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

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176 Volume Outcome KCE reports 113 REVISION RATE AT 18 MONTHS, BY HOSPITAL The funnel plot of the relationship between revision rate within 18 months and volume of interventions is presented in Figure 7.5. A few small hospitals were located above the 99.8% boundaries. Figure 7.5: Total hip arthroplasty: Funnel plot of the revision rate at 18 months, by hospital DESCRIPTION OF DIFFERENCES IN CHARACTERISTICS ACCORDING TO THE VOLUME CATEGORY OF THE HOSPITAL Table 7.11 presents the differences in case-mix in function of the volume of total hip arthroplasty performed per hospital. Low-volume hospitals (in which less than 61 THR were performed in 2004) have slightly more male and older patients, and the latter have more co-morbidities (i.e. they have a higher Charlson index score). This was confirmed by the fact that, for principal diagnosis 715, the severity of illness seemed to be higher in these small hospitals. The ICD-9-CM principal diagnosis 715 “Osteoarthrosis” was less frequently coded in the small hospitals, in favour of code 733 “Other disorders of bone and cartilage”. This could reveal a different case-mix or be due to a less specific coding behaviour in small hospitals.
KCE Reports 113 Volume Outcome 177 Table 7.11: Total hip arthroplasty: Differences in case-mix and outcomes by volume category of hospital Tertile based on volume ≤60 THR > 60 and > 110 THR ≤110 THR All Number hospitals 39 38 38 115 Number stays 1327 3248 7281 11856 Male % 42.0 38.0 39.5 39.4 Age Mean 69.0 68.2 67.1 67.6 Std 11.1 11.3 11.8 11.6 Charlson index score Mean 0.6 0.4 0.4 0.4 Std 1.1 1.0 0.9 1.0 Charlson ≥ 3 % 6.8 4.2 3.3 3.9 Principal diagnosis 715 Osteoarthrosis % 86.7 92.3 92.4 91.7 733 Other disorders of bone & cartilage % 8.4 6.3 6.3 6.6 Other principal diagnosis % 4.8 1.4 1.3 1.7 Severity index (APR-DRG) for stays with principal diagnosis 715 1151 2997 6725 10873 1 % 42.9 51.1 52.9 51.3 2 % 42.7 40.8 41.2 41.2 3 % 13.5 7.3 5.3 6.7 4 % 0.9 0.8 0.7 0.7 Complication rate (any) within 90 days % 4.1 4.1 2.9 3.3 Revision rate at 18 months % 1.9 2.3 1.7 1.8 RELATION BETWEEN HOSPITAL VOLUME AND 90-DAY COMPLICATION (ANY) RATE The effects from the logistic regression, with the 90-day complication rate as dependent variable, are presented in Table 7.12. Without taking case-mix into account, an increase of volume of 10% is associated with a statistically significant change in the odds of a complication of -2.62% 95% CI (-4.30%, -0.94%). After adjustment for the case-mix, the change is reduced to -1.63% 95% CI (-3.43%, 0.17%) and is not statistically significant anymore. On the basis of these results, we therefore conclude that, taking case-mix into account, there is no association between the hospital volume of THR and the 90-day complication rate. Table 7.12: Total hip arthroplasty: Correlation-corrected logistic regression (GEE) estimates of determinants of 90-day complication Model without adjustment for case mix Effect 1 95% CI Hospital volume (increase of 10%) -2.62 -4.30 -0.94 Model with adjustment for case mix Effect 1 95% CI Hospital volume (increase of 10%) -1.63 -3.43 0.17 Odds Ratio 95% CI Sex (male vs. female) 1.05 0.84 1.32 Age (increase of 1 year) 1.02 1.01 1.03 Charlson score (increase of 1 category) 1.48 1.30 1.69 715 vs. other PDX 0.70 0.35 1.39 733 vs. other PDX 1.14 0.57 2.29 1 Effect of 10% increase in volume of hospital on the odds of complication within 90 days
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