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

More documents

Recommendations

Info

150 Volume Outcome KCE reports 113 Table 6.21: Sensitivity analysis for isolated CABG, Volume categorized in high volume-low volume centres (using AHRQ cut off) Number Number patients death % death Low volume (
KCE Reports 113 Volume Outcome 151 RELATION BETWEEN SURGEON VOLUME AND MORTALITY RATE Table 6.22 shows how the results from logistic regression confirm the effect of surgeon volume on the risk of death, but to a smaller extent than hospital volume. Table 6.22: CABG and/or heart valve replacement/repair: Results of logistic regression: relative effect of 10% increase volume on mortality, surgeon volume Model without adjustment for case mix Effect 1 95% CI Surgeon volume (increase of 10%) -2.34 -3.97 -0.71 Model with adjustment for case mix Effect 1 95% CI Surgeon volume (increase of 10%) -1.89 -3.64 -0.15 OR 95% CI Sex (male vs female) 0.77 0.62 0.95 Age (increase of 1 year) 1.06 1.05 1.08 Charlson score (increase of 1 category) 2.62 2.34 2.94 396 (Diseases of mitral and aortic valves) vs other 0.47 0.25 0.90 410 (Acute myocardial infarction) vs other 1.26 0.73 2.20 414 (Other forms of chronic ischemic heart disease) vs other 0.45 0.27 0.77 424 (Other diseases of endocardium) vs other 0.36 0.23 0.56 428 (Heart failure) vs other 0.61 0.29 1.28 441 (Aortic aneurysm and dissection) vs other 1.49 0.68 3.25 996 (Complications peculiar to certain specified procedures) vs 1.10 0.52 2.32 other CABG + heart valve vs heart valve only 1.32 1.00 1.73 CABG only vs heart valve only 0.48 0.33 0.70 1 Effect of 10% increase in volume on the odds of mortality 6.2.7 Discussion Analyses which take into account both surgeon as hospital volume concomitantly show that hospital volume plays a more important role than surgeon volume. See Table 6.23. Table 6.23: CABG and/or heart valve replacement/repair: Results of logistic regression: relative effect of 10% increase volume on mortality, surgeon and hospital volume Model with adjustment for case mix Effect 1 95% CI Volume of centre (increase of 10%) -4.31 -7.11 -1.15 Volume of surgeon (increase of 10%) -0.07 -2.67 1.14 1 Effect of 10% increase in volume on the odds of mortality Coronary artery bypass surgery (isolated or in combination with heart valve intervention) is probably one of the most studied procedures in the whole volume outcome literature. It was first mentioned in the seminal article by Luft in 1979 which lead, ten years later, to the first publicly available mortality rates presented per centre and per surgeon in the State of New York. 98, 264 The US Agency for Healthcare Research and Quality (AHRQ) also includes the volume of CABG in its list of quality indicators (Inpatient Quality Indicator 5). 248 The AHRQ applies two thresholds to benchmark hospitals: the lower threshold is >100 procedures per year, the upper threshold is >200 CABG per year. 29 The US Leapfrog Group uses the cut off of 450 operations per year to select providers. 126 6.2.7.1 External validation of the definition of the procedure The external validation of our definition process is based on the data from the Belgian Working Group for Interventional Cardiology (BWGIC) and the Belgian Association for Cardio-Thoracic Surgery (BACTS) for the year 2004, as published in KCE report 66 (table 1.2 on page 11). 265
Page 1 and 2:
Het volume van chirurgische ingrepe
Page 3 and 4:
Het volume van chirurgische ingrepe
Page 5 and 6:
KCE reports 113A Volume - Uitkomst
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
KCE Reports 113 Volume Outcome 1 Sc
Page 19 and 20:
KCE Reports 113 Volume Outcome 3 6.
Page 21 and 22:
KCE Reports 113 Volume Outcome 5 Ab
Page 23 and 24:
KCE Reports 113 Volume Outcome 7 2
Page 25 and 26:
KCE Reports 113 Volume Outcome 9 5.
Page 27 and 28:
KCE Reports 113 Volume Outcome 11 O
Page 29 and 30:
KCE Reports 113 Volume Outcome 13 F
Page 31 and 32:
KCE Reports 113 Volume Outcome 15 T
Page 33 and 34:
KCE Reports 113 Volume Outcome 17 P
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
KCE Reports 113 Volume Outcome 33 H
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
KCE Reports 113 Volume Outcome 57 R
Page 75 and 76:
Page 77 and 78:
KCE Reports 113 Volume Outcome 61 C
Page 79 and 80:
KCE Reports 113 Volume Outcome 63 A
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
KCE Reports 113 Volume Outcome 77 D
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
KCE Reports 113 Volume Outcome 93 R
Page 111 and 112:
Page 113 and 114:
KCE Reports 113 Volume Outcome 97 V
Page 115 and 116: KCE Reports 113 Volume Outcome 99 5
Page 117 and 118: KCE Reports 113 Volume Outcome 101
Page 165: KCE Reports 113 Volume Outcome 149
Page 217 and 218:
KCE Reports 113 Volume Outcome 201
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
This page is left intentionally bla
Page 255 and 256:
KCE reports 1. Effectiviteit en kos
Page 257 and 258:
73. Financiering van het zorgprogra
show all

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

Create successful ePaper yourself

Delete template?

Save as template?