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

96 Volume Outcome KCE reports 113
Table 5.46: Colon cancer surgery: Mortality: comparison of Volume-
Outcome KCE study with other studies
KCE 2004 Schrag 2000 209 &
Schrag 2003 210
Marusch 2001 200
Country & Study period Belgium 2004 USA 1991-1996 Germany 1999
30-day mortality 5.6% 4.6% 4.9%
1-year survival 82.0%
2-year survival 71.8% 66.9%
Country
Study period
PATIENT CASE MIX
The studies by Schrag and Marusch allowed a proper comparison of patients since their
patient selection was similar to ours. 200, 209, 210 See Table 5.47.
Table 5.47: Colon cancer surgery: Patient and tumour characteristics:
comparison of Volume-Outcome KCE study with other studies
KCE 2004 Schrag 2000209 Marusch 2001200 Belgium
2004
USA
1991-1996
Germany
1999
Age (mean) 72.3 yr 68.5 yr
Male 50.0% 44.8% 51.6%
Tumour stage
unknown 5.1% 2.1%
I 12.5% 19.2% 18.3%
II 40.8% 36.2% 31.0%
III 35.0% 25.6% 29.5%
IV 11.7% 13.9% 19.2%
153, 209,
We found several studies that applied tumour characteristics for risk adjustment.
210
The following characteristics were additionally used for risk adjustment in other
studies but could not be applied in the KCE study because they are not available in
MCD or BCR data:
115, 153, 185, 209, 210
• race;
115, 153, 185, 209, 210
• median household income;
• college education; 153
115, 153, 185, 198, 209,
• acuity of index admission i.e. elective, urgent or emergent;
210
153, 209
• use of adjuvant therapy;
209, 210
• urgency of surgery i.e. perforation or obstruction;
• type of colectomy i.e. right, left, sigmoid, abdominoperineal or
transverse. 185
With respect to adjustment for use of adjuvant treatment Birkmeyer and Schrag found
that patients at low-volume hospitals were less likely to receive adjuvant chemotherapy
for colon cancer. Nevertheless, adjusting for differences in adjuvant therapy only had a
153, 209
negligible effect in attenuating differences in 5-year survival.