[Evolution and future of the National Clinical Database: feedback for surgical quality improvement]

The National Clinical Database (NCD) was founded in April 2010 as the parent body of a database linked to the surgical board certification system. Registration began in 2011, and to date more than 3,900 facilities have enrolled, with an accumulation of more than 1.02 million cases per year. Related activities will primarily focus on providing high-quality healthcare to patients and the general public, with the clinical setting serving as the driving force behind improvements. Clinical research using the database and evidence-based policy recommendations will impact businesses, the government, and insurers. In the gastroenterological surgery section, 120,000 cases have accumulated with items representing surgical performance in each specialty for eight procedures: esophagectomy; partial and total gastrectomy; right hemicolectomy; low anterior resection; hepatectomy; pancreatoduodenectomy; and surgery for acute diffuse peritonitis. Risk models have been created for the mortality and morbidity of each procedure. These models will be available for participating hospitals and may be useful for decision making by surgeons as well as patient counseling. Studies are in progress using the NCD database to contribute to improving the quality control of surgical procedures.