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

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168 Volume Outcome KCE reports 113 7 RESULTS FOR THREE ORTHOPAEDIC PROCEDURES 7.1 ELECTIVE TOTAL HIP REPLACEMENT/ARTHROPLASTY (THR) 7.1.1 General description of procedure Hip replacement or arthroplasty is a procedure in which damaged or diseased parts of the hip joint are removed and replaced with an artificial joint, called prosthesis. There are three types of hip replacement surgery: • Partial hip replacement: either the femoral head or the hip socket (acetabulum) will be replaced with a prosthetic device; • Total hip replacement (THR): both femoral head and acetabulum are replaced with a prosthesis; • Revision hip replacement: a hip prosthesis that no longer fits or functions well is replaced. This report only studies the volume-outcome relationship for the primary (original) total hip replacement. 7.1.2 Primary data selection in MCD 2004 First selection of data was based on ICD-9-CM procedure and NIHDI procedure codes as proposed by Taylor et al. and by Jacques et al. This selection resulted in a total of 246, 309 22 369 stays (Table 7.1). Table 7.1: Total hip arthroplasty: Primary data selection in MCD 2004 SELECTION 1 SELECTION 2 ICD-9-CM procedure code NIHDI procedure code 8151 Total hip replacement 289041 Hip arthroplasty with a femoral prosthesis 8152 Partial hip replacement 8153 Revise hip replacement 289063 Hip arthroplasty with an acetabulum prosthesis 289085 Hip arthroplasty with a total prosthesis (acetabulum and femoral head) 293440 Removal of a total hip prosthesis and placement of a new total prosthesis STAYS SELECTED =22 048 STAYS SELECTED = 20 267 TOTAL STAYS SELECTED=22 369 (selection 1 OR selection 2) 7.1.3 Definition of procedure Table 7.2 shows that for 89% of all stays both ICD-9-CM procedure and NIHDI procedure were encoded. Nine percent of the stays (number = 2 102) did not have a NIHDI procedure code for hip replacement (or revision) on their bill. Table 7.2: Total hip arthroplasty: Cross table ICD-9 and NIHDI procedures codes Cumulative Cumulative Number Percent Number Percent ICD-9 only 2 102 9.40 2 102 9.40 NIHDI only 321 1.44 2 423 10.83 Both 19 946 89.17 22 369 100.00
KCE Reports 113 Volume Outcome 169 Table 7.3 shows which NIHDI procedures were billed for the 2 102 stays with only an ICD-9-CM procedure code for THR. Forty-seven percent of these stays concerned the surgical treatment of a femoral neck fracture with prosthesis. This is a typical nonelective, emergency procedure. Finally, all 2 102 stays were excluded from further analysis since they do not belong to the target population of patients with elective hip replacement. To avoid flaws in the data selection, stays without ICD-9-CM codes were also not considered (number = 321). NIHDI code Table 7.3 Total hip arthroplasty: first NIHDI procedure codes for stays with only an ICD-9-CM procedure code for THR (number = 2 102) COUNT PERCENT 289402 Surgical treatment of a femoral neck fracture with prosthesis. 1 545 46.78 294803 Supplementary fee for continuous traction through a pin to manage 334 10.11 fractures of the lower limbs. 299386 Continuous skin traction of a lower limb. 157 4.75 290286 Femoro-tibial arthroplasty with articulated prosthesis 121 3.66 289365 Surgical treatment of a per- or intertrochanteric femoral fracture. 89 2.69 298745 Non-surgical treatment of a femoral neck fracture (without 75 2.27 reduction). 298023 Non-surgical treatment of a hip luxation. 71 2.15 289026 Hip prosthesis with interposition of tissue or a cup. 65 1.97 Among the remaining 19 946 stays, there were 14 636 stays with one THR which were encoded with the NIHDI procedure code 289085 as well as the ICD-9-CM procedure code 8151. In order to obtain a homogeneous population, the following procedures were excluded from further analysis: partial arthroplasties (number = 3246), revision hip replacements (number = 2117) and bilateral procedures (number = 133). In addition, some data abnormalities were also discarded (number = 27). After this first selection on the basis of procedure code, we looked at the available clinical information. Major Diagnostic Category (MDC) 08 “Diseases & disorders of the musculoskeletal system” represented 99.16% of the 14 636 stays. Their APR-DRGs are presented in Table 7.4. Table 7.4 Total hip arthroplasty: All APR-DRGs of stays from MDC 08- Diseases & disorders of the musculoskeletal system AND with one hip arthroplasty coded in NIHDI procedure AND in ICD-9-CM procedure COUNT PERCENT 302-MAJOR JOINT & LIMB REATTACH PROC OF LOWER EXTREM EXC FOR TRAUMA / 8 P 13 204 90.98 301-MAJOR JOINT & LIMB REATTACH PROC OF LOWER EXTREMITY FOR TRAUMA 1 302 8.97 / 8 P 300-BILATERAL & MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY / 8 - P 7 0.05 TOTAL 14 513 100.0 The hip replacements after trauma i.e. APR-DRG 301 were excluded (9% of the MDC 08) since this study focuses on elective THR. A remaining handful of stays in APR-DRG 300 with bilateral and multiple procedures were also excluded. Table 7.5 shows that the majority (90.8%) of the stays in APR-DRG 302 had principal diagnosis 715 “Osteoarthrosis & allied disorders”. 66 stays with principal diagnosis 996x “Complications peculiar to certain specified procedures” and 3 stays with V54x “Other orthopaedic aftercare” were rejected.
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73. Financiering van het zorgprogra
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