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IntroductionThe efficacy of early surgery in preventing complications among Japanese elderly patients with hip fractures requires further investigation. This study aims to use a comprehensive Japanese hip fracture case database to determine whether surgery within the day of admission and the following day reduces the incidence of complications and mortality during hospitalization in elderly hip fracture patients.Materials and methodsWe retrospectively analyzed the Japanese National Administrative DPC (Diagnosis Procedure Combination) database from April 2016 to March 2022. Approximately 1100 DPC-affiliated hospitals consistently provided medical records with consent for research. The study investigated the association between postoperative pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization after propensity score matching, focusing on surgeries conducted on the day of admission and the following day.ResultsAfter one-to-one propensity score matching for age, gender, and comorbidity, we identified 146,441 pairs of patients who underwent surgery either within the day of admission and the following day or after the third day of admission. Surgery on the third day or later was independently associated with increased risks of pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization with risk ratios of 1.367 (95% CI 1.307–1.426), 1.328 (95% CI 1.169–1.508), 1.338 (95% CI 1.289–1.388), and 1.167 (95% CI 1.103–1.234), respectively.ConclusionA comprehensive study of elderly Japanese patients with hip fractures in the DPC database showed that surgery on admission and the following day is crucial for preventing complications like pneumonia, deep vein thrombosis, pulmonary embolism, and mortality during hospitalization.

In February 2013, Japan became the first country in the world to cover Helicobacter pylori eradication for chronic gastritis under its National Health Insurance (NHI) system. Now that eradication therapy is covered by NHI, its usage has increased dramatically, and gastric cancer deaths have begun to decrease. We undertook a detailed epidemiological analysis to investigate effects of expanded NHI coverage for H. pylori eradication therapy on gastric cancer deaths in specific age groups. Numbers of gastric cancer deaths were determined by referencing data from Ministry of Health, Labour and Welfare reports and “Cancer Statistics in Japan – 2018” published by the Foundation for Promotion of Cancer Research. Gastric cancer deaths across all age groups have been clearly decreasing since 2013, but deaths of people aged 80 years and older are still increasing. The number of gastric cancer deaths in people aged in their 80s was 2 times higher than in people aged in their 70s and 4 times higher than in people aged in their 60s. The number of people in their 80s who had an endoscopy was less than half that of people in their 60s and 70s. The eradication therapy has increased dramatically, and gastric cancer deaths are clearly decreasing in Japan. However, this decrease in deaths has not extended to elderly adults aged in their 80s, which suggests that measures to prevent gastric cancer in people aged 80 years and older will be critical to achieving the mission of eliminating gastric cancer in Japan. Japan became the first country to cover H. pylori eradication for chronic gastritis under its insurance system. The eradication therapy has increased dramatically, and gastric cancer deaths are clearly decreasing.

Introduction The risk of postoperative sequelae and in-hospital mortality in Japanese patients aged 90 years and older with hip fractures is unexplored. This study aims to use a comprehensive medical claims database in Japan to compare super-elderly patients aged 90 years and older with elderly aged 65–89 and clarify the risk of sequelae and in-hospital mortality in super-elderly patients. Materials and methods We retrospectively analyzed the Diagnosis Procedure Combination (DPC) database for all of Japan from April 2016 to March 2022. Medical records from approximately 1100 DPC-related hospitals were provided with consistent consent during this period. In this study, we focused on super-elderly patients and examined the association with the risk of postoperative pneumonia, pulmonary embolism, myocardial infarction, urinary tract infection, acute renal dysfunction, subsequent cognitive dysfunction, and in-hospital mortality after one-to-one propensity score matching. Results After performing propensity score matching based on sex and comorbidities, 129,953 pairs of patients were identified. These pairs were compared to elderly and super-elderly patients. The results of this study showed that compared with hip fractures in the elderly, hip fractures in the super-elderly were associated with an increased risk of pneumonia, urinary tract infection, acute renal dysfunction, subsequent cognitive dysfunction, and in-hospital mortality after adjustment for confounders. The odds ratio of in-hospital mortality was 2.190 (95% CI 2.062–2.325). Conclusion As it has been shown that super-elderly patients with hip fractures are at greater risk of respiratory and urinary tract infections and increased in-hospital mortality, careful attention should be required for perioperative management.

Although the rate of total hip arthroplasty (THA) is declining among rheumatoid arthritis (RA) patients, the complex etiology of RA and associated immunomodulatory therapies may contribute to elevated risks of postoperative complications. This study aimed to evaluate in-hospital complications following THA in RA patients compared to osteoarthritis (OA) patients using a Japanese nationwide database. This retrospective study analyzed data from the Diagnosis Procedure Combination database, including THA patients between December 2011 and March 2023. The RA and OA groups were matched in a one-to-three ratio using propensity scores, considering factors such as age, sex, and comorbidities. Multivariate logistic regression was conducted to assess independent risk factors for complications. Among 353,465 patients, 3,977 underwent THA for RA and 298,326 for OA. After matching, 3,951 RA and 11,853 OA patients were included. RA was an independent risk factor for dislocation (OR: 2.783, 95% CI 1.641–4.720) and reoperation (OR: 2.254, 95% CI 1.687–3.013). No significant differences were observed in infection, periprosthetic fracture, venous thromboembolism, or mortality. RA patients undergoing THA are at higher risk for dislocation and reoperation. These findings emphasize the need for careful surgical planning and implementation to improve outcomes in RA patients.

IntroductionOnly a few large-scale studies have examined the care gap in Japan. The aim of this study was to investigate the persistence of and adherence to osteoporosis pharmacotherapy in Japan.Materials and MethodsThe rates of continuation (persistence) of and adherence to osteoporosis pharmacotherapy were investigated using medical insurance data, issued from July 2013 to December 2018, from the medical care system for elderly individuals in Hokkaido, Japan.ResultsThe study included 7918 male and 52,585 female patients. Persistence rates were 62.1% in the first year and 45.3% in the second year. There were 33,096 patients who discontinued medication; 8296 patients resumed medication during the observation period of 730 days. The median time to the discontinuation of medication for all the patients was 702 days. The 2-year medication possession ratio (MPR) was 63.8%; 30,989 patients (51.2%) had an MPR ≥ 80% and 20,788 (34.4%) had an MPR < 50%. Both the persistence and adherence were better in females than in males and worsened with increasing age. Comparisons of fracture history showed that persistence and MPR were higher in the no hip or vertebral fracture group, followed by hip fracture, vertebral fracture, and hip and vertebral fracture groups. Meanwhile, more patients in the hip fracture group had an MPR ≥ 80%.ConclusionPersistence of and adherence to osteoporotic pharmacotherapy are not very high in Japan. To bridge the care gap following osteoporosis pharmacotherapy, improvements are required for males, the elderly, and those with a history of vertebral fracture.

Critical bleeding is a common cause of maternal mortality in obstetric patients. However, the non-obstetric factors underlying critical obstetric bleeding remain uncertain. Therefore, this study aimed to clarify the impact of chronic hypertension on obstetric hemorrhage by evaluating a nationwide administrative database in Japan. Women who gave birth between 2018 and 2022 were enrolled. The primary outcome was critical hemorrhage requiring massive red blood cell (RBC) transfusion during childbirth. In total, 354, 299 eligible women were selected from the database. The maternal mortality rate was >1.0% among those who received a massive RBC transfusion (≥4000 cc), and this amount was used as the cutoff of the outcome. Critical hemorrhage was less frequent with elective Caesarean section (CS) compared with vaginal childbirth or emergent CS (odds ratio [OR], 0.38; 95% confidence interval, 0.30–0.47). Multiple logistic regression analysis adjusting for these obstetric risks revealed that a higher maternal age (adjusted OR [aOR] per 1 year, 1.07 [1.05–1.09]); oral medications with prednisolone (aOR, 2.5 [1.4–4.4]), anti-coagulants (aOR, 10 [5.4–19]), and anti-platelets (aOR, 2.9 [1.3–6.4]); and a prenatal history of hypertension (aOR, 2.5 [1.5–4.4]) and hypoproteinemia (aOR, 5.8 [1.7–20]) are the risks underlying critical obstetric hemorrhage. Prenatal history of hypertension was significantly associated with obstetric disseminated intravascular coagulation (OR, 1.9 [1.5–2.4]); Hemolysis, Elevated Liver enzymes, and Low platelet count (HELLP) syndrome (OR, 3.3 [2.7–4.2]); and eclampsia (OR, 6.1 [4.6–8.1]). In conclusion, a maternal prenatal history of hypertension is associated with the development of HELLP syndrome, eclampsia, and resultant critical hemorrhage.

BackgroundDelayed bleeding is the major adverse event in upper gastrointestinal endoscopic treatment (UGET). We aimed to investigate the efficacy of vonoprazan, which is the novel strong antisecretory agent, to reduce the risk for delayed bleeding in comparison with proton pump inhibitors (PPIs) in UGET.MethodsThis retrospective population-based cohort study used the Diagnosis Procedure Combination database in Japan. We included patients on vonoprazan or PPI in UGET between 2014 and 2019. The primary outcome was delayed bleeding. We conducted propensity score matching to balance the comparison groups, and logistic regression analyses to compare the bleeding outcomes.ResultsWe enrolled 124,422 patients, in which 34,822 and 89,600 were prescribed with vonoprazan and PPI, respectively. After propensity score matching, the risk for delayed bleeding was lower in vonoprazan than in PPI (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.71–0.80), consistent with sensitivity analysis results. In the subgroup analyses of seven UGET procedures, vonoprazan was significantly advantageous in esophageal endoscopic submucosal dissection (E-ESD) (OR, 0.71; 95% CI, 0.54–0.94) and gastroduodenal endoscopic submucosal dissection (GD-ESD) (OR, 0.70; 95% CI, 0.65–0.75), although correction for multiple testing of the outcome data removed the significance in E-ESD. These results were also consistent with sensitivity analysis results. In the five other procedures, no significant advantage was found.ConclusionsThis nationwide study found that, compared with PPI, vonoprazan can reduce delayed bleeding with approximately 30% in GD-ESD. Vonoprazan has the possibility to become a new treatment method for preventing delayed bleeding in this procedure.

Dialysis patients who develop degenerative hip disease or femoral neck fractures may require total hip arthroplasty, and their comorbidities predispose them to complications. This study aimed to evaluate whether dialysis was associated with early postoperative complications using a large database of Japanese. In this cohort study, using the Japanese National Administrative Diagnosis Procedure Combination database on THA for patients on hemodialysis or not from December 2011 to March 2023, we assessed the surgical-related complications, medical complications, and mortality during hospitalization after propensity score matching by age, sex, BMI, and comorbidities. A total of 2,111 pairs of patients on hemodialysis and non-dialysis were included. In THA for patients on hemodialysis, the significant odds ratios for various complications were as follows: dislocation (2.616, 95% CI: 1.282 to 5.338, p  < 0.01), reoperation (2.104, 95% CI: 1.222 to 3.623, p  < 0.01), deep vein thrombosis (0.407, 95% CI: 0.286 to 0.579, p  < 0.01), cerebrovascular events (4.426, 95% CI: 1.495 to 13.10, p  < 0.01). These findings help identify postoperative THA risks for patients on dialysis, suggesting that more attention should be paid to preoperative planning and postoperative care.

Hip fractures in elderly dialysis patients are associated with increased postoperative complications and mortality, but large-scale analyses remain limited. This retrospective cohort study utilized Japan’s nationwide Diagnosis Procedure Combination database (2016–2022). After applying 1:1 propensity score matching, 9,601 chronic hemodialysis patients were compared with 9,601 non-dialysis patients for postoperative outcomes, including venous thromboembolism (VTE), cognitive dysfunction, and in-hospital mortality. The study cohort included only patients receiving chronic maintenance hemodialysis; peritoneal dialysis patients were not included. Statistical significance was defined as a p  < 0.001. The in-hospital mortality rate was 5.2% in dialysis patients versus 1.7% in non-dialysis patients. Thirty-day postoperative survival was 99.2% in non-dialysis patients and 97.5% in dialysis patients. Dialysis patients had higher odds of postoperative cognitive dysfunction (OR: 1.944; 95% CI: 1.515–2.495, p  < 0.0001) and in-hospital mortality (OR: 3.288; 95% CI: 2.743–3.941, p  < 0.0001). The incidence of VTE was lower among dialysis patients. Male sex, older age, and lower BMI were also independent risk factors for mortality. Dialysis is associated with markedly worse outcomes following hip fracture surgery. Comprehensive perioperative management and preventive strategies are essential to improve prognosis in this high-risk population.