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

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114 Volume Outcome KCE reports 113 5.6 LUNG CANCER SURGERY 5.6.1 General description of procedure As reported by the Belgian Cancer Registry, lung cancer is the second most frequent cancer in males (17%) and the third most frequent in females (7%). It is the most important cause of death by cancer in males (33%). 108 In general, lung cancer surgery is usually limited to early stages of lung cancer that have not spread beyond the lung. It is also performed more often in cases of non-small cell lung cancer, although, in cases of small cell lung cancer, surgery may be performed in conjunction with chemotherapy or radiation. 5.6.2 Primary data selection in MCD 2004 First selection of data was based on ICD-9-CM diagnostic and procedure codes as proposed by Bach, Begg and Sioris, and on NIHDI procedure codes. 129, 236, 237 Note that we deliberately omitted NIHDI procedure 227382 “Thoracotomy with attempted exeresis” because there is no actual lung excision performed during this procedure. This selection resulted in a total of 29 762 hospital stays but is too broad since it also includes patients with a secondary diagnosis of malignant neoplasm. This implies that patients with lung 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 5.61: Lung cancer surgery: Primary data selection in MCD 2004 SELECTION 1 SELECTION 2 SELECTION 3 ICD-9-CM (principal ICD-9-CM procedure NIHDI procedure code or secondary) diagnosis code code 1622 Malignant 321 Other excision of bronchus 227220 Total or partial lung excision neoplasm of with lymph node dissection for main bronchus cancer 1623 Malignant 3229 Other local excision or 227242 Radical pneumonectomy with neoplasm of destruction of lesion or tissue mediastinal lymph node upper lobe, of lung dissection and with ligation of bronchus or lung the lung vessels within the pericardial (heart) sac 1624 Malignant neoplasm of middle lobe, bronchus or lung 323 Segmental resection of lung 227264 Total or partial lung excision 1625 Malignant 324 Lobectomy of lung 227286 Resection of bronchial trunk neoplasm of or trachea via thoracotomy lower lobe, with tracheobronchial or bronchus or lung bronchobronchial anastomosis 1628 Malignant neoplasm of other parts of bronchus or lung 325 Pneumonectomy 1629 Malignant 326 Radical dissection of thoracic neoplasm of bronchus and lung, unspecified structures STAYS SELECTED STAYS SELECTED STAYS SELECTED = 28 989 stays = 1 913 stays = 1 958 stays TOTAL STAYS SELECTED = 29 762 stays (selection 1 OR selection 2 OR selection 3)
KCE Reports 113 Volume Outcome 115 5.6.3 Definition of procedure 5.6.3.1 Primary hospital stays in Minimal Clinical Data Only 10 701 of the 29 762 selected hospital stays had a principal diagnosis of malignant neoplasm of bronchus and lung. As shown in Table 5.62, 1 313 stays (12.3% of 10 701 stays) corresponding to 1 296 patients (17.6% of 7 360 patients) had a procedure for lung cancer surgery as described above. Table 5.62: Lung cancer surgery: Principal diagnosis and percentage of cancer surgery (per stay and per patient) Principal diagnosis Total Stays with lung Total Patients with lung number cancer surgery number cancer surgery hospital patients stays Number % Number % 162 Malignant neoplasm of bronchus and lung 10 701 1 313 12.3 7 360 1 296 17.6 The APR-DRGs of these 1 313 stays are described in Table 5.63. To create a study population of patients which is as homogenous as possible, we retained only the 1 206 stays (corresponding to 1 192 patients) that are included in the APR-DRG 120 “Major respiratory procedures” and were retained in our analysis. Table 5.63: Lung cancer surgery: All APR-DRGs of stays with a principal diagnosis of a malignant neoplasm of bronchus and lung AND with surgical resection of the lung APR-DRG Number Percent 004-TRACHEOSTOMY EXCEPT FOR FACE, MOUTH & NECK 20 1.52 DIAGNOSES / p3 - P 120-MAJOR RESPIRATORY PROCEDURES / 4 - P 1206 91.85 121-NON-MAJOR RESPIRATORY PROCEDURES / 4 - P 87 6.63 TOTAL 1313 100.00 Results of definition: 1 206 stays with surgery for resectable lung cancer were selected in the Minimal Clinical Data. These stays concerned 1 192 individual patients and 97 centres. 5.6.3.2 Linkage with data from IMA and BCR The MCD data were linked with the Common Sickness Funds Agency (IMA) database and the Belgian Cancer Registry (BCR) database. Table 5.64 shows that 98.2% of 1 206 MCD stays could be linked with IMA data and 87.4% with BCR data on the basis of ICD-10 code C34 “Malignant neoplasm of bronchus and lung”. Information on tumour stage could be retrieved for 74.8% of 1 206 MCD stays. Table 5.64: Lung cancer surgery: Percentage of linkage of MCD data with data from IMA and BCR Number % Number of stays in MCD selection 1 206 Linkage with IMA 1 184 98.2 Linkage with BCR 1 054 87.4 Linkage with BCR and data about stage 902 74.8 Results of linkage: 1 054 patients with lung cancer surgery could be linked with Belgian Cancer Registry data. For 902 of these patients, the BCR contained information on the stage of the tumour.
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73. Financiering van het zorgprogra
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