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

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88 Volume Outcome KCE reports 113 5.4.6 Volume outcome relationship 5.4.6.1 Analysis by hospital 2-YEAR MORTALITY RATE, BY HOSPITAL Figure 5.19 presents the funnel plot of the number of colon cancer procedures per centre and the 2-year mortality (observed, i.e. without risk adjustment). The size of the point is proportional to the number of hospitals with the same volume and the same outcome. The horizontal line represents the overall 2-year mortality i.e. 28.2%. Only one small volume hospital is outlier above the 99.8% limits of variability. Figure 5.19: Colon cancer surgery: Funnel plot of 2-year mortality rate, by hospital DESCRIPTION OF DIFFERENCES IN CHARACTERISTICS ACCORDING TO THE VOLUME CATEGORY OF THE HOSPITAL As shown in Table 5.41, 2 year mortality is 24% in lowest volume hospitals (1-10 procedures/yr) and around 31% for centres performing at least 41 interventions. The percentage of missing stage data reaches 39% in lowest volume hospitals (compared to 26% in all hospitals), so comparison of stages between centres should be made cautiously.
KCE Reports 113 Volume Outcome 89 Table 5.41: Colon cancer surgery: Differences in case-mix and outcomes by hospital volume Hospital volume 1-10/yr 11-20/yr 21-40/yr 41-60/yr >60/yr All Number centres 19 35 48 8 4 114 Number stays 138 552 1318 366 284 2658 Gender %male 56.5 47.6 50.1 50.8 51.1 50.1 Mean 70.9 72.5 72.3 72.8 71.4 72.3 Age Std 10.8 10.9 11.2 10.9 12.3 11.2 Charlson ≥ 3 % 6.5 12.1 11.5 8.5 12.0 11.0 Mean 0.8 0.9 0.9 0.8 1.0 0.9 Charlson Std 1.2 1.3 1.4 1.2 1.5 1.4 Severity index (APR-DRG) Principal Diagnosis (MCD) 1 % 6.5 10.3 10.1 9.0 5.6 9.3 2 % 39.9 29.7 35.2 28.1 44.4 34.3 3 % 38.4 41.5 40.6 44.5 33.8 40.5 4 % 15.2 18.5 14.1 18.3 16.2 15.9 Colon tumour % 92.8 94.7 95.1 95.6 94.0 94.8 Rectosigmoid junction tumour % 7.2 5.3 4.9 4.4 6.0 5.2 Length of stay Median 15.5 14.0 15.0 14.0 13.0 14.0 In-hospital + approximate 30day mortality % 4.3 4.2 4.6 4.4 3.2 4.3 2-year mortality % 23.9 29.9 26.7 30.6 31.0 28.2 Missing stage data % 39.1 27.7 23.6 26.8 30.6 26.4 Stage I % 19.0 10.3 12.1 13.1 15.2 12.5 II % 33.3 42.4 41.4 35.4 44.7 40.8 III % 36.9 34.3 35.3 38.1 30.5 35.0 IV % 10.7 13.0 11.2 13.4 9.6 11.7 RELATION BETWEEN HOSPITAL VOLUME AND 2-YEAR MORTALITY RATE None of the models in Table 5.42 showed a relationship between hospital volume and 2-year mortality rate. All OR estimates are below and close to 1, except in the first volume category, where OR is 0.64 (0.38, 1.07). Survival rate is lower in patients with a colon cancer when compared with those with cancer of the rectosigmoid junction (OR = 0.44, 95%CI 0.30-0.65). Disease stage is again an important predictor of 2-year mortality. Patients with stage 2, 3 and 4 disease have significant higher 2-year mortality than those with stage 1 disease.
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