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

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170 Volume Outcome KCE reports 113 Table 7.5 Total hip arthroplasty: List of all principal diagnostic ICD-9 codes in APR-DRG 302 Principal diagnosis Freq % 715 Osteoarthrosis & allied disorders 11988 90.79 733 Other disorders of bone & cartilage 922 6.98 996 Complications peculiar to certain specified procedures 66 0.50 716 Other & unspecified arthropathies 51 0.39 730 Osteomyelitis, periostitis & other infections involving bone 35 0.27 755 Other congenital anomalies of limbs 21 0.16 718 Other derangement of joint 20 0.15 714 Rheumatoid arthritis & other inflammatory polyarthropathies 17 0.13 736 Other acquired deformities of limbs 16 0.12 198 Secondary malignant neoplasm of other specified sites 11 0.08 719 Other & unspecified disorders of joint 10 0.08 754 Certain congenital musculoskeletal deformities 8 0.06 732 Osteochondropathies 6 0.05 905 Late effects of musculoskeletal & connective tissue injuries 4 0.03 711 Arthropathy associated with infections 3 0.02 720 Ankylosing spondylitis & other inflammatory spondylopathies 3 0.02 724 Other & unspecified disorders of back 3 0.02 813 Fracture of radius & ulna 3 0.02 V54 Other orthopaedic aftercare 3 0.02 171 Malignant neoplasm of connective & other soft tissue 2 0.02 727 Other disorders of synovium, tendon, & bursa 2 0.02 812 Fracture of humerus 2 0.02 170 Malignant neoplasm of bone & articular cartilage 1 0.01 277 Other & unspecified disorders of metabolism 1 0.01 712 Crystal arthropathies 1 0.01 721 Spondylosis & allied disorders 1 0.01 722 Intervertebral disc disorders 1 0.01 723 Other disorders of cervical region 1 0.01 731 Osteitis deformans & osteopathies associated with other disorders classified 1 0.01 elsewhere 756 Other congenital musculoskeletal anomalies 1 0.01 TOTAL 13204 100.00 The final step in the selection was to discard 1 239 patients who had undergone two THR during two consecutive hospitalizations in the period 2004-2005. This was done to avoid confusion in identifying and allocating adverse events. The final population comprised only patients with one THR in 2004-2005. The volume per hospital was thus derived from this selection of stays. Results of definition: 11 856 stays with one elective total hip replacement were selected (for 11 856 patients).
KCE Reports 113 Volume Outcome 171 7.1.4 Definition of volume Table 7.6 shows that 115 hospitals performed 103 elective total hip arthroplasties on average in 2004. One hospital performed 608 procedures, the second in volume accounting for 396 procedures. Three quarters of the hospitals performed 121 elective THR or less. Table 7.6: Total hip arthroplasty: Summary measures of volume per hospital Number Minimum Mean 25th Pctl 50th Pctl 75th Pctl Maximum 115 5.0 103.1 42.0 84.0 121.0 608.0 Figure 7.1: Total hip arthroplasty: Volume per hospital Table 7.7 gives information on the number of elective THR per surgeon. For surgeons who work in several hospitals, a sum was made of all their THR. On average, a surgeon performed 23 elective THR in 2004. The maximum was 250 elective THR. Three quarters of surgeons performed 27 elective THR or less. Table 7.7: Total hip arthroplasty: Summary measures of volume per surgeon Number Minimum Mean 25th Pctl 50 Pctl 75th Pctl Maximum 522 1.0 22.7 4.0 11.0 27.0 250.0
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