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

132 Volume Outcome KCE reports 113
• CVA: ICD-9-CM code 431 ‘Intracerebral haemorrhage’, 432 ‘Other
and unspecified intracranial haemorrhage’, 434 ‘Occlusion of cerebral
arteries’ or 436 ‘Acute, but ill-defined, cerebrovascular disease’.
As shown in Table 6.5, in-hospital mortality after CEA/CAS is a very rare event i.e.
0.92%. It was lower after CAS (0.59%) than after CEA (0.98%), although this finding
does not permit any conclusion on causality.
Because of possible errors in in-hospital mortality as encoded in the MCD (discussed in
section 4.2.4.2 page 41), we retrieved additional information on mortality in the IMA
database. This lead to the combined (i.e. combination of MCD and IMA mortality)
outcome measure “in-hospital and approximate 30-day mortality” which was 1.27%
after CAS/CEA. When this outcome is compared between CAS and CEA, mortality
seems higher after CAS (2.0% versus 1.1%). Note that the 30-day mortality is an
approximation i.e. minimum 1 day and maximum 60 days, as explained in Chapter 2 (see
section 2.3.2.2, page 15).
Acute myocardial infarction (AMI) and stroke (i.e. cerebrovascular accident or CVA)
are also rare events after CEA/CAS, i.e., respectively 0.65% and 1.51%.
Table 6.5: CEA/CAS: Outcome measures
Number
Total
Number
outcome
In-hospital mortality All 3368 31 0.92
CAS 508 3 0.59
CEA 2860 28 0.98
In-hospital mortality and approximate All 3304 42 1.27
30-day mortality *
CAS 500 10 2.00
CEA 2804 32 1.14
In-hospital AMI All 3368 22 0.65
CAS 508 3 0.59
CEA 2860 19 0.66
In-hospital CVA All 3368 51 1.51
CAS 508 6 1.18
CEA 2860 45 1.57
* Only for 3 304 patients with linkage to IMA database
6.1.6 Volume outcome relationship
IN-HOSPITAL MORTALITY RATE, BY HOSPITAL
%
outcome
The funnel plot of the relationship between in-hospital mortality and volume of
interventions is presented in Figure 6.3. The horizontal line represents the overall inhospital
mortality i.e. 0.92%. As in-hospital mortality is a very rare event, the majority of
the centres have 0% mortality. The funnel plot identifies two outlying centres in terms
of outcome: one with low volume and one with medium volume. The two highest
volume centres have also 0% mortality.