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

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2 Volume Outcome KCE reports 113 4.2.4 Definition of outcome...................................................................................................................41 4.3 STATISTICAL ANALYSES ON VOLUME OUTCOME RELATIONSHIP......................................42 4.3.1 Funnel Plots .....................................................................................................................................42 4.3.2 Risk adjustment...............................................................................................................................42 4.3.3 Logistic regression models...........................................................................................................44 4.3.4 Kaplan-Meier survival analysis and Cox PH models ...............................................................44 5 RESULTS FOR FIVE CANCER SURGERY PROCEDURES ..................................... 45 5.1 THE SELECTED CANCERS .....................................................................................................................45 5.2 OESOPHAGEAL CANCER SURGERY..................................................................................................46 5.2.1 General description of procedure..............................................................................................46 5.2.2 Primary data selection in MCD 2004.........................................................................................46 5.2.3 Definition of procedure................................................................................................................47 5.2.4 Definition of volume......................................................................................................................49 5.2.5 Definition of outcomes .................................................................................................................50 5.2.6 Volume outcome relationship .....................................................................................................52 5.2.7 Discussion........................................................................................................................................59 5.3 PANCREATIC CANCER SURGERY......................................................................................................65 5.3.1 General description of procedure..............................................................................................65 5.3.2 Primary data selection in MCD 2004.........................................................................................65 5.3.3 Definition of procedure................................................................................................................66 5.3.4 Definition of volume......................................................................................................................70 5.3.5 Definition of outcomes .................................................................................................................71 5.3.6 Volume outcome relationship .....................................................................................................72 5.3.7 Discussion........................................................................................................................................79 5.4 COLON CANCER SURGERY.................................................................................................................83 5.4.1 General description of procedure..............................................................................................83 5.4.2 Primary data selection in MCD 2004.........................................................................................83 5.4.3 Definition of procedure................................................................................................................84 5.4.4 Definition of volume......................................................................................................................86 5.4.5 Definition of outcomes .................................................................................................................87 5.4.6 Volume outcome relationship .....................................................................................................88 5.4.7 Discussion........................................................................................................................................94 5.5 BREAST CANCER SURGERY..................................................................................................................99 5.5.1 General description of procedure..............................................................................................99 5.5.2 Primary data selection in MCD 2004.........................................................................................99 5.5.3 Definition of procedure..............................................................................................................100 5.5.4 Definition of volume....................................................................................................................103 5.5.5 Definition of outcomes ...............................................................................................................104 5.5.6 Volume outcome relationship ...................................................................................................105 5.5.7 Discussion......................................................................................................................................110 5.6 LUNG CANCER SURGERY...................................................................................................................114 5.6.1 General description of procedure............................................................................................114 5.6.2 Primary data selection in MCD 2004.......................................................................................114 5.6.3 Definition of procedure..............................................................................................................115 5.6.4 Definition of volume....................................................................................................................117 5.6.5 Definition of outcomes ...............................................................................................................118 5.6.6 Volume outcome relationship ...................................................................................................119 5.6.7 Discussion......................................................................................................................................124 6 RESULTS FOR FOUR CARDIOVASCULAR PROCEDURES................................128 6.1 CAROTID ENDARTERECTOMY (CEA) + CAROTID STENTING (CAS)................................128 6.1.1 General description of procedure............................................................................................128 6.1.2 Primary data selection in MCD 2004.......................................................................................128 6.1.3 Definition of procedure..............................................................................................................129 6.1.4 Definition of volume....................................................................................................................131 6.1.5 Definition of outcomes ...............................................................................................................131 6.1.6 Volume outcome relationship ...................................................................................................132 6.1.7 Discussion......................................................................................................................................137
KCE Reports 113 Volume Outcome 3 6.2 CORONARY ARTERY BYPASS SURGERY (CABG) AND/OR HEART VALVE REPLACEMENT OR REPAIR .................................................................................................................140 6.2.1 General description of procedure............................................................................................140 6.2.2 Primary data selection in MCD 2004.......................................................................................140 6.2.3 Definition of procedure..............................................................................................................142 6.2.4 Definition of volume....................................................................................................................144 6.2.5 Definition of outcomes ...............................................................................................................145 6.2.6 Volume outcome relationship ...................................................................................................145 6.2.7 Discussion......................................................................................................................................151 6.3 PERCUTANEOUS CORONARY INTERVENTION (PCI)..............................................................156 6.3.1 General description of procedure............................................................................................156 6.3.2 Primary data selection in MCD 2004.......................................................................................156 6.3.3 Definition of procedure..............................................................................................................157 6.3.4 Definition of volume....................................................................................................................158 6.3.5 Definition of outcome.................................................................................................................159 6.3.6 Volume outcome relationship ...................................................................................................160 6.3.7 Discussion......................................................................................................................................164 7 RESULTS FOR THREE ORTHOPAEDIC PROCEDURES .....................................168 7.1 ELECTIVE TOTAL HIP REPLACEMENT/ARTHROPLASTY (THR) .............................................168 7.1.1 General description of procedure............................................................................................168 7.1.2 Primary data selection in MCD 2004.......................................................................................168 7.1.3 Definition of procedure..............................................................................................................168 7.1.4 Definition of volume....................................................................................................................171 7.1.5 Definition of outcomes ...............................................................................................................172 7.1.6 Volume outcome relationship ...................................................................................................175 7.1.7 Discussion......................................................................................................................................181 7.2 ELECTIVE TOTAL KNEE REPLACEMENT/ARTHROPLASTY (TKR)..........................................187 7.2.1 General description of procedure............................................................................................187 7.2.2 Primary data selection in MCD 2004.......................................................................................187 7.2.3 Definition of procedure..............................................................................................................187 7.2.4 Definition of volume....................................................................................................................189 7.2.5 Definition of outcomes ...............................................................................................................190 7.2.6 Volume outcome relationship ...................................................................................................193 7.2.7 Discussion......................................................................................................................................199 7.3 HIP FRACTURE SURGERY (HFS) ........................................................................................................204 7.3.1 General description of procedure............................................................................................204 7.3.2 Primary data selection in MCD 2004.......................................................................................204 7.3.3 Definition of procedure..............................................................................................................205 7.3.4 Definition of volume....................................................................................................................206 7.3.5 Definition of outcomes ...............................................................................................................208 7.3.6 Volume outcome relationship ...................................................................................................208 7.3.7 Discussion......................................................................................................................................211 8 DISCUSSION ...............................................................................................................214 9 REFERENCES...............................................................................................................219
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