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

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178 Volume Outcome KCE reports 113 RELATION BETWEEN HOSPITAL VOLUME AND REVISION RATE AT 18 MONTHS Table 7.13 presents the results of the Cox proportional hazards model. When taking the case-mix into account (i.e. adjusting for age, gender, Charlson score and principal diagnosis), medium-volume hospitals have a statistically significant higher revision rate at 18 months than high-volume hospitals: 1.451 95% CI (1.004, 2.098). There was, however, no effect when small and high volume hospitals were compared: 1.137 95% CI (0.701, 1.846). These opposite results are difficult to understand. Table 7.13: Total hip arthroplasty: Results of regression: hazard ratio of hospital volume category on revision rate at 18 months Model without adjustment for case mix Effect 1 95% CI Volume: low-volume (110 THR) 1.103 0.678 1.794 Medium-volume versus high–volume hospital 1.427 0.986 2.066 Model with adjustment for case mix Effect 1 95% CI Volume: low-volume (110 THR) 1.137 0.701 1.846 Medium-volume versus high–volume hospital 1.451 1.004 2.098 Hazard Ratio 95% CI Sex (male vs. female) 1.146 0.877 1.498 Age (increase of 1 year) 0.988 0.977 0.998 Charlson score (increase of 1 category) 0.969 0.768 1.222 715 vs. other PDX 1.992 0.506 7.841 733 vs. other PDX 2.791 0.650 11.976 1 Hazard ratio of volume category on revision within 18 months
KCE Reports 113 Volume Outcome 179 7.1.6.2 Analysis by surgeon 90-DAY COMPLICATION (ANY) RATE, BY SURGEON The funnel plot (Figure 7.6) of the relationship between the complication rate within 90 days and the volume of interventions is presented in Figure 6.2. About 9 surgeons with less than 50 elective THR were located outside the 99.8% limits and may therefore be considered as outliers. Figure 7.6: Total hip arthroplasty: Funnel plot of the 90-day complication rate, by surgeon REVISION RATE AT 18 MONTHS, BY SURGEON As presented on the funnel plot in Figure 7.7, about 12 surgeons were located outside the 99.8% limits of the distribution of the revision rate at 18 months; all but one had a volume of less than 50 elective THR in 2004. Figure 7.7: Total hip arthroplasty: Funnel plot of the revision rate at 18, by surgeon
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KCE reports 1. Effectiviteit en kos
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73. Financiering van het zorgprogra
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