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

124 Volume Outcome KCE reports 113
Volume of
surgeon
Volume of
surgeon
RELATION BETWEEN SURGEON VOLUME AND 2-YEAR MORTALITY
RATE
There was a statistically significant inverse relationship between the (log of) volume of
surgeon and 2-year mortality, after adjustment for patients and tumour characteristics.
However, this association was not robust when the largest outlying surgeon (>
100/year) was removed from the analysis.
Table 5.71: Lung cancer surgery: Correlation-corrected logistic regression
(GEE) estimates of determinants of 2-year mortality
Increase of
10%
Increase of
10%
Adjustment for patients and
tumour characteristics
Sensitivity analysis: after
exclusion of 1 high volume
surgeon (>100/year)
5.6.7 Discussion
5.6.7.1 External validation of the definition of the procedure
Effect 95%CI
-1.55 -2.80 -0.31
-0.74 -2.08 0.59
The Belgian Cancer Registry registered 6 994 new cases of lung and bronchus cancer in
Belgium in 2004. See Table 5.1 (page 45). In the 2004 Minimal Clinical Data (MCD), we
identified 7 360 patients with the principal diagnosis of malignant neoplasm of lung or
bronchus (see Table 5.62). The higher number of patients in the MCD is explainable by
the fact that these hospital stays are not restricted to patients whose cancer started in
2004.
5.6.7.2 Summarized results of literature review
The systematic literature search identified 7 systematic reviews in which the volume
outcome association (VOA) for lung cancer surgery was studied. 1, 5, 59, 60, 62, 64, 69 These
115, 116, 129, 133, 141, 142, 189, 197, 236, 239, 240
systematic reviews were based on 11 primary studies.
An additional search for more recent studies which were published in the period 2004-
2009 resulted in 8 additional primary studies. 94, 145, 153, 237, 241-244 This brings us to a total of
19 primary studies that analyzed the volume outcome association for lung cancer
surgery. For more insight in how these studies were retrieved see the Supplement.
On the basis of the systematic reviews it was concluded in Chapter 2 (see Table 2.2 on
page 19) that there is evidence for an inverse relation between hospital volume and
mortality for lung cancer surgery. This means that mortality decreases when the
number of procedures performed by a hospital increases. Such relationship could not be
proved between surgeon volume and mortality.
However, the effect of volume on outcome for this procedure is small when compared
to pancreatic or oesophageal cancer surgery. Killeen et al. calculated that the number of
patients that a high-volume unit would need to treat to prevent one death associated
with low volume is between 20 and 50. 69
In relation to a cut off point to define low and high volume, studies differed widely.
Therefore, it was impossible to define one minimal hospital volume threshold.
Detailed results of the literature review are described in the evidence tables in
Appendix 8.