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

KCE Reports 113 Volume Outcome 93
RELATION BETWEEN SURGEON VOLUME AND 2-YEAR MORTALITY
RATE
Table 5.44 shows the results from logistic regression (with GEE adjustment for
clustering of patients within centres). All three models only suggest that patients treated
by low-volume surgeons (1-5 procedures/yr) have a higher 2 year mortality rate than
patients operated by high-volume surgeons (>20/yr), without reaching statistical
significance.
Table 5.44: Colon cancer surgery: Correlation-corrected logistic regression
(GEE) estimates of determinants of 2-year mortality (surgeon volume)
Model without adjustment for case mix
Factor OR 95%CI
Surgeon volume 1-5/year 1.38 0.82 2.33
6-10/year 1.30 0.78 2.18
11-15/year 1.13 0.67 1.91
16-20/year 1.08 0.63 1.85
> 20 /year 1.00 1.00 1.00
Model with adjustment for patient characteristics (MCD data)
Surgeon volume 1-5/year 1.34 0.78 2.31
6-10/year 1.27 0.74 2.16
11-15/year 1.14 0.66 1.95
16-20/year 1.08 0.62 1.89
> 20 /year 1.00 1.00 1.00
sex male vs female 1.14 0.96 1.36
age increase of 1 y. 1.05 1.04 1.06
Principal diagnosis Malignant
neoplasm of colon
vs of rectosigmoid
junction
0.46 0.32 0.67
Charlson score increase of 1 1.27 1.16 1.40
Model with adjustment for patient and tumour characteristics
(MCD and BCR data)
Surgeon volume 1-5/year 1.36 0.84 2.20
6-10/year 1.24 0.79 1.95
11-15/year 1.17 0.71 1.92
16-20/year 1.11 0.68 1.81
> 20 /year 1.00 1.00 1.00
sex male vs female 1.21 1.00 1.46
age increase of 1 y. 1.06 1.05 1.07
Principal diagnosis Malignant
neoplasm of colon
vs of rectosigmoid
junction
0.44 0.30 0.65
Charlson score increase of 1 1.34 1.20 1.49
Stage
unknown 3.73 2.11 6.62
IV 27.17 13.55 54.50
III 6.89 4.02 11.80
II 2.51 1.38 4.54
I 1.00 1.00 1.00