new-onset AF patients. At the AF onset, mean arterial pressure decreased and the heart rate increased. Eighty-four patients (20%) spontaneously restored sinus rhythm and 328 patients (78%) received various pharmacological interventions (rate-control drugs, 67%; rhythm-control drugs, 34%). Anticoagulants were administered in 173 patients (40%) and 13 patients (3%) experienced bleeding complications. Twenty-four patients (6%) were still in AF at 168 h after the onset (sustained AF 4%; recurrent AF 2%).The overall hospital mortality was 26% and the incidence of in-hospital stroke was 4.5%.Conclusions: Although the proportion of patients with AF continued to decrease with various treatments, these patients had high risk of death. Further research to assess the management of new-onset AF in critically ill patients is warranted. (C) 2020 Elsevier Inc. All rights reserved.
  • Yusuke Sasabuchi, Sachiko Ono, Satoru Kamoshita, Tomoe Tsuda, Haruka Murano, Akiyoshi Kuroda
    CLINICAL NUTRITION ESPEN 39 198 - 205 2020年10月 
    Background & aims: Identifying the prevalence of underfed patients and risk factors for underfeeding in patients with total parenteral nutrition (TPN) is essential to improve the management of patients receiving TPN. The aim of this study was to examine the prevalence and risk factors for underfeeding using a medical claims database.Methods: In this retrospective cohort study using a medical claims database, we analyzed patient characteristics, timing and duration of nutrition prescription, daily dose of nutrients, and types of parenteral nutrition products administered after central venous catheter (CVC) insertion in hospitalized Japanese patients between 2009 and 2018. The mean prescriptions of energy <20 kcal/kg/day, amino acids <1.0 g/kg/day, and fat 2.5 g/day received by patients between the 4th and 10th day after CVC insertion were regarded as underfeeding. To study the association between nutritional adequacy and body mass index (BMI) with TPN, the proportions of patients with a prescription of energy 20 kcal/kg/ day or amino acids >1.0 g/kg/day were calculated and categorized according to BMI, and the CochranArmitage trend test was performed.Results: Of 54,687 patients included in the study, 70.3% were aged >= 70 years, and 31.3% had a BMI <18.5. The mean prescription of energy was insufficient in 49.9% of patients, and 82.9% were insufficiently prescribed with amino acids. In addition, 44.4% of the patients were never prescribed a single dose of fat emulsion during their hospital stay. On the 10th day after CVC insertion, the majority of patients used commercial 2-in-1 compounds containing carbohydrates and amino acids. A higher BMI was associated with underfeeding of energy and amino acids (both p < 0.001).Conclusions: It is important to adjust the nutrition dose according to the patient's body size and weight, and it is necessary to supplement inadequate nutrients by single-nutrition solutions in addition to compounded solutions. (c) 2020 The Author(s). Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
  • Takuo Yoshida, Shigehiko Uchino, Yusuke Sasabuchi, Yasuhiro Hagiwara
    INTENSIVE CARE MEDICINE 2020年10月 
    The original version of this article unfortunately contained incorrect data for the SOFA score in the table.
  • Susumu Ookawara, Kiyonori Ito, Yusuke Sasabuchi, Hideyuki Hayasaka, Masaya Kofuji, Takayuki Uchida, Keita Horigome, Sojiro Imai, Toshiko Akikawa, Noriko Wada, Satoshi Kiryu, Satoru Made, Mitsutoshi Shindo, Haruhisa Miyazawa, Keiji Hirai, Yasushi Onishi, Hirofumi Shimoyama, Akihisa Watanabe, Kaoru Tabei, Yoshiyuki Morishita
    PLOS ONE 15 8 e0236720  2020年08月 
    Hemoglobin (Hb) is associated with cerebral oxygenation status owing to its important role of carrying oxygen to systemic tissues. However, data concerning the associations between Hb levels and cerebral regional oxygen saturation (rSO(2)) of hemodialysis (HD) patients is limited. We aimed to identify these associations to consider a target Hb level for renal anemia management. This study included 375 HD patients. Cerebral rSO(2)before HD was monitored using the INVOS 5100c oxygen saturation monitor. Multivariable linear regression analysis showed that cerebral rSO(2)was independently associated with natural logarithm (Ln)-HD duration (standardized coefficient: -0.36), mean blood pressure (standardized coefficient: 0.13), pH (standardized coefficient: -0.10), serum albumin (standardized coefficient: 0.14), presence of diabetes mellitus (standardized coefficient: -0.20), and Hb level (standardized coefficient: 0.29). Furthermore, a generalized linear model with restricted cubic spline function was used to investigate the non-linear association between cerebral rSO(2)and Hb levels. In the multivariable analysis for the adjustment with Ln-HD duration, mean blood pressure, pH, serum albumin, and presence of diabetes mellitus, a linear relationship was demonstrated between the two variables (pfor linearity = 0.79). Hb levels revealed the positive and significant association with cerebral rSO(2)in this study. Moreover, the relationship between cerebral rSO(2)and Hb level was proven to be linear. Therefore, the target Hb level in renal anemia management would be considered to be the upper limits for the appropriate management of renal anemia by previous guidelines and position statement from the viewpoint of maintaining cerebral oxygenation in HD patients.
  • Jun Suzuki, Yusuke Sasabuchi, Shuji Hatakeyama, Hiroki Matsui, Teppei Sasahara, Yuji Morisawa, Toshiyuki Yamada, Hideo Yasunaga
    JOURNAL OF INTENSIVE CARE 8 1 56 - 56 2020年07月 
    Background Studies have shown the potential benefit of stress ulcer prophylaxis including histamine-2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) in critically ill patients. However, the adverse effects of stress ulcer prophylaxis such asClostridioides difficileinfection (CDI) and hospital-acquired pneumonia have been reported. Abdominal septic shock is associated with increased risk of bleeding, CDI, and pneumonia; however, which ulcer prophylaxis might be associated with better outcomes in patients with septic shock after lower gastrointestinal tract perforation is unknown. Methods In this retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2015, we identified patients aged 18 years or older who received open abdominal surgery for lower gastrointestinal tract perforation and who used vasopressors and antibiotics within 2 days of admission. We performed propensity score matching and inverse probability of treatment weighting (IPTW) to compare the outcomes between patients who received H2RA and those who received PPI within 2 days of admission. The outcomes included gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission, 28-day mortality, CDI, and hospital-acquired pneumonia. Results The propensity score matching created 1088 pairs of patients who received H2RA or PPI within 2 days of admission. There were no significant differences between the H2RA and PPI groups regarding gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission (0.74% vs 1.3%, risk ratio 0.57 (0.24-1.4), andP= 0.284), 28-day mortality (11.3% vs 12.9%, risk ratio 0.88 (0.68-1.1), andP= 0.386), CDI (0.64% vs 0.46%, risk ratio 1.4 (0.45-4.4), andP= 0.774), and hospital-acquired pneumonia (3.0% vs 4.3%, risk ratio 0.70 (0.45-1.1), andP= 0.138). IPTW analysis showed similar results. Conclusions There were no significant differences in gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission, 28-day mortality, CDI, and hospital-acquired pneumonia between H2RA and PPI in patients with septic shock after lower gastrointestinal tract perforation.
  • Takeshi Kitamura, Mikio Nakajima, Iwanari Kawamura, Hiroyuki Ohbe, Yusuke Sasabuchi, Hiroki Matsui, Kiyohide Fushimi, Seiji Fukamizu, Hideo Yasunaga
    JOURNAL OF ARRHYTHMIA 36 3 464 - 470 2020年06月 
    Background Nationwide data are insufficient with respect to the characteristics of patients undergoing ventricular tachycardia (VT) ablation, complications of VT ablation, and procedure details including catheter devices used during VT ablation. The present study was performed to describe the patient characteristics, procedure details including catheter devices, and in-hospital complications of catheter ablation for VT using a national inpatient database.Methods We used the Diagnosis Procedure Combination database, a national Japanese inpatient database, to identify patients who underwent VT ablation from July 2010 to March 2017. We examined patients' age, gender, baseline diseases, comorbid conditions, admission status, catheter devices and drugs used, and in-hospital complications of VT ablation.Results We identified 10 641 patients (median age, 61 years) who underwent VT ablation. The most frequently observed background heart disease among patients with structural heart disease was ischemic cardiomyopathy. An irrigated ablation catheter was used in 73% of patients, a force-sensing ablation catheter was used in 22%, and intracardiac echocardiography was used in 25%. The frequency of using these procedures continuously increased over time. Overall, the prevalence of in-hospital complications was 3.5% (cardiac tamponade, 0.8%; stroke, 0.6%; critical bleeding, 1.9%; mechanical circulatory support, 0.9%; and in-hospital death, 0.8%).Conclusions The results of this study show the clinical features of VT ablation in a real-world clinical setting. The use of irrigated catheters, force-sensing catheters, and intracardiac echocardiography increased over time. The prevalence of in-hospital complications was 3.5%.
  • Kentarou Hayashi, Yusuke Sasabuchi, Hiroki Matsui, Mikio Nakajima, Hiroyuki Ohbe, Kazuyuki Ono, Hideo Yasunaga
    BLOOD PURIFICATION 49 3 364 - 371 2020年05月 
    Introduction: Sepsis is a systemic inflammatory response syndrome caused by infectious diseases, with cytokines possibly having an important role in the disease mechanism. Acrylonitrile-co-methallyl sulfonate surface-treated (AN69ST) membrane is expected to improve the outcomes of patients with sepsis through cytokine adsorption. Objective: This study aimed to investigate the clinical effect of the AN69ST membrane in comparison to standard continuous renal replacement therapy (CRRT) membranes for panperitonitis due to lower gastrointestinal perforation. Methods: Using the Diagnosis Procedure Combination database, we identified adult patients with sepsis due to panperitonitis receiving any CRRT. Propensity score matching was used to compare patients who received CRRT with the AN69ST membrane (AN69ST group) and those who received CRRT with other membranes (non-AN69ST group). The primary outcome measure was in-hospital mortality. Results: A total of 528 and 1,445 patients were included in the AN69ST group and in the non-AN69ST group, respectively. Propensity score matching resulted in 521 pairs. There was no significant difference in in-hospital mortality (32.1 vs. 35.5%; p = 0.265) and 30-day mortality (41.3 vs. 42.8%, p = 0.074) between the AN69ST group and the non-AN69ST group. Conclusion: There is no significant difference in-hospital mortality between CRRT with the AN69ST membrane and CRRT with standard CRRT membranes for panperitonitis due to lower gastrointestinal perforation. These results indicate that the AN69ST membrane is not superior to the standard CRRT membrane.
  • Toru Takiguchi, Mikio Nakajima, Hiroyuki Ohbe, Yusuke Sasabuchi, Hiroki Matsui, Kiyohide Fushimi, Shiei Kim, Hiroyuki Yokota, Hideo Yasunaga
    CRITICAL CARE MEDICINE 48 5 E356 - E361 2020年05月 
    Objectives:Previous studies have suggested that vasodilator therapy may be beneficial for patients with nonocclusive mesenteric ischemia. However, robust evidence supporting this contention is lacking. We examined the hypothesis that vasodilator therapy may be effective in patients diagnosed with nonocclusive mesenteric ischemia.Design:Retrospective cohort study.Setting:The Japanese Diagnosis Procedure Combination inpatient database.Patients:A total of 1,837 patients with nonocclusive mesenteric ischemia from July 2010 to March 2018.Interventions:None.Measurements and Main Results:We compared patients who received vasodilator therapy (vasodilator group; n = 161) and those who did not (control group; n = 1,676) using one-to-four propensity score matching. Vasodilator therapy was defined as papaverine and/or prostaglandin E1 administered via venous and/or arterial routes within 2 days of admission. Only patients who did not receive abdominal surgery within 2 days of admission were analyzed. The main outcomes were in-hospital mortality and abdominal surgery performed greater than or equal to 3 days after admission. After propensity score matching, in-hospital mortality was significantly lower in the vasodilator group (risk difference, -11.6%; p = 0.005). The proportion of patients who received abdominal surgery at greater than or equal to 3 days after admission was also significantly lower in the vasodilator group (risk difference, -10.2%; p = 0.002).Conclusions:Vasodilator therapy with papaverine and/or prostaglandin E1 is associated with lower in-hospital mortality and prevalence of abdominal surgery in patients with nonocclusive mesenteric ischemia.
  • Yasuhiko Miyakuni, Mikio Nakajima, Hiroyuki Ohbe, Yusuke Sasabuchi, Richard H. Kaszynski, Miho Ishimaru, Hiroki Matsui, Kiyohide Fushimi, Yoshihiro Yamaguchi, Hideo Yasunaga
    ACUTE MEDICINE & SURGERY 7 1 2020年01月 
    Aim: Clinical guidelines for acute lower gastrointestinal bleeding (LGIB) recommend non-endoscopic treatment when endoscopic treatment is difficult or the patient is hemodynamically unstable. The aim of this study was to investigate whether angiography should be prioritized as initial treatment for severe LGIB patients over colonoscopy.Methods: We undertook a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We compared adult patients who underwent colonoscopy or angiography within 1 day of admission for severe LGIB from 2010 to 2017. The primary outcome was in-hospital mortality. Secondary outcomes included surgery carried out within 1 day after admission and surgery carried out between 2 and 7 days of admission. Propensity score-matched analyses were undertaken to adjust for confounders.Results: We identified 6,546 eligible patients. The patients were divided into the colonoscopy group (n = 5,737) and angiography group (n = 809). After one-to-four propensity score matching, we compared 3,220 and 805 patients who underwent colonoscopy and angiography, respectively. The angiography group was not significantly associated with reduced in-hospital mortality compared with the colonoscopy group. In contrast, the number of patients who underwent surgery within 1 day of admission was significantly lower in the angiography group than in the colonoscopy group.Conclusions: The present study revealed that in-hospital mortality did not significantly differ between colonoscopy and angiography, even in severe LGIB patients. Although this study was unable to identify which subgroups should undergo angiography for primary hemostasis, angiography might be a better option than colonoscopy for initial hemostasis in more severe cases of LGIB.
  • Takuo Yoshida, Shigehiko Uchino, Yusuke Sasabuchi, Yasuhiro Hagiwara, Tomonao Yoshida, Hiroshi Nashiki, Hajime Suzuki, Hiroshi Takahashi, Yuki Kishihara, Shinya Nagasaki, Tomoya Okazaki, Shinshu Katayama, Masaaki Sakuraya, Takayuki Ogura, Satoki Inoue, Masatoshi Uchida, Yuka Osaki, Akira Kuriyama, Hiromasa Irie, Michihito Kyo, Nozomu Shima, Junichi Saito, Izumi Nakayama, Naruhiro Jingushi, Kei Nishiyama, Takahiro Masuda, Yasuyuki Tsujita, Masatoshi Okumura, Haruka Inoue, Yoshitaka Aoki, Takashiro Kondo, Isao Nagata, Takashi Igarashi, Nobuyuki Saito, Masato Nakasone
    INTENSIVE CARE MEDICINE 46 1 27 - 35 2020年01月 
    Purpose The development of new-onset atrial fibrillation (AF) in critically ill patients may be associated with poor outcomes. However, it is unknown whether sustained new-onset AF contributes to worse outcome. The aim of this study was to assess whether sustained new-onset AF is associated with stroke and death and to look for a possible dose-response relationship between AF duration and death. Methods In a prospective cohort study conducted in 32 intensive care units in Japan from 2017 to 2018, we enrolled adult patients with new-onset AF. We compared patients with AF duration longer than 48 h with those with AF duration shorter than 48 h. To assess a dose-response relationship between AF duration and hospital mortality, we conducted landmark analysis and time-dependent Cox regression analysis. Results Among a total of 423 new-onset AF patients, hospital mortality was 25%, and the incidence of in-hospital stroke was 4.6%. AF duration longer than 48 h was not independently associated with hospital mortality (adjusted odds ratio: 1.52; 95% Confidence Interval: 0.87-2.64). The incidence of in-hospital stroke was 7.6% in patients with AF duration longer than 48 h and 3.8% in those with AF duration shorter than 48 h (p = 0.154). When analyzing time more continuously, we observed a time-dependent association between AF duration and hospital mortality (p = 0.005 by landmark analysis and p = 0.019 by Cox analysis). Conclusions Sustained new-onset AF was time-dependently associated with hospital mortality in ICU patients, albeit with some uncertainty since AF duration longer than 48 h was not independently associated with in-hospital death or stroke.
  • Nobu Yokoyama, Takao Nonaka, Naoyuki Kimura, Yusuke Sasabuchi, Daijiro Hori, Wataru Matsunaga, Tomonari Fujimori, Kosuke Miyoshi, Harunobu Matsumoto, Atsushi Yamaguchi
    ANNALS OF VASCULAR DISEASES 13 1 45 - 51 2020年 
    Objective: To investigate predictors of acute kidney injury (AKI) following open aortic repair (OAR) requiring suprarenal clamping.Methods: The study included 833 nonhemodialysis patients who had undergone elective OAR (with suprarenal clamping, n=73; with infrarenal clamping, n=760). We evaluated AKI as defined by the criteria of the Kidney Disease Improving Global Outcomes (KDIGO) and compared in-hospital outcomes between the two groups. We also investigated the effects of AKI on outcomes, factors related to post-suprarenal clamping AKI, and efficacy of hypothermic renal perfusion (HRP) in the suprarenal clamping group.Results: For the suprarenal vs. infrarenal clamping group, in-hospital mortality was 0% (0/73) vs. 0.5% (4/760). The incidence of AKI was greater in the suprarenal clamping group (37% vs. 15%, P< 0.001), and the hospital stay for patients with AKI was longer than for those patients without AKI (median, 21 days vs. 16 days; P=0.005). Renal ischemia time and bleeding volume >1,000 mL were associated with post-suprarenal clamping AKI. Renal ischemia time was longer with HRP (n=15) than without HRP (n=58) (median, 51 min vs. 33 min; P=0.011), and HRP did not decrease the incidence of AKI (40% vs. 36%; P=0.78).Conclusion: Prolonged renal ischemia and substantial intraoperative bleeding are associated with postoperative AKI following suprarenal clamping.
  • Jun Suzuki, Yusuke Sasabuchi, Shuji Hatakeyama, Hiroki Matsui, Teppei Sasahara, Yuji Morisawa, Toshiyuki Yamada, Hideo Yasunaga
    JOURNAL OF INTENSIVE CARE 8 1 8 - 8 2020年01月 [査読有り][通常論文]
     
    Background Studies showed potential benefits of recombinant human-soluble thrombomodulin (rhTM) and antithrombin for treating sepsis associated disseminated intravascular coagulation. However, benefits of their combination have been inconclusive. Methods Using a nationwide inpatient database in Japan, we performed propensity-score matched analyses to compare outcomes between rhTM combined with antithrombin and rhTM alone for severe community-acquired pneumonia associated disseminated intravascular coagulation from July 2010 to March 2015. The outcomes included in-hospital mortality and requirement of red cell transfusion. Results Propensity score matching created 189 pairs of patients who received rhTM combined with antithrombin or rhTM alone within 2 days of admission. There was no significant difference between the two groups for in-hospital mortality (40.2% vs. 45.5%). Patients treated with rhTM and antithrombin were more likely to require red cell transfusion than those treated with rhTM alone (37.0% vs. 25.9%). Conclusions Compared with rhTM alone, combination of rhTM with antithrombin for severe community-acquired pneumonia-associated disseminated intravascular coagulation may be ineffective for reducing mortality and may increase bleeding.
  • Iwanari Kawamura, Mikio Nakajima, Takeshi Kitamura, Richard H. Kaszynski, Rintaro Hojo, Hiroyuki Ohbe, Yusuke Sasabuchi, Hiroki Matsui, Kiyohide Fushimi, Seiji Fukamizu, Hideo Yasunaga
    JOURNAL OF ARRHYTHMIA 35 6 842 - 847 2019年12月 
    Background Clinical features and complications of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation for Brugada syndrome have not been well studied. Methods We used the Japanese Diagnosis Procedure Combination database to retrospectively investigate patients who had undergone ICD implantation between April 2016 and March 2017. We compared the characteristics and in-hospital complications of patients with Brugada syndrome implanted with S-ICD or transvenous (TV)-ICD. Results We extracted 3090 patients who received ICD implantation. Among them, we identified 278 Brugada patients. The mean age was 43 +/- 14.4 years and 262 (94%) were male. Of these 278 patients, 136 (49%) received S-ICD and 142 (51%) received TV-ICD. TV-ICD recipients had a history of atrial fibrillation more frequently compared with S-ICD recipients. The median (interquartile range) of length of hospital stay was not significantly different between patients with S-ICD and TV-ICD (13 days [10-20.5] vs 12 days [10-18], respectively). The prevalence of in-hospital complications after ICD implantation was similar between the two groups. There were no patients with cardiac tamponade, hemothorax, pneumothorax, cardiovascular event, stroke, and death following the procedure during hospitalization in either group. Conclusions Short-term safety of S-ICD implantation may be identical to that of TV-ICD. Large prospective studies are warranted to compare the effects and long-term safety of S-ICD compared with TV-ICD.
  • Suzuki J, Sasabuchi Y, Hatakeyama S, Matsui H, Sasahara T, Morisawa Y, Yamada T, Yasunaga H
    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 25 12 1012 - 1018 2019年12月 [査読有り][通常論文]
     
    Previous studies showed potential benefits of macrolide combined with beta-lactam for severe communityacquired pneumonia (CAP). However, it remains inconclusive whether macrolide plus beta-lactam is superior to respiratory fluoroquinolone plus beta-lactam for patients with severe CAP. Using a nationwide inpatient database in Japan, we performed propensity score matching and inverse probability of treatment weighting (IPTW) to compare 28-day mortality and in-hospital mortality between azithromycin plus beta-lactam and levofloxacin plus beta-lactam for severe CAP patients admitted to hospital between July 2010 and March 2015. We identified 1,999 patients with severe pneumonia who received azithromycin plus beta-lactam (n = 840) or levofloxacin plus beta-lactam (n = 1,159) within 2 days after admission. Fivehundred sixty propensity score-matched pairs showed no significant differences between azithromycin plus beta-lactam and levofloxacin plus beta-lactam in 28-day mortality and in-hospital mortality (19.3% vs. 20.7%, p = 0.601 and 24.8% vs. 26.8%, p = 0.495, respectively). IPTW analysis also showed no significant differences between azithromycin plus 13-lactam and levofloxacin plus beta-lactam in 28-day mortality (risk difference, -3.5% [95% confidence interval, -8.8% to 1.7%I and in-hospital mortality (risk difference, -3.6%; 95% confidence interval, -9.4% to 2.1%). In conclusion, there were no significant differences in 28-day mortality and in-hospital mortality between azithromycin plus beta-lactam and levofloxacin plus beta-lactam for severe CAP patients. (C) 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
  • Wataru Matsunaga, Masamitsu Sanui, Yusuke Sasabuchi, Yasuma Kobayashi, Asuka Kitajima, Fumitaka Yanase, Yutaka Takisawa, Alan Kawarai Lefor
    PERIOPERATIVE MEDICINE 8 1 13 - 13 2019年10月 
    Background The safety of intraoperative administration of hydroxyethyl starch (HES) has been debated. We hypothesized that intraoperative use of HES is associated with postoperative acute kidney injury (AKI) following cardiopulmonary bypass (CPB). Materials and methods Patients who underwent cardiothoracic surgery using CPB between 2007 and 2014 were retrospectively reviewed. The incidence of AKI within 7 days after surgery, defined by the Kidney Disease Improving Global Outcome criteria, was compared for patients who did or did not receive 6% (70/0.5) or 6% (130/0.4) HES for anesthesia management before or after CPB. Multivariable logistic regression and propensity matching analysis were performed to examine whether use of HES is associated with postoperative AKI. Outcomes comparing patients receiving HES >= 1000 mL and < 1000 mL were also compared. Results Data from 1976 patients were reviewed. All patients received 70/0.5 HES as a part of the priming solution for CPB. The incidence of postoperative AKI was 28.2% in patients who received HES and 26.0% in patients who did not (p = 0.33). In multivariable analysis, there was no correlation between the use of HES and the incidence of AKI (odds ratio 0.87, 95% CI 0.30-2.58, p = 0.81). Propensity matching showed that the incidence of AKI was not significantly different between 481 patients administered with HES and 962 patients (26.6% vs. 26.9%, p = 0.95) who did not receive HES for anesthesia management. However, peak creatinine levels, needed for renal replacement therapy, and in-hospital mortality were higher, and 28-day hospital-free days were lower in patients receiving HES >= 1000 mL than those receiving HES < 1000 mL (p < 0.05). Conclusions Intraoperative use of HES was not associated with postoperative AKI following CPB. However, administration of large volumes of HES may be associated with kidney-related adverse clinical outcomes.
  • Hideki Hashimoto, Hiroki Matsui, Yusuke Sasabuchi, Hideo Yasunaga, Kazuhiko Kotani, Ryozo Nagai, Shuji Hatakeyama
    BMJ OPEN 9 4 e026251  2019年06月 
    Objectives To investigate oral antibiotic prescribing patterns and identify factors associated with antibiotic prescriptions, with the aim of guiding future interventions to reduce inappropriate prescribing.Design Retrospective cohort study.Setting Database of public health insurance claims in Kumamoto prefecture (Japan).Participants Beneficiaries of the national or late elders' health insurance system between April 2012 and March 2013.Main outcome measures Of the 7 770 481 outpatient visits, 682 822 had a code for antibiotics (860 antibiotic prescriptions per 1000 population). Third-generation cephalosporins (35%), macrolides (32%) and quinolones (21%) were the most frequently prescribed. Acute respiratory tract infections (ARTIs), including viral upper respiratory infections (URI) (22%), pharyngitis (18%), bronchitis (11%) and sinusitis (10%) were the most frequently diagnosed for antibiotic prescribing, followed by gastrointestinal (9%), urinary tract (8%) and skin, cutaneous and mucosal infections (5%). Antibiotic prescribing rates for viral URI, pharyngitis, bronchitis, sinusitis and gastrointestinal infections were 35%, 54%, 53%, 57% and 30%, respectively. In multivariable analysis for ARTIs and gastrointestinal infections, patient age (10-19 years especially), patient sex (male) and facility scale (free-standing clinics or small-scale hospital-based clinics) were associated with increased antibiotic prescribing.Conclusions Broad-spectrum antibiotics constituted 88% of oral outpatient antibiotic prescriptions. Approximately 70% of antibiotics were prescribed for ARTIs and gastroenteritis with modest benefit from antibiotic treatment. The quality of antibiotic prescribing needs to be improved. Antimicrobial stewardship interventions should target ARTIs and gastroenteritis, as well as young patients and small-scale institutions.
  • Nobuaki Michihata, Daisuke Shigemi, Yusuke Sasabuchi, Hiroki Matsui, Taisuke Jo, Hideo Yasunaga
    INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS 145 2 182 - 186 2019年05月 
    Objectives To investigate whether Japanese Kampo medicines, including Sho-hange-kabukuryou-to, Touki-syakuyaku-san, and Hange-kouboku-to, are safe for fetuses, and whether these medicines reduce hospitalizations and medical costs in pregnant women with hyperemesis gravidarum. Methods We used the Japan Medical Data Center database to extract data for pregnant women (aged >= 19 years) admitted to obstetric clinics or hospitals for delivery between January 1, 2005, and December 31, 2016. Eligible patients were classified into three groups: Kampo medicines for hyperemesis gravidarum, other medicines for hyperemesis gravidarum, and without hyperemesis gravidarum. Safety outcome measures were neonatal outcomes (congenital anomalies, low birthweight, and preterm birth), and effectiveness measures were mother's unplanned hospitalization for hyperemesis gravidarum and total medical costs within 20 weeks of gestation. Results We identified 121 287 eligible mothers. No significant differences in the safety measures were observed among the groups. The Kampo medication group had a significantly lower proportion of mothers with unplanned hospital admission (odds ratio 0.80, 95% confidence interval [CI] 0.69-0.92) and lower total costs (coefficient [US$] 12.8, 95% CI -23.2 to -2.4) than the other medication group. Conclusion Kampo medicines may reduce unplanned admissions and medical costs among pregnant women with hyperemesis gravidarum.
  • Toru Sugihara, Hideo Yasunaga, Hiroki Matsui, Yusuke Sasabuchi, Haruki Kume, Tetsuya Fujimura
    JOURNAL OF UROLOGY 201 4 E105 - E105 2019年04月
  • Shinjiro Saito, Shigehiko Uchino, Mineji Hayakawa, Kazuma Yamakawa, Daisuke Kudo, Yusuke Iizuka, Masamitsu Sanui, Kohei Takimoto, Toshihiko Mayumi, Yusuke Sasabuchi, Takeo Azuhata, Fumihito Ito, Shodai Yoshihiro, Katsura Hayakawa, Tsuyoshi Nakashima, Takayuki Ogura, Eiichiro Noda, Yoshihiko Nakamura, Ryosuke Sekine, Yoshiaki Yoshikawa, Motohiro Sekino, Keiko Ueno, Yuko Okuda, Masayuki Watanabe, Akihito Tampo, Nobuyuki Saito, Yuya Kitai, Hiroki Takahashi, Iwao Kobayashi, Yutaka Kondo, Wataru Matsunaga, Sho Nachi, Toru Miike, Hiroshi Takahashi, Shuhei Takauji, Kensuke Umakoshi, Takafumi Todaka, Hiroshi Kodaira, Kohkichi Andoh, Takehiko Kasai, Yoshiaki Iwashita, Hideaki Arai, Masato Murata, Masahiro Yamane, Kazuhiro Shiga, Naoto Hori
    JOURNAL OF CRITICAL CARE 50 23 - 30 2019年04月 
    Purpose: We investigated the epidemiology and outcome of disseminated intravascular coagulation (DIC) in patients with sepsis.Materials and methods: We analyzed data from a multicenter observational study (Japan Septic Disseminated Intravascular Coagulation [JSEPTIC-DIC] study) conducted in 42 intensive care units in Japan. DIC scores were calculated using two scoring systems: the International Society on Thrombosis and Haemostasis (ISTH) and Japanese Association for Acute Medicine (JAAM) criteria. We compared demographics and clinical characteristics of patients with and without DIC, and performed multivariable logistic regression analyses to assess the association of diagnosis and scores for DIC with in-hospital mortality.Results: Of 1895 eligible patients, 1162 (61%) and 554 patients (29%) were diagnosed as having DIC by the JAAM and ISTH criteria, respectively. Patients with DIC had higher in-hospital mortality compared with those without DIC (33% vs. 20% in JAAM and 38% vs. 24% in ISTH). However, in multivariable analysis, the JAAM score (odds ratio 1.026, 95% confidence interval 0.958-1.097; p = 0.465) and the ISTH score (odds ratio 1.049, 95% confidence interval 0.969-1.135; p = 0.238) did not have an independent association with in-hospital mortality.Conclusions: Patients with sepsis and DIC have high mortality. However, the DIC are not independently associated with in-hospital mortality. (C) 2018 Elsevier Inc. All rights reserved.
  • Katsuyuki Hoshina, Shin Ishimaru, Yusuke Sasabuchi, Hideo Yasunaga, Kimihiro Komori, Kunihiro Shigematsu, Atsushi Hirayama, Masanao Toma, Kimi-Hiko Kichikawa, Osamu Sato, Hiroyuki Sadogawa, Nobuya Koyama, Takashi Nishimura, Hideyuki Shimizu, Shigeru Furui, Shin Ishimaru, Masaaki Kato
    ANNALS OF SURGERY 269 3 564 - 573 2019年03月 
    Objective: To analyze data on patients treated with a bifurcated stent graft for abdominal aortic aneurysm (AAA).Background: The Japan Committee for Stentgraft Management (JACSM) was established in 2007 to manage the safety of endovascular aortic aneurysm repair (EVAR) in Japan. The JACSM registry includes detailed anatomical and clinical data of all patients who undergo stent graft insertion in Japan.Methods: Among 51,380 patients treated with bifurcated stent graft for AAA, we identified 38,008 eligible patients (excluding those with rupture or insufficient data). The analyzed factors included age, sex, comorbidities, AAA pathology and etiology, aneurysm and neck diameters, 7 anti-instructions for use (IFU) factors, and endoleaks at hospital discharge. The endpoints were death, adverse events, sac dilatation (>= 5 mm), and reintervention.Results: The rates of intraoperative and in-hospital mortality were 0.08% and 1.07%, respectively. Infectious aneurysm and pseudo-aneurysm were associated with overall survival and reintervention. Older age, large aneurysm diameter, and all types of persistent endoleaks were strong predictors of adverse events, sac dilatation, and reintervention. Comorbid cerebrovascular disease, renal dysfunction, and respiratory disorders were also risk factors. In total, 47.6% of patients violated the IFU; among the anti-IFU factors assessed, poor access and severe neck calcification were strong risk factors for mortality, reintervention, and adverse events. The sac dilatation rate at 5 years was 23.3%.Conclusions: Although the analysis included EVAR with poor anatomy, the perioperative mortality rate was acceptable compared with that in previous large population studies.
  • Koshi Ota, Yusuke Sasabuchi, Hiroki Matsui, Taisuke Jo, Kiyohide Fushimi, Hideo Yasunaga
    BMC PULMONARY MEDICINE 19 1 38 - 38 2019年02月 
    Background: Acute eosinophilic pneumonia (AEP) is a rare inflammatory lung disease. Previous studies have shown that most patients with AEP are aged 20 to 40 years, whereas several case studies have included older patients with AEP. These studies also suggested that AEP is more prevalent in summer, but they were limited due to their small sample sizes. We therefore investigated the age distribution and seasonality among patients with AEP using a national inpatient database.Methods: Using the Japanese Diagnosis Procedure Combination database, we identified patients with a recorded diagnosis of AEP from 1 July 2010 to 31 March 2015. We examined patient characteristics and clinical practices including age, sex, seasonal variation, length of stay, use of corticosteroids, use of mechanical ventilation, and in-hospital mortality.Results: During the 57-month study period, we identified 213 inpatients with AEP. The age distribution of AEP peaked twice: at 15 to 24 years and 65 to 79 years. The proportion of patients with AEP was highest in summer for those aged < 40 years, whereas it was distributed evenly throughout the year for those aged >= 40 years. The interval from hospital admission to corticosteroid administration and the duration of corticosteroid use were significantly longer in the older than younger age group.Conclusions: The age distribution of patients with AEP was bimodal, and seasonality was undetected in older patients. Older patients may be more likely to have delayed and prolonged treatment.
  • Taisuke Jo, Nobuaki Michihata, Hayato Yamana, Yusuke Sasabuchi, Hiroki Matsui, Hirokazu Urushiyama, Akihisa Mitani, Yasuhiro Yamauchi, Kiyohide Fushimi, Takahide Nagase, Hideo Yasunaga
    INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE 14 129 - 139 2019年 
    Purpose: Patients with symptomatic COPD are recommended to use inhaled bronchodilators containing long-acting muscarinic receptor antagonists (LAMAs). However, bronchodilators may cause gastrointestinal adverse effects due to anticholinergic reactions, especially in advanced-age patients with COPD. Dai-kenchu-to (TU-100, Da Jian Zhong Tang in Chinese) is the most frequently prescribed Japanese herbal Kampo medicine and is often prescribed to control abdominal bloating and constipation. The purpose of this study was to evaluate the role of Dai-kenchu-to as a supportive therapy in advanced-age patients with COPD.Patients and methods: We used the Japanese Diagnosis Procedure Combination inpatient database and identified patients aged >= 75 years who were hospitalized for COPD exacerbation. We then compared the risk of re-hospitalization for COPD exacerbation or death between patients with and without Dai-kenchu-to using 1-to-4 propensity score matching. A Cox proportional hazards model was used to compare the two groups. We performed subgroup analyses for patients with and without LAMA therapy.Results: Patients treated with Dai-kenchu-to had a significantly lower risk of re-hospitalization or death after discharge; the HR was 0.82 (95% CI, 0.67-0.99) in 1-to-4 propensity score matching. Subgroup analysis of LAMA users showed a significant difference in re-hospitalization or death, while subgroup analysis of LAMA non-users showed no significant difference.Conclusion: Our findings indicate that Dai-kenchu-to may have improved the tolerability of LAMA in advanced-age patients with COPD and, therefore, reduced the risk of re-hospitalization or death from COPD exacerbation. Dai-kenchu-to may be recommended as a useful supportive therapy for advanced-age patients with COPD.
  • Manabu Kawata, Yusuke Sasabuchi, Shuji Taketomi, Hiroshi Inui, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga, Sakae Tanaka
    KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 26 12 3699 - 3705 2018年12月 
    Purpose Although various risk factors for surgical site infection after anterior cruciate ligament reconstruction (ACLR) have been reported, the number of studies with large sample sizes on this topic is limited. The aim of the present study was to clarify the risk factors for early surgical site infection after ACLR in a large cohort using a national database in Japan.Methods The data of patients who underwent ACLR from 2010 to 2015 were obtained from the Diagnosis Procedure Combination database, which covers approximately half of all hospital admissions in Japan. The outcome measures were the prevalences of surgical site infection and deep surgical site infection after ACLR during hospitalization. The association between the occurrence of surgical site infection and patients' demographic data, including sex, age, body mass index (BMI), smoking status, preoperative steroid use, and comorbidities such as diabetes, hepatic dysfunction, renal dysfunction, and atopic dermatitis, were examined using a multivariable logistic regression model.Results Among 30,536 patients who underwent ACLR, 288 patients with surgical site infection (0.94%) and 86 with deep surgical site infection (0.28%) were identified. The univariate analysis showed that higher prevalences of surgical site infection and deep surgical site infection were associated with male sex, a higher BMI, atopic dermatitis, and preoperative steroid use. Patients with diabetes or hepatic dysfunction had a significantly higher prevalence of surgical site infection. The multivariable analysis showed that surgical site infection was significantly associated with male sex vs. female sex; odds ratio (OR), 2.90; 95% confidence interval (CI), 2.17-3.89, age of <= 19 vs. 20-29 years; OR, 1.56; 95% CI 1.13-2.15, BMI of >= 30.0 vs. 18.5-22.9 kg/m(2); OR, 1.72; 95% CI 1.16-2.54, diabetes (OR, 2.70; 95% CI 1.28-5.71), atopic dermatitis (OR, 7.19; 95% CI 2.94-17.57), and preoperative steroid use (OR, 6.18; 95% CI 2.32-16.52).Conclusion Atopic dermatitis, preoperative steroid use, young age (<= 19 years), obesity (BMI of >= 30.0 kg/m(2)), male sex, and diabetes were independent demographic risk factors for surgical site infection after ACLR. The present study will be useful when surgeons evaluate the risk of SSI after ACLR in terms of demographic aspects.
  • Takuma Maeda, Nobuaki Michihata, Yusuke Sasabuchi, Hiroki Matsui, Yoshihiko Ohnishi, Shigeki Miyata, Hideo Yasunaga
    PEDIATRIC CRITICAL CARE MEDICINE 19 12 E637 - E642 2018年12月 
    Objectives: The present study aimed to examine the association between tranexamic acid use and adverse effects (seizures, thromboembolism, and renal dysfunction) in a pediatric trauma population using a national inpatient database in Japan. We also assessed the association between tranexamic acid use and in-hospital mortality. Design: A nationwide, retrospective cohort study using propensity score analyses. Setting: Japanese Diagnosis Procedure Combination inpatient database. Patients: Pediatric patients less than or equal to 12 years old admitted in hospital with the diagnosis of trauma between July 2010 and March 2014 (n = 61,779). Interventions: None. Measurements and Main Results: Propensity score matching created 1,914 pairs of patients with and without tranexamic acid administration. Propensity-matched analysis showed that the proportion of seizures was significantly higher in the tranexamic acid group than in the nontranexamic acid group (7/1,914, 0.37% vs 0/1,914, 0%; difference, 0.37%; 95% CI, 0.10-0.64; p = 0.008). However, none of the other outcomes were significantly different between the groups. Conclusions: Tranexamic acid use is associated with a significantly increased risk of seizures. However, no difference exists among any other outcomes between the tranexamic acid and nontranexamic acid groups.
  • Ono S, Ono Y, Michihata N, Sasabuchi Y, Yasunaga H
    Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention 24 6 448 - 450 2018年12月 [査読有り][通常論文]
     
    Pokemon GO (Niantic Labs, released on 22 July 2016 in Japan) is an augmented reality game that gained huge popularity worldwide. Despite concern about Pokemon GO-related traffic collisions, the effect of playing Pokemon GO on the incidence of traffic injuries remains unknown. We performed a population-based quasi-experimental study using national data from the Institute for Traffic Accident Research and Data Analysis, Japan. The outcome was incidence of traffic injuries. Of 127 082 000 people in Japan, 886 fatal traffic injuries were observed between 1 June and 31 August in 2016. Regression discontinuity analysis showed a non-significant change in incidence of fatal traffic injuries after the Pokemon GO release (0.017 deaths per million, 95%CI -0.036 to 0.071). This finding was similar to that obtained from a difference-in-differences analysis. Effect of Pokemon GO on fatal traffic injuries may be negligible.
  • Tatsuhiko Abe, Shigehiko Uchino, Yusuke Sasabuchi, Masanori Takinami
    AMERICAN JOURNAL OF SURGERY 216 5 886 - 892 2018年11月 
    Background: Although hyperlactatemia is often developed in critically ill patients, it is unclear whether hyperlactatemia is associated with poor prognosis for surgical ICU (SICU) patients.Methods: We performed a retrospective analysis in an academic hospital in Tokyo. The maximum lactate was defined as the highest value within the SICU stay. The primary outcome was the composite outcome of in-hospital mortality, re-admission to the SICU or admission to the general ICU and emergency reoperation.Results: There were 3421 patients with normal lactate (<2 mmoL/L), 1642 with moderate hyperlactatemia (2-3.9 mmoL/L) and 299 with severe hyperlactatemia (>= 4 mmoL/L). The composite outcome occurred in 6.2%. In multivariable logistic regression analysis, the odds ratio for the composite outcome was 1.49 for moderate hyperlactatemia and 1.42 for severe hyperlactatemia.Conclusions: The odds ratio was similar between moderate and severe hyperlactatemia, so the cause and meaning of hyperlactatemia might be different among patients with elective surgery. (C) 2018 Elsevier Inc. All rights reserved.
  • Yusuke Sasabuchi, Hiroki Matsui, Alan Kawarai Lefor, Kiyohide Fushimi, Hideo Yasunaga
    INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 49 10 1848 - 1854 2018年10月 
    Introduction: Although early surgery for elderly patients with hip fracture is recommended in existing clinical guidelines, the results of previous studies are inconsistent. The aim of this study was to compare postoperative outcomes of early and delayed surgery for elderly patients with hip fracture.Materials and Methods: In this retrospective study using a national inpatient database in Japan, patients aged 65 years or older who underwent surgery for hip fracture between July 2010 and March 2014 were included. Early surgery was defined as surgery on the day or the next day of admission. Assessed outcomes included death within 30 days and hospital-acquired pneumonia.Results: In this cohort, 47,073 (22.5%) patients underwent surgery for hip fractures within two days of admission (early surgery group) and 161,805 (77.5%) underwent surgery for hip fractures thereafter (delayed surgery group). Early surgery was significantly associated with lower odds for hospital-acquired pneumonia (odds ratio, 0.42; 95% confidence interval, 0.25-0.69) and pressure ulcers (odds ratio, 0.56, 95%Cl: 0.33-0.96, p = 0.035), but was not associated with 30-day mortality (odds ratio, 0.96; 95% confidence interval, 0.49-1.86) or pulmonary embolism (odds ratio, 1.62, 95%CI: 0.58-4.52, p = 0.357).Conclusions: These results support current guidelines, which recommend early surgery for elderly hip fractures patients. (C) 2018 Elsevier Ltd. All rights reserved.
  • Noriko Hiyama, Yusuke Sasabuchi, Taisuke Jo, Tetsuya Hirata, Yutaka Osuga, Jun Nakajima, Hideo Yasunaga
    EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY 54 3 572 - 578 2018年09月 
    OBJECTIVES: Women are the minority among patients with spontaneous pneumothorax, but catamenial pneumothorax (CP) is unique to them. We aimed to clarify the clinical characteristics of female patients with spontaneous pneumothorax using a nationwide database.METHODS: Medical records from the Japanese Diagnosis Procedure Combination database for inpatients with pneumothorax between July 2010 and March 2016 were retrospectively reviewed. Age, underlying diseases, body mass index, smoking status, laterality, number of hospitalizations and treatments were studied.RESULTS: We identified 157 087 patients with pneumothorax, including 27 716 (17.6%) women and 129 371 (82.4%) men. The age distribution of female patients with pneumothorax had 3 peaks: 18 years, around 40 years and 80 years; male patients had 2 peaks: 18 years and 79 years. We identified 873 patients with CP; this number was not sufficient to account for the female-specific peak around 40 years. The characteristics of female patients of reproductive age were significantly different between those with and without CP. The patients with CP were older (average age: 37.9 +/- 7.7 years vs 31.3 +/- 11.5 years, P < 0.001), were right side dominant (right: 64.9%, left 6.5%), had more hospitalizations (average number of hospitalizations: 1.6 +/- 0.9 vs 1.3 +/- 0.6, P < 0.001) and had more frequently undergone surgery (57.1% vs 37.3%, P < 0.001).CONCLUSIONS: The age distribution of women with pneumothorax had 3 distinct peaks while that of men had 2. CP has different characteristics from other types of pneumothorax, thus requiring different treatment strategies for women of reproductive age.
  • Taisuke Jo, Hideo Yasunaga, Nobuaki Michihata, Yusuke Sasabuchi, Wakae Hasegawa, Hideyuki Takeshima, Yukiyo Sakamoto, Hiroki Matsui, Kiyohide Fushimi, Takahide Nagase, Yasuhiro Yamauchi
    PARKINSONISM & RELATED DISORDERS 54 25 - 29 2018年09月 
    Introduction: Pneumonia is one of the most frequent reasons for hospitalization in patients with Parkinson's disease. The present study aimed to evaluate the impact of Parkinsonism on the clinical courses of elderly patients hospitalized for pneumonia.Methods: We conducted a retrospective cohort study of patients aged >= 60 years who were hospitalized for pneumonia, using data from a national inpatient database in Japan. We performed one-to-four matching for age and sex between patients with and without Parkinsonism. Multivariable regression analyses were carried out for in-hospital mortality, length of stay, and discharge to home.Results: Patients with Parkinsonism had significantly lower in-hospital mortality than those without Parkinsonism (odds ratio, 0.81; 95% confidence interval, 0.74-0.89). Length of stay was 8.1% longer in patients with Parkinsonism. Patients with Parkinsonism were less likely to be discharged to home (odds ratio, 0.62; 95% confidence interval, 0.58-0.67).Conclusion: Parkinsonism was not an independent predictor of in-hospital mortality, but was related to prolonged length of stay and discharge other than to home in patients with pneumonia. (C) 2018 Elsevier Ltd. All rights reserved.
  • Yusuke Sasabuchi, Hiroki Matsui, Kazuhiko Kotani, Alan Kawarai Lefor, Hideo Yasunaga
    BMJ OPEN 8 7 e021294  2018年09月 
    Background and objectives The Kumamoto earthquakes struck Kumamoto prefecture, in the southwest part of Japan in April 2016. Physical and mental disorders presenting to hospital increased after the 2016 Kumamoto earthquakes. Impaired access to primary care due to the earthquakes may have contributed to this increase. However, it is not known whether the 2016 Kumamoto earthquakes affected access to primary care. The objective of the present study was to investigate the impact of the 2016 Kumamoto earthquakes on short-term health conditions by analysing ambulatory care sensitive conditions (ACSCs), using administrative data from Kumamoto prefecture.Design A retrospective cohort study.Setting Residents enrolled in National Health Insurance or Late Elders' Health Insurance from Kumamoto prefecture, Japan.Participants All hospital admissions due to ACSCs between 15 March and 16 May in each year from 2013 to 2016.Outcome measures ACSCs are defined as conditions for which appropriate primary care interventions could prevent admission to the hospital.Results We identified a total of 7921, 18 763 and 85436 admissions for vaccine, acute and chronic preventable ACSCs, respectively, during the study period. Admissions within 7 days after the 2016 Kumamoto earthquakes increased to 32.6% (10.2, 59.5), 44.1% (27.0, 63.5) and 27.7% (20.2, 35.6) for vaccine-preventable, acute and chronic ACSCs, respectively. However, admissions for ACSCs did not change significantly 30 days after the earthquakes.Conclusion The 2016 Kumamoto earthquakes were associated with increased hospital admissions for ACSCs. The impact of the earthquakes on admissions for ACSCs did not persist for more than 7 days.
  • Daisuke Obinata, Toru Sugihara, Hideo Yasunaga, Junichi Mochida, Kenya Yamaguchi, Yasutaka Murata, Tsuyoshi Yoshizawa, Tsuyoshi Matsui, Hiroki Matsui, Yusuke Sasabuchi, Tetsuya Fujimura, Yukio Homma, Satoru Takahashi
    INTERNATIONAL JOURNAL OF UROLOGY 25 7 655 - 659 2018年07月 
    ObjectiveTo compare nationwide outcomes of tension-free vaginal mesh surgery and laparoscopic sacrocolpopexy for the treatment of pelvic organ prolapse in Japan.MethodsUsing the Diagnosis Procedure Combination database, we collected data on female patients who underwent tension-free vaginal mesh surgery or laparoscopic sacrocolpopexy for pelvic organ prolapse from April 2014 to March 2015. We compared the proportion of perioperative adverse events, duration of anesthesia, total costs and postoperative length of stay between the groups. Univariate and multivariate analyses were carried out for age, comorbidity, mesh volume, additional concomitant surgery and hospital volume.ResultsWe identified 3023 patients, including 2388 who underwent tension-free vaginal mesh surgery, and 635 who underwent laparoscopic sacrocolpopexy. The median age at the time of surgery was significantly higher in the tension-free vaginal mesh group (71 vs 66 years; P < 0.001). The tension-free vaginal mesh group had a higher proportion of all adverse events (7.1% vs 1.8%; P < 0.001) and a higher proportion of genitourinary complications (5.7% vs 1.1%; P < 0.001). The median duration of anesthesia was shorter in the tension-free vaginal mesh group (150 vs 286 min; P < 0.001). The total cost was significantly lower in the tension-free vaginal mesh group.ConclusionsBoth procedures offer favorable results for surgical treatment of pelvic organ prolapse. Overall, the tension-free vaginal mesh procedure seems to represent a good option for high-risk women, such as elderly patients, whereas laparoscopic sacrocolpopexy is useful for younger patients with a higher level of sexual activity.
  • Tomoyuki Masuyama, Masamitsu Sanui, Naoto Yoshida, Yusuke Ilzuka, Kunio Ogi, Satoko Yagihashi, Kanae Nagatomo, Yusuke Sasabuchi, Alan K. Lefor
    PSYCHOGERIATRICS 18 3 209 - 215 2018年05月 
    Background: Benzodiazepine use is a risk factor for the development of delirium in adult intensive care unit (ICU) patients. Suvorexant is an alternative to benzodiazepines to induce sleep, but the incidence of delirium in critically ill patients is unknown. We undertook this retrospective study to investigate the incidence of delirium in patients who receive suvorexant in the ICU.Methods: This retrospective cohort study was conducted in a closed 12-bed ICU at a tertiary teaching hospital. Patients admitted to the ICU for 72 h or longer between January and June 2015 were evaluated for delirium using the Confusion Assessment Method for the Intensive Care Unit tool. We evaluated the incidence of delirium in patients who received suvorexant and those who did not. To adjust for confounding factors, multivariable logistic regression analysis was conducted.Results: Study subjects included 118 patients, with a median age of 72 years and a median Acute Physiology and Chronic Health Evaluation II score of 18 points. Eighty-two patients (69.5%) were admitted after cardiovascular surgery. In the suvorexant group, there were fewer post-cardiovascular surgical patients and more medical patients. The duration of mechanical ventilation during ICU stay was longer in the suvorexant group, and sedatives and sleep inducers other than suvorexant were used more frequently in the suvorexant group. The incidence of delirium was 43.8% in the suvorexant group and 58.8% in the non-suvorexant group (P = 0.149). After adjustment for risk factors using multivariable logistic regression analysis, suvorexant was associated with a lower incidence of delirium (odds ratio = 0.23, 95% confidence interval: 0.07-0.73; P = 0.012).Conclusions: Suvorexant was associated with decreased odds of transitioning to delirium in critically ill patients. The use of suvorexant may lower the incidence of delirium in ICU patients. Future prospective studies are warranted.
  • Manabu Kawata, Yusuke Sasabuchi, Shuji Taketomi, Hiroshi Inui, Hiroki Matsui, Kiyohide Fushimi, Hirotaka Chikuda, Hideo Yasunaga, Sakae Tanaka
    PLOS ONE 13 4 e0194854  2018年04月 
    BackgroundThe importance of meniscus preservation is widely recognized. There have been a few studies describing trends in meniscectomy and meniscus repair in the United States; however, they presented differing results. We reported annual trends in meniscus surgery, using a national database in Japan.MethodsWe interrogated the Diagnosis Procedure Combination database, which represents approximately half of all hospital admissions in Japan. We included the patients who underwent meniscectomy and meniscus repair between July 2007 and March 2015. The diagnosis, age and sex of each patient were recorded.ResultsWe identified 83,105 patients: 69,310 underwent meniscectomy; 13,416 underwent meniscus repair and 379 underwent both in a single admission. The proportion of patients undergoing meniscus repair rose from 7.0% in 2007 to 25.9% in 2014 (p < 0.001), while the proportion undergoing meniscectomy fell from 92.8% in 2007 to 73.3% in 2014 (p < 0.001). Among patients under 30 years old, the proportions undergoing meniscus repair or meniscectomy in 2014 were 50.3% versus 48.3%, respectively. A bimodal age distribution was observed for meniscectomy, with peaks at 10-19 years of age and 60-69 years of age, whereas most patients undergoing meniscus repair were 10-19 years of age.ConclusionsWe found characteristic trends where the popularity of meniscus repair increased rapidly at the expense of meniscectomy in Japan during the study period. In the last survey year, the proportion of meniscus repair exceeded that of meniscectomy in those younger than 30 years. Meniscectomy was undertaken most often in adolescents and early old age, while meniscus repair was undertaken most often in adolescents.
  • Yusuke Sawada, Yusuke Sasabuchi, Yasuo Nakahara, Hiroki Matsui, Kiyohide Fushimi, Nobuhiko Haga, Hideo Yasunaga
    AMERICAN JOURNAL OF CRITICAL CARE 27 2 97 - + 2018年03月 
    Background Community-acquired pneumonia is one of the most common infectious diseases and can be fatal. The benefits of early rehabilitation in intensive care units are known, but the association between early rehabilitation and in-hospital mortality of patients with community-acquired pneumonia admitted to intensive care units has not been studied.Objectives To study the association between early rehabilitation and the in-hospital mortality of patients with community-acquired pneumonia admitted to intensive care units, effects of early rehabilitation on unit and hospital lengths of stay, and total costs of hospitalization.Methods A retrospective observational cohort study using a national inpatient database of patients with community-acquired pneumonia admitted to intensive care units in acute care hospitals in Japan from July 2011 through March 2014. Propensity score-matching analysis was used to compare outcomes between patients with and without early rehabilitation (within 2 days of admission).Results Among 8732 eligible patients, propensity score matching created 972 pairs of patients with and without early rehabilitation. The early rehabilitation group had significantly lower in-hospital mortality than did the group without early rehabilitation (17.9% vs 21.9%, respectively; P = .03). The groups did not differ significantly in intensive care unit or hospital lengths of stay or in total costs of hospitalization.Conclusions Early rehabilitation within 2 days of admission was associated with reduced in-hospital mortality of patients with community-acquired pneumonia admitted to intensive care units.
  • Yusuke Sasabuchi, Hiroki Matsui, Alan Kawarai Lefor, Taisuke Jo, Nobuaki Michihata, Kiyohide Fushimi, Hideo Yasunaga
    EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018 8620198 - 8620198 2018年 
    Background. Infectious complications after hip fracture surgery are common in the elderly. Although experimental studies have suggested that kampo medicine, Hochu-ekki-to and Juzen-taiho-to, can prevent infectious complications, only a few small clinical studies have been published to date. Primary Study Objective. The aim of the present study is to investigate the impact of Hochu-ekki-to or Juzen-taiho-to on postoperative infectious complications in patients undergoing surgery for hip fracture. Methods and Design. In this retrospective cohort study using a nationwide inpatient database in Japan, we performed propensity score matching to compare patients who did or did not receive kampo medicine after surgery for hip fracture. Settings. A nationwide inpatient database. Participants. Patients who did or did not receive kampo medicine after surgery for hip fracture. Intervention. Kampo medicine after surgery for hip fracture. Primary Outcome Measures. Infectious complications. Results. The proportions of postoperative infectious complications were not significantly different between the 424 propensity-matched pairs with and without kampo medicine (11 versus 8, P = 0.644). Conclusion. The present study suggests that Hochu-ekki-to or Juzen-taiho-to postoperatively is not associated with decreased occurrence of infectious complications in patients who underwent surgery for hip fracture.
  • Takao Nonaka, Naoyuki Kimura, Daijiro Hori, Yusuke Sasabuchi, Mitsunori Nakano, Koichi Yuri, Masamitsu Sanui, Harunobu Matsumoto, Atsushi Yamaguchi
    ANNALS OF VASCULAR DISEASES 11 3 298 - 305 2018年 
    Objective: To investigate the predictors of acute kidney injury (AKI) following surgery for abdominal aortic aneurysm.Materials and Methods: Subjects were 642 non-hemodialysis patients (open aortic repair [OAR] group, n = 453; endovascular aortic repair [EVAR] group, n = 189) who underwent elective surgery between 2009 and 2015. AKI was assessed according to the Kidney Disease Improving Global Outcomes criteria. In-hospital mortality and incidence of AKI were compared between the OAR and EVAR groups. The effect of AKI on outcomes and predictors of AKI were examined in both groups.Results: In-hospital mortalities were 0.7% (3/453) in the OAR group and 0.5% (1/189) in the EVAR group. The incidence of AKI increased in the OAR group (14.1% vs. 3.7%, P<0.01). In the OAR group, in-hospital mortality (0% vs. 4.7%, P<0.01) increased in patients with AKI. In the OAR group, hemoglobin level <10 g/dL, estimated glomerular filtration rate <60 mL/min/1.73 m(2), operation time >300 min, history of ischemic heart disease, and amount of bleeding >1,000 mL were predictors of AKI. In the EVAR group, amount of transfusion>1,000 mL was a predictor of AKI, but AKI was not found to worsen outcomes.Conclusion: AKI affected outcomes of OAR. Knowledge of predictors may optimize perioperative care.
  • Manabu Kawata, Yusuke Sasabuchi, Hiroshi Inui, Shuji Taketomi, Hiroki Matsui, Kiyohide Fushimi, Hirotaka Chikuda, Hideo Yasunaga, Sakae Tanaka
    KNEE 24 5 1198 - 1205 2017年10月 
    Background: Various nationwide studies have reported differing annual trends in utilization of knee arthroplasty and tibial osteotomy. Using the Diagnosis Procedure Combination database in Japan, the present series examined annual trends and demographics in total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) and tibial osteotomy.Methods: All patients were identified who underwent TKA, UKA or tibial osteotomy for osteoarthritis, osteonecrosis or rheumatoid arthritis of the knee between July 2007 and March 2015.Results: A total of 170,433 cases of TKA, 13,209 cases of UKA and 8760 cases of tibial osteotomy were identified. The proportion of patients undergoing UKA rose from 4.0% in 2007 to 8.1% in 2014 (P < 0.001), and that of tibial osteotomy from 2.6% in 2007 to 5.5% in 2014 (P < 0.001); the proportion undergoing TKA fell from 93.4% in 2007 to 863% in 2014 (P < 0.001). Between 2007 and 2014 the proportions of patients with osteonecrosis who underwent UKA and tibial osteotomy increased from 34.7% and 11.6% to 38.6% and 16.2%, respectively (P = 0.001 for UKA and P = 0.004 for tibial osteotomy). The proportions of patients with osteonecrosis undergoing UKA or tibial osteotomy were significantly greater than those with other diagnoses (P < 0.001 for both).Conclusions: The popularity of UKA and tibial osteotomy in Japan increased during the period 2007-2014 at the expense of TKA. The proportions of UKA and tibial osteotomy in patients with osteonecrosis also increased, and were larger than those in patients with other causative diseases. (C) 2017 Published by Elsevier B.V.
  • Taisuke Jo, Hideo Yasunaga, Yusuke Sasabuchi, Nobuaki Michihata, Kojiro Morita, Yasuhiro Yamauchi, Wakae Hasegawa, Hideyuki Takeshima, Yukiyo Sakamoto, Hiroki Matsui, Kiyohide Fushimi, Takahide Nagase
    BMC PULMONARY MEDICINE 17 1 128 - 128 2017年10月 
    Background: Pneumonia is the most common cause of death in patients with dementia, but the outcomes of patients with dementia hospitalized with pneumonia are poorly understood. We sought to illuminate the association between dementia and in-hospital mortality and discharge status in patients hospitalized with pneumonia.Methods: We used the Diagnosis Procedure Combination database, a national inpatient database in Japan, to identify retrospectively patients aged >= 60 years admitted to hospital with pneumonia during the study period of May 1, 2010 to March 31, 2014. We recorded their sex, age, body mass index, severity of pneumonia and comorbidities (including dementia). The outcomes were in-hospital mortality and discharge home. Multivariable Cox regression analysis was performed to analyze factors influencing discharge home.Results: We identified 470,829 patients hospitalized with pneumonia; 45,031 were recorded as having dementia (9.6%). In-hospital mortality was 13.1% and 13.4% in patients with and without dementia, respectively (P = 0.63). The proportions of patients discharged home were 52.9% and 71.3% in patients with and without dementia, respectively (P < 0.001). The adjusted hazard ratio for discharge home for patients with dementia was 0.68 (95% confidence interval, 0.67-0.69; P < 0.001).Conclusions: In-hospital mortality from pneumonia did not differ significantly between patients with and without dementia; however, those with dementia were less likely to be discharged home.
  • Masaaki Nagano, Junji Ichinose, Yusuke Sasabuchi, Jun Nakajima, Hideo Yasunaga
    JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 154 3 1137 - 1143 2017年09月 
    Objective: Although the treatment options for pulmonary arteriovenous malformation are surgery and percutaneous transcatheter embolization, no study has compared the outcomes between these 2 treatments.Methods: From the Japanese Diagnosis Procedure Combination database, the medical records of 996 patients who received treatment for pulmonary arteriovenous malformation between 2010 and 2015 were retrospectively reviewed. We created balanced groups for surgery or percutaneous transcatheter embolization using propensity scoring. The primary outcome was the rate of reintervention for pulmonary arteriovenous malformation, and the secondary outcomes were composite complications and postoperative length of stay. Patients who had any 1 of the complications during hospitalization were considered to have experienced a composite complication.Results: Of the total sample, 211 patients underwent surgery and 785 patients underwent percutaneous transcatheter embolization. By using 1-to-1 propensity score matching, 202 pairs were selected. Compared with percutaneous transcatheter embolization, surgery was associated with a significantly higher proportion of composite complications (6.9% vs 2.0%, P = .027) and longer postoperative length of hospital stay (median, 6 vs 2 days, P < .01). However, surgery resulted in a significantly lower rate of reintervention for pulmonary arteriovenous malformation (2.1% vs 8.3% at 2 years; P < .01).Conclusions: Percutaneous transcatheter embolization had the advantage in composite complications and shorter postoperative length of stay compared with surgery, but surgery had higher curability than percutaneous transcatheter embolization. Surgery may be considered as a therapeutic option for patients with lesions that can be completely resected and are difficult to treat with percutaneous transcatheter embolization.
  • Wakae Hasegawa, Yasuhiro Yamauchi, Hideo Yasunaga, Hideyuki Takeshima, Yukiyo Sakamoto, Taisuke Jo, Yusuke Sasabuchi, Hiroki Matsui, Kiyohide Fushimi, Takahide Nagase
    BMC PULMONARY MEDICINE 17 1 108 - 108 2017年08月 
    Background: Asthma exacerbation may require a visit to the emergency room as well as hospitalization and can occasionally be fatal. However, there is limited information about the prognostic factors for asthma exacerbation requiring hospitalization, and no methods are available to predict an inpatient's prognosis. We investigated the clinical features and factors affecting in-hospital mortality of patients with asthma exacerbation and generated a nomogram to predict in-hospital death using a national inpatient database in Japan.Methods: We retrospectively collected data concerning hospitalization of adult patients with asthma exacerbation between July 2010 and March 2013 using the Japanese Diagnosis Procedure Combination database. We recorded patient characteristics and performed Cox proportional hazards regression analysis to assess the factors associated with all-cause in-hospital mortality. Then, we constructed a nomogram to predict in-hospital death.Results: A total of 19,684 patients with asthma exacerbation were identified; their mean age was 58.8 years (standard deviation, 19.7 years) and median length of hospital stay was 8 days (interquartile range, 5-12 days). Among study patients, 118 died in the hospital (0.6%). Factors associated with higher in-hospital mortality included older age, male sex, reduced level of consciousness, pneumonia, and heart failure. A nomogram was generated to predict the in-hospital death based on the existence of seven variables at admission. The nomogram allowed us to estimate the probability of in-hospital death, and the calibration plot based on these results was well fitted to predict the in-hospital prognosis.Conclusion: Our nomogram allows physicians to predict individual risk of in-hospital death in patients with asthma exacerbation.
  • Yusuke Iizuka, Masamitsu Sanui, Yusuke Sasabuchi, Alan Kawarai Lefor, Mineji Hayakawa, Shinjiro Saito, Shigehiko Uchino, Kazuma Yamakawa, Daisuke Kudo, Kohei Takimoto, Toshihiko Mayumi, Takeo Azuhata, Fumihito Ito, Shodai Yoshihiro, Katsura Hayakawa, Tsuyoshi Nakashima, Takayuki Ogura, Eiichiro Noda, Yoshihiko Nakamura, Ryosuke Sekine, Yoshiaki Yoshikawa, Motohiro Sekino, Keiko Ueno, Yuko Okuda, Masayuki Watanabe, Akihito Tampo, Nobuyuki Saito, Yuya Kitai, Hiroki Takahashi, Iwao Kobayashi, Yutaka Kondo, Wataru Matsunaga, Sho Nachi, Toru Miike, Hiroshi Takahashi, Shuhei Takauji, Kensuke Umakoshi, Takafumi Todaka, Hiroshi Kodaira, Kohkichi Andoh, Takehiko Kasai, Yoshiaki Iwashita, Hideaki Arai, Masato Murata, Masahiro Yamane, Kazuhiro Shiga, Naoto Hori
    CRITICAL CARE 21 1 181 - 181 2017年07月 
    Background: The administration of low-dose intravenous immunoglobulin G (IVIgG) (5 g/day for 3 days; approximate total 0.3 g/kg) is widely used as an adjunctive treatment for patients with sepsis in Japan, but its efficacy in the reduction of mortality has not been evaluated. We investigated whether the administration of low-dose IVIgG is associated with clinically important outcomes including intensive care unit (ICU) and in-hospital mortality.Methods: This is a post-hoc subgroup analysis of data from a retrospective cohort study, the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study. The JSEPTIC DIC study was conducted in 42 ICUs in 40 institutions throughout Japan, and it investigated associations between sepsis-related coagulopathy, anticoagulation therapies, and clinical outcomes of 3195 adult patients with sepsis and septic shock admitted to ICUs from January 2011 through December 2013. To investigate associations between low-dose IVIgG administration and mortalities, propensity score-based matching analysis was used.Results: IVIgG was administered to 960 patients (30.8%). Patients who received IVIgG were more severely ill than those who did not (Acute Physiology and Chronic Health Evaluation (APACHE) II score 24.2 +/- 8.8 vs 22.6 +/- 8.7, p < 0.001). They had higher ICU mortality (22.8% vs 17.4%, p < 0.001), but similar in-hospital mortality (34.4% vs 31.0%, p = 0.066). In propensity score-matched analysis, 653 pairs were created. Both ICU mortality and in-hospital mortality were similar between the two groups (21.0% vs 18.1%, p = 0.185, and 32.9% vs 28.6%, p = 0.093, respectively) using generalized estimating equations fitted with logistic regression models adjusted for other therapeutic interventions. The administration of IVIgG was not associated with ICU or in-hospital mortality (odds ratio (OR) 0.883; 95% confidence interval (CI) 0.655-1.192, p = 0.417, and OR 0.957, 95% CI, 0.724-1.265, p = 0.758, respectively).Conclusions: In this analysis of a large cohort of patients with sepsis and septic shock, the administration of low-dose IVIgG as an adjunctive therapy was not associated with a decrease in ICU or in-hospital mortality.Trial registration: University Hospital Medical Information Network Individual Clinical Trials Registry, UMINCTR000012543. Registered on 10 December 2013.
  • Takuma Maeda, Yusuke Sasabuchi, Hiroki Matsui, Yoshihiko Ohnishi, Shigeki Miyata, Hideo Yasunaga
    JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 31 2 549 - 553 2017年04月 
    Objectives: The present study aimed to examine the association between tranexamic acid (TXA) use and adverse effects (seizures, thromboembolism, and renal dysfunction) in a pediatric cardiac surgery population using a national inpatient database in Japan. The authors also assessed the association between TXA use and other clinical outcomes (length of hospital stay and in-hospital mortality).Design: A nationwide, retrospective cohort study using propensity score analyses.Setting: Japanese Diagnosis Procedure Combination inpatient database.Participants: Pediatric patients who underwent cardiac surgery using cardiopulmonary bypass between July 2010 and March 2014 (N 11,275).Interventions: None.Measurements and Main Results: Propensity-score matching created 3,739 pairs of patients with and without TXA administration. Propensity matched analysis showed that the proportion of seizures was significantly higher in the TXA group than in the non-TXA group (1.6% v 0.2%, difference, 1.4%; 95% confidence interval, 1.0-1.9; p < 0.001). However, none of the other outcomes was significantly different between the groups.Conclusions: TXA use is associated with a significantly increased risk of seizures. However, there is no difference in any other outcomes between the TXA and non-TXA groups. (C) 2017 Elsevier Inc. All rights reserved.
  • Yusuke Sasabuchi, Hiroki Matsui, Hideo Yasunaga, Kiyohide Fushimi
    JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH 71 3 248 - 252 2017年03月 
    Background The Great East Japan Earthquake and subsequent tsunami and nuclear disaster on 11 March 2011 had a short-term influence on the increase in emergency department visits and hospital admissions due to various diseases. However, it remains unclear whether the earthquake and tsunami disaster affected the long-term health conditions of people in the affected areas.Methods Using a national inpatient database in Japan, we investigated people's ambulatory care sensitive conditions (ACSCs), which are defined as conditions for which effective management and treatment should prevent admission to a hospital. We compared the number of admissions for ACSCs before-quake (July 2010 to February 2011) with after-quake (July 2012 to February 2013) periods in the disaster area compared with other areas using a difference-in-differences design. Linear regression models with the interaction between periods and areas were used to estimate the impact of the earthquake on admissions for ACSCs.Results No significant difference in difference was seen in preventable ACSCs (where immunisation and other interventions can prevent illness) or chronic ACSCs (where effective care can prevent flare-ups), while acute ACSCs (where early intervention can prevent more serious progression) increased significantly (3.3 admissions per 100 000 population; 95% CI 0.4 to 6.3; p=0.028).Conclusions Preventable and chronic ACSCs may have increased just after the earthquake and then immediately decreased. However, avoidable admissions due to acute ACSCs remained high in the long term after the earthquake and tsunami disaster.
  • Yukiyo Sakamoto, Yasuhiro Yamauchi, Hideo Yasunaga, Hideyuki Takeshima, Wakae Hasegawa, Taisuke Jo, Yusuke Sasabuchi, Hiroki Matsui, Kiyohide Fushimi, Takahide Nagase
    INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE 12 1605 - 1611 2017年 
    Background and objectives: Patients with chronic obstructive pulmonary disease ( COPD) often experience exacerbations of their disease, sometimes requiring hospital admission and being associated with increased mortality. Although previous studies have reported mortality from exacerbations of COPD, there is limited information about prediction of individual in-hospital mortality. We therefore aimed to use data from a nationwide inpatient database in Japan to generate a nomogram for predicting in-hospital mortality from patients' characteristics on admission.Methods: We retrospectively collected data on patients with COPD who had been admitted for exacerbations and been discharged between July 1, 2010 and March 31, 2013. We performed multivariable logistic regression analysis to examine factors associated with in-hospital mortality and thereafter used these factors to develop a nomogram for predicting in-hospital prognosis.Results: The study comprised 3,064 eligible patients. In-hospital death occurred in 209 patients (6.8%). Higher mortality was associated with older age, being male, lower body mass index, disturbance of consciousness, severe dyspnea, history of mechanical ventilation, pneumonia, and having no asthma on admission. We developed a nomogram based on these variables to predict in-hospital mortality. The concordance index of the nomogram was 0.775. Internal validation was performed by a bootstrap method with 50 resamples, and calibration plots were found to be well fitted to predict in-hospital mortality.Conclusion: We developed a nomogram for predicting in-hospital mortality of exacerbations of COPD. This nomogram could help clinicians to predict risk of in-hospital mortality in individual patients with COPD exacerbation.
  • Yusuke Sasabuchi, Naoyuki Kimura, Junji Shiotsuka, Tetsuya Komuro, Hideyuki Mouri, Tetsu Ohnuma, Kayo Asaka, Alan K. Lefor, Hideo Yasunaga, Atsushi Yamaguchi, Hideo Adachi, Masamitsu Sanui
    ANNALS OF THORACIC SURGERY 102 6 2003 - 2009 2016年12月 
    Background. Although acute kidney injury (AKI) is known as a serious complication after operation for acute type A aortic dissection (AAAD), the long-term impact of AKI remains unclear. The aim of the present study is to investigate the long-term survival in patients with AKI after operation for AAAD.Methods. This study included 403 patients who underwent operation for AAAD from 1990 to 2011 at Jichi Medical University, Saitama Medical Center. Postoperative AKI was identified according to the Kidney Disease Improving Global Outcomes criteria. Kaplan-Meier survival analysis and Cox proportional hazards regression were modeled to analyze the association between the AKI stage and postoperative long-term survival.Results. Of 403 patients, 181 (44.9%) experienced postoperative AKI. Kaplan-Meier estimates for long-term survival were significantly different among patients without AKI and patients with stage 1, 2, and 3 AKI (p < 0.001). Hazard ratios of long-term survival for patients with stages 1, 2, and 3 AKI compared with patients without AKI were 1.38 (95% confidence interval [CI]: 0.84 to 2.26), 1.82 (95% CI: 0.95 to 3.51), and 3.79 (95% CI: 1.95 to 7.37), respectively. More patients with AKI died because of cardiovascular disease after discharge than patients without AKI (1.8% versus 6.0%, p = 0.03).Conclusions. Stage 3 AKI is significantly associated with lower long-term survival after operation for AAAD. Patient follow-up after discharge that focuses on cardiovascular issues may benefit patients who survive AKI after AAAD operation. (C) 2016 by The Society of Thoracic Surgeons
  • Yusuke Sasabuchi, Hiroki Matsui, Alan K. Lefor, Kiyohide Fushimi, Hideo Yasunaga
    CRITICAL CARE MEDICINE 44 7 E464 - E469 2016年07月 
    Objectives: The Surviving Sepsis Campaign Guidelines recommend stress ulcer prophylaxis for patients with severe sepsis who have bleeding risks. Although sepsis has been considered as a risk factor for gastrointestinal bleeding, the effect of stress ulcer prophylaxis has not been studied in patients with severe sepsis. Furthermore, stress ulcer prophylaxis may be associated with an increased risk of hospital-acquired pneumonia or Clostridium difficile infection. The aim of this study was to investigate the risks and benefits of stress ulcer prophylaxis for patients with severe sepsis.Design: Retrospective cohort study.Setting: Five hundred twenty-six acute care hospitals in Japan.Patients: A total of 70,862 patients with severe sepsis.Interventions: None.Measurements and Main Results: One-to-one propensity score matching created 15,651 pairs of patients who received stress ulcer prophylaxis within 2 days of admission and those who did not. Patient characteristics were well balanced between the two groups. No significant differences were seen between the stress ulcer prophylaxis group and the control group with regard to-gastrointestinal bleeding requiring endoscopic hemostasis (0.6% vs 0.5%; p = 0.208), 30-day mortality (16.4% vs 16.9%; p = 0.249), and Clostridium difficile infection (1.4% vs 1.3%; p = 0.588). The stress ulcer prophylaxis group had a significantly higher proportion of hospital-acquired pneumonia (3.9% vs 3.3%; p = 0.012) compared with the control group.Conclusions: Since the rate of gastrointestinal bleeding requiring endoscopic hemostasis is not different comparing patients with and without stress ulcer prophylaxis, and the increase in hospital-acquired pneumonia is significant, routine stress ulcer prophylaxis for patients with severe sepsis may be unnecessary.
  • Kenji Shibuya, Shuhei Nomura, Hiromasa Okayasu, Satoshi Ezoe, Seigo Hara, Yuriko Hara, Takashi Izutsu, Takuma Kato, Shunsuke Mabuchi, Yujiro Maeda, Yuki Murakami, Hiroko Nishimoto, Tomoko Ono, Kayoko Shioda, Atsushi Sorita, Amina Sugimoto, Kazuo Tase, Akihito Watabe, Anne Smith, Sarah K. Abe, Stuart Gilmour, Lawrence O. Gostin, Gavin Yamey, Marco Schaeferhoff, Elina M. Suzuki, Jessica Kraus, Takashi Oshio, Reiko Hayashi, Naoki Kondo, Koichiro Shiba, Hideo Yasunaga, Yusuke Sasabuchi, Yohsuke Takasaki, Naoki Akahane, Shingo Kasahara, Munehito Machida, Satoshi Maruyama, Shuushou Okada, Tadayuki Tanimura, Tomohiko Sugishita, Ikuo Takizawa, Maki Ozawa, Yoshiharu Yoneyama, Hidechika Akashi, Chiaki Miyoshi, Hitoshi Murakami, Toshiro Kumakawa, Satoko Horii, Kenichiro Taneda, Hideaki Shiroyama, Yasushi Katsuma, Makiko Matsuo, Sayako Kanamori, Chiaki Sato, Kayo Yasuda, Jonas Kemp, B. T. Slingsby, Kei Katsuno, Bumpei Tamamura, Keizo Takemi, Hideki Hashimoto, Michael R. Reich
    LANCET 387 10033 2155 - 2162 2016年05月 
    In today's highly globalised world, protecting human security is a core challenge for political leaders who are simultaneously dealing with terrorism, refugee and migration crises, disease epidemics, and climate change. Promoting universal health coverage (UHC) will help prevent another disease outbreak similar to the recent Ebola outbreak in west Africa, and create robust health systems, capable of withstanding future shocks. Robust health systems, in turn, are the prerequisites for achieving UHC. We propose three areas for global health action by the G7 countries at their meeting in Japan in May, 2016, to protect human security around the world: restructuring of the global health architecture so that it enables preparedness and responses to health emergencies; development of platforms to share best practices and harness shared learning about the resilience and sustainability of health systems; and strengthening of coordination and financing for research and development and system innovations for global health security. Rather than creating new funding or organisations, global leaders should reorganise current financing structures and institutions so that they work more effectively and efficiently. By making smart investments, countries will improve their capacity to monitor, track, review, and assess health system performance and accountability, and thereby be better prepared for future global health shocks.
  • Yusuke Sasabuchi, Hideo Yasunaga, Hiroki Matsui, Alan K. Lefor, Kiyohide Fushimi, Masamitsu Sanui
    JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 29 6 1426 - 1431 2015年12月 
    Objectives: Acute kidney injury is a common complication after aortic surgery. Carperitide, a human atrial natriuretic peptide, was reported to be effective for preventing acute kidney injury after cardiac surgery. However, most studies were from single centers, and results of meta-analyses are subject to publication bias. The aim of the present study was to investigate whether carperitide preserved renal function in patients undergoing cardiovascular surgery.Design: Retrospective cohort study.Setting: Participating hospitals (N = 281) in a national database from 2010 to 2013.Participants: Adult patients (N = 47,032) who underwent cardiovascular surgery.Interventions: None.Measurements and Main Results: The main intervention variable investigated was the use of carperitide on the day of surgery. Assessed outcomes included receiving renal replacement therapy within 21 days of surgery and in-hospital mortality. Data were available for 47,032 patients, of whom 2,186 (4.6%) received carperitide on the day of surgery. Multivariate logistic regression analysis revealed that carperitide was significantly associated with a greater likelihood of receiving renal replacement therapy within 21 days of surgery, but not with in-hospital mortality.Conclusions: In patients undergoing cardiovascular surgery, carperitide significantly increased the odds of receiving renal replacement therapy within 21 days after surgery. (C) 2015 Elsevier Inc. All rights reserved.
  • Kojiro Morita, Yusuke Sasabuchi, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
    INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY 21 5 604 - 609 2015年11月 
    OBJECTIVES: The timing of cardiac surgery for infective endocarditis with ischaemic stroke remains controversial.METHODS: Using a nationwide inpatient database in Japan, we conducted a retrospective observational study. We identified patients aged 20 years or older with ischaemic stroke on admission who were diagnosed with infective endocarditis and underwent cardiac surgery during the initial hospitalization between July 2010 and March 2013. In-hospital mortality and perioperative complications were compared between the early (<= 7 days) and late (>7 days) surgery groups using logistic regression analyses with adjustment for propensity scores and inverse probability of treatment weighting.RESULTS: We identified 253 patients who underwent cardiac valve surgery for infective endocarditis with ischaemic stroke on admission. In-hospital mortality rates were 8.6 and 9.5% in the early (n = 105) and late (n = 148) surgery groups, respectively. There were no significant differences in the in-hospital mortality between the early and late surgery groups in the propensity score-adjusted model [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.35-2.54] and inverse probability-weighted model (risk difference, -0.82%; 95% CI, -6.43 to 4.84%). The perioperative complication rates were 42.9 and 37.8% in the early and late surgery groups, respectively, and showed no significant differences in the propensity score-adjusted model (OR, 1.11; 95% CI, 0.63-1.97) and inverse probability-weighted model (risk difference, 1.54%; 95% CI, -7.13 to 10.2%).CONCLUSIONS: Early timing of surgery for infective endocarditis patients with ischaemic stroke was not associated with higher in-hospital mortality or complications after admission. Early timing of surgery may not be contraindicated for infective endocarditis patients with ischaemic stroke.
  • Hayato Yamana, Hiroki Matsui, Yusuke Sasabuchi, Kiyohide Fushimi, Hideo Yasunaga
    JOURNAL OF CLINICAL EPIDEMIOLOGY 68 9 1028 - 1035 2015年09月 
    Objectives: Comorbidity measures are widely used in administrative databases to predict mortality. The Japanese Diagnosis Procedure Combination database is unique in that secondary diagnoses are recorded into subcategories, and procedures are precisely recorded. We investigated the influence of these features on the performance of mortality prediction models.Study Design and Setting: We obtained data of adult patients with main diagnosis of acute myocardial infarction, congestive heart failure, acute cerebrovascular disease, gastrointestinal hemorrhage, pneumonia, or septicemia during a I-year period. Multiple models were constructed representing different subcategories from which Charlson and Elixhauser comorbidities were extracted. Prevalence of comorbidities and C statistics of logistic regression models predicting in-hospital mortality was compared. Associations between four procedures (computed tomography, oxygen administration, urinary catheter, and vasopressors) and mortality were also evaluated.Results: C statistics of the model using all secondary diagnoses (Charlson: 0.717; Elixhauscr: 0.762) were greater than those using a limited subcategory to strictly specify comorbidities (Charlson: 0.708; Elixhauser: 0.744). However, misidentification of complications and main diagnoses as comorbidities was observed in the all-diagnosis model. The four procedures were associated with mortality.Conclusion: Subcategorized diagnoses allowed correct identification of comorbidities and procedures predicted mortality. Incorporation of these two features should be considered for other administrative databases. (C) 2015 Elsevier Inc. All rights reserved.
  • Yusuke Sasabuchi, Hideo Yasunaga, Hiroki Matsui, Alan T. Lefor, Hiromasa Horiguchi, Kiyohide Fushimi, Masamitsu Sanui
    RESPIRATORY CARE 60 7 983 - 991 2015年07月 
    BACKGROUND: Obesity has been associated with increased mortality in the general population, whereas a paradoxical relationship between higher body mass index and lower mortality has been referred to as the obesity paradox in critically ill patients. However, it remains unknown whether a particular subgroup is most affected. The aim of the present study is to elucidate whether obesity is associated with lower mortality in the ICU population by comparing subjects with and without mechanical ventilation. METHODS: A total of 334,238 subjects from a nationwide database who were discharged between July 2010 and March 2012 and who were admitted to general ICUs during their hospitalization were included in this study. The primary outcome was in-hospital mortality. RESULTS: Of all subjects evaluated, 23.3% were started on mechanical ventilation within the first 2 d after ICU admission. Compared with the non-ventilated group, the ventilated group was more likely to have sepsis, pneumonia, or coma. The ventilated group underwent more procedures within the first 2 d after ICU admission compared with the non-ventilated group. A restricted cubic spline function showed lower mortality in subjects with a higher body mass index among the ventilated group, whereas mortality was increased with increasing body mass index in the non-ventilated group. CONCLUSIONS: This study shows that a high body mass index is associated with low mortality in the mechanically ventilated group, whereas the non-ventilated group showed a reverse J-shaped association. There was a higher mortality rate in underweight subjects in both groups.
  • Yusuke Sasabuchi, Hideo Yasunaga, Hiroki Matsui, Alan K. Lefor, Hiromasa Horiguchi, Kiyohide Fushimi, Masamitsu Sanui
    CRITICAL CARE MEDICINE 43 6 1239 - 1245 2015年06月 
    Objectives: A volume-outcome relationship in ICU patients has been suggested in recent studies. However, it is unclear whether the ICU-to-hospital bed ratio affects the volume-outcome relationship. The aim of this study is to investigate the relationship between hospital volume and in-hospital mortality of adult ICU patients in relation to the ratio of ICU beds to regular hospital beds.Design: Retrospective cohort study.Setting: Four hundred seventy-seven Japanese hospitals from 2007 to 2012 in the Japanese Diagnosis Procedure Combination database.Patients: A total of 596,143 patients discharged from acute care hospitals.Interventions: None.Measurements and Main Results: We analyzed data from 596,143 ICU patients from 2007 through 2012 using a nationwide administrative database. Patients were categorized into nine subgroups (the tertiles of hospital volume of ICU patients combined with the tertiles of ICU-to-hospital bed ratio). Multivariable logistic regression analyses were performed to examine the concurrent effects of hospital volume of ICU patients and ICU-to-hospital bed ratio on in-hospital mortality, with adjustment for patient and hospital characteristics. Higher hospital volume of ICU patients and a higher ICU-to-hospital bed ratio were independently associated with lower mortality. When patients were stratified by ICU-to-hospital bed ratio categories, in-hospital mortality was significantly lower in the high-volume subgroup (odds ratio, 0.74; 95% CI, 0.58-0.93) compared with the low-volume subgroup in hospitals with a high ICU-to-hospital bed ratio. However, these relationships were not significant in hospitals with low ICU-to-hospital bed ratios (odds ratio, 0.94; 95% CI, 0.59-1.50) or in hospitals with intermediate ICU-to-hospital bed ratios (odds ratio, 0.80; 95% CI, 0.71-1.08).Conclusions: An inverse relationship between hospital volume of ICU patients and mortality was seen only when the ICU-to-hospital bed ratio was sufficiently high. Regionalization and increasing the number of ICU beds in referral centers may improve patient outcomes.
  • Tetsu Ohnuma, Naoyuki Kimura, Yusuke Sasabuchi, Kayo Asaka, Junji Shiotsuka, Tetsuya Komuro, Hideyuki Mouri, Alan T. Lefor, Hideo Adachi, Masamitsu Sanui
    HEART AND VESSELS 30 3 355 - 361 2015年05月 [査読有り][通常論文]
     
    Little evidence exists regarding the need for a reduction in postoperative heart rate after repair of type A acute aortic dissection. This single-center retrospective study was conducted to determine if lower heart rate during the early postoperative phase is associated with improved long-term outcomes after surgery for patients with type A acute aortic dissection. We reviewed 434 patients who underwent aortic repair between 1990 and 2011. Based on the average heart rate on postoperative days 1, 3, 5, and 7, 434 patients were divided into four groups, less than 70, 70-79, 80-89, and greater than 90 beats per minute. The mean age was 63.3 +/- 12.1 years. During a median follow-up of 52 months (range 16-102), 10-year survival in all groups was 67 %, and the 10-year aortic event-free rate was 79 %. The probability of survival and being aortic event-free using Kaplan-Meier estimates reveal that there is no significant difference when stratified by heart rate. Cox proportional regression analysis for 10-year mortality shows that significant predictors of mortality are age [Hazard Ratio (HR) 1.04; 95 % confidence interval (CI) 1.07-1.06; p = 0.001] and perioperative stroke (HR 2.30; 95 % CI 1.18-4.50; p = 0.024). Neither stratified heart rate around the time of surgery nor beta-blocker use at the time of discharge was significant. There is no association between stratified heart rate in the perioperative period with long-term outcomes after repair of type A acute aortic dissection. These findings need clarification with further clinical trials.
  • Naoyuki Kimura, Tetsu Ohnuma, Satoshi Itoh, Yusuke Sasabuchi, Kayo Asaka, Junji Shiotsuka, Koichi Adachi, Koich Yuri, Harunobu Matsumoto, Atsushi Yamaguchi, Masamitsu Sanui, Hideo Adachi
    AMERICAN JOURNAL OF CARDIOLOGY 113 4 724 - 730 2014年02月 [査読有り][通常論文]
     
    The Penn classification, a risk assessment system for acute type A aortic dissection (AAAD), is based on preoperative ischemic conditions. We investigated whether Penn classes predict outcomes after surgery for AAAD. Three hundred fifty-one patients with DeBakey type I AAAD treated surgically, January 1997 to January 2011, were divided into 4 groups per Penn class: Aa (no ischemia, n = 187), Ab (localized ischemia with branch malperfusion, n = 67), Ac (generalized ischemia with circulatory collapse, n = 46), and Abc (localized and generalized ischemia, n = 51). Early and late outcomes were compared between groups. In-hospital mortality was 3% (6 of 187) for Penn Aa, 6% (4 of 67) for Penn Ab, 17% (8 of 46) for Penn Ac, and 22% (11 of 51) for Penn Abc. Multivariate logistic regression analysis showed Penn classes Ac and Abc, operation time >6 hours, and entry in the descending thoracic aorta to be risk factors for in-hospital mortality. Incidences of neurologic, respiratory, and hepatic complications differed between groups. Five-year cumulative survival was 85% in the Penn Aa group, 74% in the Penn Ab group (p = 0.027 vs Penn Aa), 78% in the Penn Ac group, and 67% in the Penn Abc group (p <0.001 vs Penn Aa). In conclusion, morbidity and mortality are high in patients with generalized ischemia. The Penn classification appears to be a useful risk assessment system for AAAD, predictive of outcomes. (C) 2014 Elsevier Inc. All rights reserved.
  • Kayo Asaka, Tetsu Ohnuma, Norio Iwamoto, Junji Shiotsuka, Michio Nagashima, Yusuke Sasabuchi, Tetsuya Komuro, Takeshi Fukatsu, Masamitsu Sanui
    CRITICAL CARE MEDICINE 40 12 U208 - U208 2012年12月
  • Tetsu Ohnuma, Naoyuki Kimura, Junji Shiotsuka, Yusuke Sasabuchi, Tetsuya Komuro, Hideyuki Mouri, Kayo Asaka, Alan Lefor, Hideo Adachi, Masamitsu Sanui
    CRITICAL CARE MEDICINE 40 12 U188 - U188 2012年12月
  • Kenji Itou, Tatsuya Fukuyama, Yusuke Sasabuchi, Hiroyuki Yasuda, Norihito Suzuki, Hajime Hinenoya, Chol Kim, Masamitsu Sanui, Hideki Taniguchi, Hideki Miyao, Norimasa Seo, Mamoru Takeuchi, Yasuhide Iwao, Atsuhiro Sakamoto, Yoshihisa Fujita, Toshiyasu Suzuki
    JOURNAL OF ANESTHESIA 26 1 20 - 27 2012年02月 
    In many countries, patients are generally allowed to have clear fluids until 2-3 h before surgery. In Japan, long preoperative fasting is still common practice. To shorten the preoperative fasting period in Japan, we tested the safety and efficacy of oral rehydration therapy until 2 h before surgery.Three hundred low-risk patients scheduled for morning surgery in six university-affiliated hospitals were randomly assigned to an oral rehydration solution (ORS) group or to a fasting group. Patients in the ORS group consumed up to 1,000 ml of ORS containing balanced glucose and electrolytes: 500 ml between 2100 the night before surgery and the time they woke up the next morning and 500 ml during the morning of surgery until 2 h before surgery. Patients in the fasting group started fasting at 2100 the night before surgery. Primary endpoints were gastric fluid volume and pH immediately after anesthesia induction. Several physiological measures of hydration and electrolytes including the fractional excretion of sodium (FENa) and the fractional excretion of urea nitrogen (FEUN) were also evaluated.Mean (SD) gastric fluid volume immediately after anesthesia induction was 15.1 (14.0) ml in the ORS group and 17.5 (23.2) ml in the fasting group (P = 0.30). The mean difference between the ORS group and fasting group was -2.5 ml. The 95% confidence interval ranged from -7.1 to +2.2 ml and did not include the noninferior limit of +8 ml. Mean (SD) gastric fluid pH was 2.1 (1.9) in the ORS group and 2.2 (2.0) in the fasting group (P = 0.59). In the ORS group, mean FENa and FEUN immediately after anesthesia induction were both significantly greater than those in the fasting group (P < 0.001 for both variables). The ORS group reported they had been less thirsty and hungry before surgery (P < 0.001, 0.01).Oral rehydration therapy until 2 h before surgery is safe and feasible in the low-risk Japanese surgical population. Physicians are encouraged to use this practice to maintain the amount of water in the body and electrolytes and to improve the patient's comfort.

書籍

MISC

  • レセプトデータを活用した臨床疫学研究
    笹渕 裕介 日本糖尿病情報学会年次学術集会プログラム・抄録集 20回 20 -20 2020年09月
  • 笹渕 裕介, 康永 秀生 Precision Medicine 2 (8) 710 -713 2019年07月 
    大規模災害に対して地域医療が果たす役割は大きいと考えられる。しかし、それを定量的に評価した研究は少ない。これまで我々は、東日本大震災および熊本県地震後に「適切な外来診療を受けることで避けられる入院(Ambulatory Care Sensitive Condition:ACSC)」が増加する実態を、医療ビッグデータを用いた研究で明らかにしてきた。本稿ではこれらの研究結果を紹介し、大規模災害に対する備えという観点から医療ビッグデータの可能性について考察する。(著者抄録)
  • Rapid Response System起動から現場到着までの時間に影響を及ぼす因子
    増山 智之, 小室 哲也, 笹渕 裕介, 塩塚 潤二, 岩崎 夢大, 窪田 佳史, 喜久山 和貴, 梶原 絢子, 讃井 將満, In-Hospital Emergency Study Group 日本集中治療医学会雑誌 26 (Suppl.) [O107 -4] 2019年02月
  • 田中 栄, 康永 秀生, 笹渕 裕介, 筑田 博隆 Bone Joint Nerve 9 (1) 125 -136 2019年01月
  • レセプトデータを用いた外来経口抗菌薬使用実態の疫学解析
    橋本 英樹, 畠山 修司, 松居 宏樹, 笹渕 裕介, 康永 秀生 日本化学療法学会雑誌 66 (Suppl.A) 370 -370 2018年04月
  • 腎嚢胞を合併する腹部大動脈瘤の臨床像と治療成績に関する検討
    中野 光規, 木村 直行, 野中 崇央, 板垣 翔, 堀 大治郎, 由利 康一, 笹渕 裕介, 花岡 一成, 松本 春信, 山口 敦司 日本外科学会定期学術集会抄録集 118回 1189 -1189 2018年04月
  • DPCデータを用いた女性気胸の解析 月経随伴性気胸を中心に
    桧山 紀子, 笹渕 裕介, 城 大祐, 平田 哲也, 大須賀 穣, 中島 淳, 康永 秀生 日本外科学会定期学術集会抄録集 118回 2509 -2509 2018年04月
  • 社会保険対策委員会の活動報告
    土井 松幸, 武居 哲洋, 坂本 哲也, 森崎 浩, 上田 恭敬, 讃井 將満, 八木橋 智子, 笹渕 裕介, 林田 賢史, 志馬 伸朗 日本集中治療医学会雑誌 25 (Suppl.) [CP14 -2] 2018年02月
  • 待機的腹部大動脈瘤開腹手術におけるAcute kidney injury発生因子に関する検討
    野中 崇央, 木村 直行, 松本 春信, 中野 光規, 板垣 翔, 堀 大治郎, 由利 康一, 讃井 將満, 笹渕 裕介, 山口 敦司 日本心臓血管外科学会学術総会抄録集 48回 221 -221 2018年02月
  • 大日方 大亮, 杉原 亨, 山口 健哉, 康永 秀生, 松居 宏樹, 笹渕 裕介, 松井 強, 持田 淳一, 本間 之夫, 高橋 悟 Japanese Journal of Endourology 30 (3) 196 -196 2017年11月
  • 笹渕 裕介 Intensivist 9 (4) 1035 -1041 2017年10月
  • 腹部CT実施割合と虫垂切除術後合併症との関連 DPCデータを用いた病院特性の解析
    太田 孝志, 康永 秀生, 笹渕 裕介, 高須 朗 日本救急医学会雑誌 28 (9) 641 -641 2017年09月
  • ビッグデータ時代の外科医療 肺動静脈瘻に対する肺切除術と経皮カテーテル塞栓術の比較 診断群分類包括評価データベースを用いた検討
    長野 匡晃, 一瀬 淳二, 笹渕 裕介, 中島 淳, 康永 秀生 日本外科学会定期学術集会抄録集 117回 SY -5 2017年04月
  • 本邦における半月手術の年次推移 DPCデータベースを用いた解析
    河田 学, 笹渕 裕介, 武冨 修治, 乾 洋, 松居 宏樹, 伏見 清秀, 筑田 博隆, 康永 秀生, 田中 栄 日本整形外科学会雑誌 91 (3) S1014 -S1014 2017年03月
  • 小児人工呼吸患者の鎮静 プロポフォールとミダゾラムの比較
    笹渕 裕介, 康永 秀生, 松居 宏樹, Lefor Alan, 伏見 清秀 日本集中治療医学会雑誌 24 (Suppl.) O3 -1 2017年02月
  • 小児外傷患者においてトラネキサム酸の使用は安全か
    前田 琢磨, 笹渕 裕介, 宮田 茂樹, 大西 佳彦, 康永 秀生 日本集中治療医学会雑誌 24 (Suppl.) DP149 -4 2017年02月
  • 笹渕 裕介 Intensivist 9 (1) 232 -236 2017年01月
  • 笹渕 裕介 Intensivist 8 (4) 953 -957 2016年10月
  • 前田 琢磨, 笹渕 裕介, 宮田 茂樹, 大西 佳彦, 康永 秀生 Cardiovascular Anesthesia 20 (Suppl.) 242 -242 2016年09月
  • 笹渕 裕介 Intensivist 8 (3) 694 -698 2016年07月
  • 笹渕 裕介 Intensivist 8 (2) 482 -486 2016年04月
  • DPCデータの解析による女性気胸の疫学的特徴
    桧山 紀子, 平田 哲也, 笹渕 裕介, 桑野 秀規, 長山 和弘, 似鳥 純一, 安樂 真樹, 佐藤 雅昭, 大須賀 穣, 康永 秀生, 中島 淳 日本呼吸器外科学会雑誌 30 (3) O14 -4 2016年04月
  • 重症敗血症に対するストレス潰瘍予防の効果
    笹渕 裕介, 松居 宏樹, Lefor Alan, 伏見 清秀, 康永 秀生 日本集中治療医学会雑誌 23 (Suppl.) 391 -391 2016年01月
  • 重症患者におけるスボレキサントのせん妄発症に与える影響
    増山 智之, 吉田 直人, 飯塚 悠祐, 小室 哲也, 神尾 直, 小林 雅矢, 八木橋 智子, 笹渕 裕介, 讃井 將満 日本集中治療医学会雑誌 23 (Suppl.) 408 -408 2016年01月
  • 集中治療室の病床規模によって重症患者の年間施設別症例数とアウトカムの関係が変化するか
    笹渕 裕介, 康永 秀生, 松居 宏樹, Lefor Alan, 堀口 裕正, 伏見 清秀, 讃井 將満 日本集中治療医学会雑誌 23 (Suppl.) 485 -485 2016年01月
  • 小室 哲也, 讃井 將満, 塩塚 潤二, 笹渕 裕介, 毛利 英之, 大沼 哲 日本集中治療医学会雑誌 21 (2) 185 -186 2014年03月 
    75歳女。4年前、1年前にそれぞれ胸腹部大動脈瘤(TAAA)、遠位弓部大動脈瘤に対する人工血管置換術が施行された。今回、下行大動脈の残存瘤に対し胸部大動脈瘤ステントグラフト内挿術(TEVAR)が行われた。手術前日に脳脊髄液ドレナージ(CSFD)カテーテルが留置され、脳脊髄液の流出は良好で挿入時の合併症を認めなかった。手術は全身麻酔下に行われ、脊髄灌流維持のため平均動脈圧70mmHg以上を目標に管理した。CSFDは麻酔開始時から終了まで開放した。術中に特記すべき所見を認めず抜管後ICUに入室した。麻酔覚醒不良を考え経過観察したが、3時間経過しても意識の改善がないため、緊急頭部CT検査を施行し、左硬膜下血腫を認めた。緊急開頭血腫除去術および外減圧術を施行した。術後1日目に意識が改善し抜管した。その後経過は良好で術後30日目に退院した。
  • 帝王切開後に腹腔穿刺所見から腸管穿孔による汎発性腹膜炎を診断しえた症例
    小室 哲也, 塩塚 潤二, 笹渕 裕介, 長島 道生, 毛利 英之, 大沼 哲, 川村 愛, 松尾 耕一, 讃井 將満 日本集中治療医学会雑誌 20 (Suppl.) 322 -322 2013年01月
  • 遷延性の高乳酸血症で発見された開心術後非閉塞性腸管虚血症の一例
    長島 道生, 讃井 將満, 川村 愛, 大沼 哲, 毛利 英之, 小室 哲也, 笹渕 裕介, 松尾 耕一, 塩塚 潤二 日本集中治療医学会雑誌 20 (Suppl.) 431 -431 2013年01月
  • 笹渕 裕介, 土屋 留美, 岩谷 理恵子 呼吸器ケア 10 (2) 178 -193 2012年02月
  • 笹渕 裕介, 土屋 留美, 岩谷 理恵子 呼吸器ケア 10 (1) 78 -92 2012年01月
  • 繰り返しの心エコー図検査で発見された感染性心内膜炎の一例
    小室 哲也, 毛利 英之, 大沼 哲, 笹渕 裕介, 塩塚 潤二, 讃井 將満 日本集中治療医学会雑誌 19 (Suppl.) 338 -338 2012年01月
  • ECMO管理中の諸問題
    大戸 美智子, 小室 哲也, 山下 和人, 石岡 春彦, 笹渕 裕介, 下園 崇宏, 塩塚 潤二, 讃井 將満, 大沼 哲 日本集中治療医学会雑誌 18 (Suppl.) 233 -233 2011年01月
  • テーパー型カフ付き気管チューブの垂れ込み予防効果の検討
    塩塚 潤二, 讃井 將満, 笹渕 裕介, 堀口 敦史, 下園 崇宏, 山下 和人, 大戸 美智子, 小室 哲也, 石岡 春彦, 毛利 英之 日本集中治療医学会雑誌 18 (Suppl.) 242 -242 2011年01月
  • 脳梗塞により発見された非細菌性血栓性心内膜炎の症例
    塩塚 潤二, 讃井 將満, 下薗 崇宏, 笹渕 裕介, 山下 和人, 大戸 美智子, 小室 哲也, 石岡 春彦, 堤 祐介, 毛利 英之 日本集中治療医学会雑誌 18 (Suppl.) 266 -266 2011年01月
  • 重症敗血症もしくは敗血症性ショック発見から抗菌薬投与までの時間の検討
    大沼 哲, 大戸 美智子, 小室 哲也, 石岡 春彦, 山下 和人, 笹渕 裕介, 下薗 崇宏, 塩塚 潤二, 讃井 將満 日本集中治療医学会雑誌 18 (Suppl.) 314 -314 2011年01月
  • 早期肩甲帯離断により救命しえた壊死性筋膜炎の一例
    榎本 真也, 大沼 哲, 小室 哲也, 石岡 春彦, 大戸 美智子, 山下 和人, 笹渕 裕介, 下園 崇宏, 塩塚 潤二, 讃井 將満 日本集中治療医学会雑誌 18 (Suppl.) 316 -316 2011年01月
  • 食道裂孔ヘルニアに合併した胃軸捻転により閉塞性ショックをきたした一例
    松尾 耕一, 小野澤 裕史, 原田 龍一, 山下 和人, 笹渕 裕介, 下園 崇宏 日本集中治療医学会雑誌 18 (Suppl.) 346 -346 2011年01月
  • 【ALI/ARDS 68の謎を解く】原疾患編 心肺バイパスによるALI/ARDSの特徴は?
    笹渕 裕介, 讃井 將満 救急・集中治療 22 (9-10) 1143 -1146 2010年10月 
    <point>●心肺バイパスによるALI/ARDSは回路と血液の接触によりひき起こされるとする説が最も有力である。●心肺バイパスを避ける以外に確立された予防法、治療法は存在しない。●全身管理については、他の原因によるALI/ARDSと同様である。(著者抄録)
  • 緊急腹部大血管手術後に血液培養陽性且つ腸管合併症を発症した3症例の検討 腸管虚血の警鐘としての意義
    石岡 春彦, 飯塚 悠佑, 上田 直美, 堤 祐介, 大戸 美智子, 山下 和人, 笹渕 裕介, 塩塚 潤二, 松尾 耕一, 讃井 將満 日本集中治療医学会雑誌 17 (Suppl.) 280 -280 2010年01月
  • 大動脈解離術後にショックを繰り返しHITの診断に難渋した症例
    上田 直美, 讃井 將満, 山下 和人, 塩塚 潤二, 笹渕 裕介, 下薗 崇宏, 大戸 美智子, 石岡 春彦, 堤 祐介 日本集中治療医学会雑誌 17 (Suppl.) 282 -282 2010年01月
  • 重症急性胆石性膵炎に対する緊急内視鏡的逆行性胆道膵管造影(ERCP)のEBM的検証
    大沼 哲, 岩城 孝明, 石岡 春彦, 山下 和人, 笹渕 裕介, 下薗 崇宏, 塩塚 潤二, 讃井 將満 日本集中治療医学会雑誌 17 (Suppl.) 290 -290 2010年01月
  • 人工呼吸中の頭部挙上角度および体位に対するプラカードによる介入の効果
    笹渕 裕介, 上田 直美, 石岡 春彦, 堤 祐介, 山下 和人, 大戸 美智子, 下薗 崇宏, 塩塚 潤二, 讃井 將満 日本集中治療医学会雑誌 17 (Suppl.) 347 -347 2010年01月
  • 筋生検にて診断した重症critical illness myopathyの一症例
    山下 和人, 塩塚 潤二, 下薗 崇宏, 笹渕 裕介, 大戸 美智子, 石岡 春彦, 堤 祐介, 上田 直美, 讃井 將満 日本集中治療医学会雑誌 17 (Suppl.) 367 -367 2010年01月
  • 腸管吻合後の内ヘルニアにより上腸間膜静脈閉塞をきたし、術後に全小腸壊死を起こした症例
    下薗 崇宏, 大沼 哲, 大戸 美智子, 上田 直美, 堤 祐介, 山下 和人, 笹渕 裕介, 石岡 春彦, 塩塚 潤二, 讃井 將満 日本集中治療医学会雑誌 17 (Suppl.) 379 -379 2010年01月
  • 油田 さや子, 坂巻 文雄, 笹渕 裕介, 関根 亜由美, 谷山 大輔, 田中 若恵, 勝井 智子, 宮原 裕美, 栗原 亜子, 杉浦 八十生, 今津 嘉弘, 関口 芳弘 Therapeutic Research 29 (10) 1741 -1743 2008年10月 
    37歳女。患者は他院で特発性肺動脈高血圧症(IPAH)を指摘され、エポプロステノール持続静脈内投与、シルデナフィル内服を継続していた。しかし、その後、急激な腹痛が出現し、消化管穿孔による汎発性腹膜炎が疑われた。緊急開腹手術を施行したところ、術中所見により十二指腸潰瘍穿孔による腹膜炎と診断され、大網充填術が行なわれた。NYHA IV、心臓超音波所見、右軸偏位を示す心電図、BNP高値・Cr上昇等、ハイリスクな手術であったと考えられたが、IPAH患者の周術期管理では可能な限り治療薬を継続させることが重要であることから、エポプロステノールを継続するとともに、術前からプロスタグランジンE1、ドパミン、ドブタミンを持続投与した。術直後にはミルリノンを開始したことで、循環動態を安定させることができた。以後、手術より5日経過で一般病棟へ移動し、9日目に前医へ転院可能となった。
  • 上部消化管穿孔にて緊急手術となった特発性肺動脈高血圧症の一例
    笹渕 裕介, 金井 琢磨, 星野 真里子, 杉田 知子, 関口 芳弘 日本臨床麻酔学会誌 28 (6) S260 -S260 2008年10月
  • 側彎症に対する手術中にモニタリングの異常を認め、術後一過性の麻痺を呈した一例
    笹渕 裕介, 金井 琢磨, 牧野 隆司, 杉田 知子, 星野 真里子, 関口 芳弘 日本臨床麻酔学会誌 27 (6) S204 -S204 2007年09月
  • 手に発生した骨化性筋炎の1例
    笹渕 裕介, 鳥越 知明, 寺門 厚彦, 内藤 聖人, 黒澤 尚 関東整形災害外科学会雑誌 36 (1) 37 -37 2005年02月


Copyright © MEDIA FUSION Co.,Ltd. All rights reserved.