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

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140 Volume Outcome KCE reports 113 6.2 CORONARY ARTERY BYPASS SURGERY (CABG) AND/OR HEART VALVE REPLACEMENT OR REPAIR 6.2.1 General description of procedure A coronary artery bypass graft (CABG) is a surgical procedure to treat patients with narrowed coronary arteries. Coronary arteries are blood vessels which supply the heart with blood and oxygen (see Figure 6.6). The narrowing (i.e. stenosis) of the coronary arteries is caused by a gradual build up of fatty material (i.e. atheromatous plaque). The American Heart Association describes CABG as follows: “A coronary artery bypass reroutes the blood supply around a blocked section of the coronary artery. During this procedure, surgeons remove healthy blood vessels from another part of the body, such as a leg or the chest wall. They then surgically attach the vessels to the diseased artery in such a way that the blood can flow around the blocked section.” 262 Most CABG procedures are performed “on-pump”: the heart is stopped and blood is pumped by a heart-lung machine. During the past several years, surgeons have started performing “off-pump CABG” (OPCAB) during which the heart continues beating while the bypass graft is sewn in place. According to the American Heart Association scientific statement on bypass surgery, published in 2005, both on-pump and off-pump CABG overall generally result in excellent outcomes and neither type should be judged to be inferior to the other. 263 CABG is sometimes combined with heart valve replacement surgery (i.e. replacing an abnormal or diseased heart valve with a healthy one) or open heart valvuloplasty (i.e. heart valve repair). Figure 6.6: The coronary circulation Source: Gray’s Anatomy – Public domain 6.2.2 Primary data selection in MCD 2004 As shown in Table 6.10, the primary selection of data for CABG was based on ICD-9- CM procedure code 361 as proposed by Christian et al., and/or by the NIHDI codes 229585, 229622, 229644 as used by Van Brabandt et al. 57, 93 A total of 8 547 stays are selected. This initial selection does not include the CABG performed in combination with heart valve replacement (i.e. NIHDI procedure code 229526). The primary selection of data for heart valve replacement or repair (valvuloplasty) was based on ICD-9-CM procedure codes 351 and 352, or NIHDI procedure codes 229526 and 229600. (see Table 6.10) A total of 3 968 stays are selected.
KCE Reports 113 Volume Outcome 141 361x Because these two procedures can be performed jointly, and because one NIHDI code was missing in the initial selection for CABG (i.e. 229526), it was decided during the definition phase to combine these two primary selections. As 1 384 stays were selected in both primary selection (in the primary selection for CABG and in the primary selection for heart valve replacement), the number of distinct stays in the combined primary selection is 11 131. Figure 6.7 provides an overview of the number of stays in the initial selection. Table 6.10: CABG and/or heart valve replacement or repair: Primary data selection in MCD 2004 ICD-9-CM procedure code NIHDI procedure code Initial selection of CABG Bypass anastomosis for heart revascularization 229585 CABG using two internal mammary arteries. On or off pump. 229622 CABG using one arterial graft (mammaria, gastroepiploica or an explanted artery) including possible venous bypass(es). On pump. 229644 CABG using one arterial graft (mammaria, gastroepiploica or an explanted artery) including possible venous bypass(es). Off-pump CABG. Initial selection of heart valve replacement or repair 352x Replacement of heart valve 229526 Surgery on the heart or the great intrathoracic 351x Open heart valvuloplasty without replacement blood vessels that involves the replacement of more than one heart valve, or the replacement of one heart valve in combination with a CABG. 229600 Surgery on the heart or the great intrathoracic blood vessels that involves valvuloplasty or heart valve replacement. TOTAL STAYS SELECTED= 11 131 (selection 1 OR selection 2) Figure 6.7: Number of stays (MCD 2004) from initial selections CABG and/or heart valve repair or replacement
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