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

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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.
KCE Reports 113 Volume Outcome 133 Figure 6.3: Funnel plot of the in-hospital mortality rate following CEA/CAS treatment, by centre DESCRIPTION OF DIFFERENCES IN CHARACTERISTICS ACCORDING TO THE VOLUME CATEGORY OF THE HOSPITAL The 110 centres have been divided in three tertiles according to their annual volume of CEA/CAS procedures: hospitals belonging to the first tertile have 16 or less CEA/CAS per year; hospitals in the second tertile perform between 17 and 31 CEA/CAS per year; centres in the third tertile have more than 31 procedures per year. Table 6.6 shows the number of hospitals and stays in each tertile. The differences in case mix and outcomes between the low volume (first tertile), medium volume (second tertile) and high volume (third tertile) centres are summarized in Table 6.6. Case mix seems very similar in the three tertiles. Observed in-hospital mortality is 1.9% in low volume centres and 0.8% in medium and high volume hospitals.
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73. Financiering van het zorgprogra
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