Het volume van chirurgische ingrepen en de impact ervan op ... - KCE

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86 Volume Outcome KCE reports 113 5.4.4 Definition of volume These 2 730 procedures were performed in 114 centres by 401 surgeons. Three quarters of the hospitals performed 30 procedures or less. Table 5.39: Colon cancer surgery: Summary measures of volume per hospital and per surgeon Number mean min 25th Pctl 50th Pctl 75th Pctl Maximum Hospitals 114 23.9 1.0 14.0 21.0 30.0 92.0 Surgeons* 401 6.8 1.0 3.0 5.0 9.0 52.0 * For 10 procedures (0.4%) the information on surgeon ID was missing. Figure 5.16: Colon cancer surgery: Volume per hospital (Number=114) X means stage missing. Figure 5.17: Colon cancer surgery: Volume per surgeon (Number=401) X means stage missing.
KCE Reports 113 Volume Outcome 87 5.4.5 Definition of outcomes 5.4.5.1 Mortality Table 5.40 shows that in-hospital and approximate 30-day mortality is 5.6% after colon cancer surgery (148 deaths). Mortality 1 year after surgery is 18.0%. After 2 years it is 28.2%. Mean survival time (median not defined) was 27 months (not visible in Table 5.40). Table 5.40 also shows that 2-year mortality after surgery is higher with patients diagnosed with a cancer of the rectosigmoid junction (4310%) in comparison with patients suffering from a colon cancer (27.4%). These differences confirm the necessity to add the principal diagnosis to the risk adjustment. Table 5.40: Colon Cancer surgery: Mortality results Number Number % Survival deaths deaths In-hospital and approximate 30-day mortality 2658 148 5.57 1-year mortality 2658 479 18.02 81.98 2-year mortality 2-year mortality in function of principal diagnosis: 2658 750 28.22 71.78 153 Malignant neoplasm of colon 2521 691 27.41 72.59 1540 Malignant neoplasm of rectosigmoid junction 137 59 43.07 56.93 Figure 5.18 shows how survival improves with decreasing disease stage. Patients with stage 3 and 4 disease have the worst survival curves while stage 1 and 2 patients have the best survival. Patients with unknown disease stage are in between these two groups. Figure 5.18: Colon cancer surgery: Survival curve by stage X means stage missing. Because of lack of reliable data on complications, all analyses on the volume-outcome association are limited to 2-year mortality rate. This implies that additional outcome measures such as postoperative rate of stoma, infection and anastomotic leakage, which are listed in Table 2.1 (page 16), are not analyzed in this report.
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KCE reports 1. Effectiviteit en kos
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73. Financiering van het zorgprogra
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