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

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98 Volume Outcome KCE reports 113 Key points on volume outcome association for colon cancer surgery • A total of 5 756 patients were hospitalized in 2004 (retrieved in MCD 2004) with a diagnosis of malignant neoplasm of colon (including rectosigmoid junction). 48% of these patients underwent a colectomy. • The population studied consisted of those 2 658 patients with colon cancer surgery and whose data could be linked to IMA databases. • In 81% of the cases, information on tumour could be retrieved in the BCR database. Data on stage was available for 72% of stays. In low volume centres ( 20 years). Other authors suggested that surgical specialization is an important additional determinant of outcome for colorectal cancer. • Because data were not retrieved or not available in the databases, the following characteristics could not be used for risk adjustment: use of (neo) adjuvant therapy (chemo- or radiation therapy), acuity of admission (elective versus urgent), intention of surgery (palliative versus curative), type of surgical resection (total or partial resection).
KCE Reports 113 Volume Outcome 99 5.5 BREAST CANCER SURGERY 5.5.1 General description of procedure As reported by the Belgian Cancer Registry, breast cancer is the most frequent cancer in females (35%) and the leading cause of death by cancer in females (20.6% of all cancer deaths). 108 Surgery is still the first-line treatment for localized breast cancer and consists of two kinds i.e. breast-conserving therapy and breast-ablative therapy. Both procedures 48, 219 carry a low risk for morbidity and mortality. 5.5.2 Primary data selection in MCD 2004 First selection of data was based on ICD-9-CM diagnostic and procedure codes as 219, 220 proposed by Roohan et al. and Guller et al., and on NIHDI procedure codes. This selection resulted in a total of 24 871 stays but is too broad since it also includes patients with a secondary diagnosis of malignant neoplasm. This implies that patients with breast cancer as pre-existing condition are also included (see section 4.2.1, page 39). The definition of the population studied will be defined in the next section. Table 5.48: Breast cancer surgery: Primary data selection in MCD 2004 SELECTION 1 SELECTION 2 SELECTION 3 ICD-9-CM (principal or secondary) diagnosis code 174x Malignant neoplasm of female breast STAYS SELECTED = 21 555 stays ICD-9-CM procedure code 8520 Excision or destruction of breast tissue, not otherwise specified NIHDI procedure code 226962 Urban procedure (i.e. extended radical mastectomy). 8521 Local excision of lesion of breast 226984 Halsted procedure (radical mastectomy) or Pattey procedure (modified radical mastectomy) with ex tempore histological analysis. 8522 Resection of quadrant of breast 227006 Halsted procedure (radical mastectomy) or Pattey procedure (modified radical mastectomy). 8523 Subtotal mastectomy 227021 Excision of a tumour out the weak tissues above the muscle fascia but with complete resection of the organ in which the tumour is located. 854x Mastectomy 227043 Removal of a tumour or a cyst from the breast. 227065 Partial mastectomy or lumpectomy with axillary clearance. STAYS SELECTED STAYS SELECTED = 12 935 stays = 12 550 stays TOTAL STAYS SELECTED = 24 871 stays (selection 1 OR selection 2 OR selection 3)
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