Het volume van chirurgische ingrepen en de impact ervan op ... - KCE
Het volume van chirurgische ingrepen en de impact ervan op ... - KCE
Het volume van chirurgische ingrepen en de impact ervan op ... - KCE
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<strong>KCE</strong> Reports 113 Volume Outcome 131<br />
6.1.4 Definition of <strong>volume</strong><br />
These 3 368 CEA/CAS procedures were distributed across 110 hospitals. The mean<br />
number of stays per hospital was 31. See Table 6.4. Two c<strong>en</strong>tres are outliers in terms of<br />
annual number of interv<strong>en</strong>tions i.e. they have more than 130 interv<strong>en</strong>tions per year.<br />
The pr<strong>op</strong>ortion of CAS is highly <strong>de</strong>p<strong>en</strong>d<strong>en</strong>t on the c<strong>en</strong>tre, and varies from 0 to 100%<br />
(Figure 6.2 ).<br />
The surgeon <strong>volume</strong> was available for CEA interv<strong>en</strong>tions only since there is no specific<br />
NIHDI co<strong>de</strong> for CAS. The average CEA <strong>volume</strong> per surgeon is 12 per year, performed<br />
by 236 surgeons.<br />
Table 6.4: Summary measures of <strong>volume</strong> per hospital (CEA/CAS) and per<br />
surgeon (CEA only)<br />
Number Mean Min 25th Pctl 50th Pctl 75th Pctl Max Total<br />
Hospital<br />
(CEA/CAS)<br />
110 30.6 1.0 13.0 24.0 39.0 152.0 3368<br />
Hospital (CEA) 109 26.2 1.0 11.0 21.0 34.0 121.0 2860<br />
Surgeon (CEA)* 236 12.0 1.0 3.0 9.0 17.0 60.0 2826*<br />
* information on surgeon is missing for 34 stays<br />
160<br />
150<br />
140<br />
130<br />
120<br />
110<br />
100<br />
90<br />
80<br />
70<br />
60<br />
50<br />
40<br />
30<br />
20<br />
10<br />
0<br />
Figure 6.2: CEA/CAS: Volume per hospital<br />
DE1<br />
E319C4<br />
7C<br />
D D277DF<br />
58C8<br />
C C7<br />
9DD0<br />
2339DB4<br />
88DD8<br />
DF6<br />
FF57AEE<br />
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7E33A6F5D9<br />
C C1B<br />
D DE<br />
D DA5<br />
EB1<br />
388069CE5<br />
4A17C8AF<br />
E464<br />
9DBC7<br />
BD<br />
9DC<br />
D DF51<br />
62D235AF0<br />
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6FD83<br />
A3005<br />
658A2<br />
AFA1<br />
38C17BD<br />
A3584<br />
A57A1<br />
E1CD<br />
44289EC<br />
DD2<br />
BDD9<br />
F7192481A3<br />
35701BFE7<br />
FB6257<br />
24BFFA5<br />
FC<br />
F070AAD<br />
9DBE<br />
FAA5<br />
5F95165<br />
A073ED4<br />
B75F9<br />
FA1<br />
A9ED<br />
3E1B9<br />
6014D2E165<br />
3E2276392<br />
0C40F7903<br />
1FD03<br />
B2C89<br />
2E3CF6<br />
5D6<br />
9A26F6EF<br />
C0<br />
94A7D1<br />
2<br />
477FBB<br />
AE5BD<br />
72C6<br />
F632F2A32C9<br />
8AD5<br />
D D347B1<br />
22C9<br />
76E182D43<br />
96916A5C6<br />
C80F487BA<br />
0EEBD4<br />
9D8<br />
838A1<br />
35221AA1<br />
8B0<br />
23500360C2<br />
D9<br />
A881C<br />
CAS CEA<br />
6.1.5 Definition of outcomes<br />
Hospital ID<br />
Carotid Endarterectomy (CEA) and Carotid st<strong>en</strong>ting (CAS) both require profici<strong>en</strong>cy<br />
since technical errors may lead to abrupt carotid occlusion with stroke or <strong>de</strong>ath as<br />
possible consequ<strong>en</strong>ces. Because CEA pati<strong>en</strong>ts oft<strong>en</strong> suffer from diffuse atheromatosis,<br />
they also have a higher risk to suffer an acute myocardial infarction in relation to<br />
g<strong>en</strong>eral anaesthesia.<br />
Information on AMI rate and CVA rate was retrieved from the MCD where the<br />
secondary diagnosis (as <strong>de</strong>fined in section 4.2.1, page 39) is <strong>en</strong>co<strong>de</strong>d with the following<br />
co<strong>de</strong>s:<br />
• AMI: ICD-9-CM co<strong>de</strong> 410 ‘Acute myocardial infarction’ but after<br />
exclusion of pati<strong>en</strong>ts with AMI as principal diagnosis;
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