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

90 Volume Outcome KCE reports 113
Table 5.42: Colon cancer surgery: Correlation-corrected logistic regression
(GEE) estimates of determinants of 2-year mortality
Model without adjustment for case mix
Factor OR 95%CI
Hospital
Volume
1-10/year 0.70 0.44 1.11
11-20/year 0.95 0.69 1.31
21-40/year 0.81 0.60 1.10
41-60/year 0.98 0.69 1.39
> 60/year 1.00 1.00 1.00
Model with adjustment for patient characteristics (MCD data)
Hospital
Volume
1-10/year 0.71 0.44 1.15
11-20/year 0.93 0.66 1.31
21-40/year 0.79 0.57 1.09
41-60/year 0.97 0.68 1.38
> 60/year 1.00 1.00 1.00
Sex male vs female 1.13 0.95 1.35
Age increase of 1 yr 1.05 1.04 1.06
Principal Malignant neoplasm of colon vs of 0.46 0.32 0.67
Diagnosis rectosigmoid junction
Charlson score increase of 1 1.28 1.17 1.41
Model with adjustment for patient and tumour characteristics (MCD
and BCR data)
Hospital 1-10/year 0.64 0.38 1.07
Volume 11-20/year 0.79 0.53 1.17
21-40/year 0.68 0.47 0.97
41-60/year 0.80 0.54 1.18
> 60/year 1.00 1.00 1.00
Sex male vs female 1.20 0.99 1.44
Age increase of 1 yr 1.06 1.05 1.07
Principal Malignant neoplasm of colon vs of 0.44 0.30 0.65
Diagnosis rectosigmoid junction
Charlson score increase of 1 1.35 1.21 1.50
Stage unknown 3.90 2.24 6.80
IV 27.95 13.98 55.84
III 6.99 4.08 11.97
II 2.52 1.39 4.55
I 1.00 1.00 1.00
Sensitivity analyses with the log of volume as a predictor variable confirmed those
results (positive coefficient of volume effect).
5.4.6.2 Analysis by surgeon
2-YEAR MORTALITY RATE, BY SURGEON
Figure 5.20 presents the funnel plot of the number of colon cancer procedures per
surgeon and the 2-year mortality (observed, i.e. without risk adjustment). The size of
the point is proportional to the number of surgeons with the same volume and the
same outcome. There are no surgeons outside the 99.8% limits of variability.