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

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.