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

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188 Volume Outcome KCE reports 113 After this first selection step, we looked at the available clinical information. Major Diagnostic Category (MDC) 08 “Diseases & disorders of the musculoskeletal system” represents 99.5% of those 12 369 stays. Table 7.21 shows the APR-DRGs from these 12 312 stays. APR-DRG 302 comprises 99.6% of all stays in MDC 08. Table 7.21 Total knee arthroplasty: All APR-DRGs from MDC 08-Diseases & disorders of the musculoskeletal system, with one TKR encoded with a NIHDI code AND an ICD-9 code COUNT PERCENT 302-MAJOR JOINT & LIMB REATTACH PROC OF LOWER EXTREM EXC FOR TRAUMA / 8 P 12 260 99.58 300-BILATERAL & MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY / 8 P 11 0.09 301-MAJOR JOINT & LIMB REATTACH PROC OF LOWER EXTREMITY FOR TRAUMA / 8 P 41 0.33 TOTAL 12 312 100 Inside MDC 08, the knee replacements after trauma are excluded i.e. APR-DRG 301 representing 0.33% of the MDC 08. The last group to be excluded was APR-DRG 300 including the bilateral and multiple procedures and concerning 0.1% of MDC 08. After this step, 12 260 stays were withheld. Table 7.22 shows that the majority (96.8%) of the stays in APR-DRG 302 had a principal diagnosis 715 “Osteoarthrosis & allied disorders”. Twenty-one stays with principal diagnosis 996x “Complications peculiar to certain specified procedures” and 2 stays with V54x “Other orthopaedic aftercare” were rejected. This way, 12 237 stays remained. Table 7.22 Total knee arthroplasty: List of all principal diagnostic ICD-9 codes in APR-DRG 302 Number Percent 715 Osteoarthrosis & allied disorders 11868 96.8 736 Other acquired deformities of limbs 134 1.09 733 Other disorders of bone & cartilage 104 0.85 717 Internal derangement of knee 32 0.26 716 Other & unspecified arthropathies 25 0.2 996 Complications peculiar to certain specified procedures 21 0.17 715 Rheumatoid arthritis & other inflammatory polyarthropathies 20 0.16 720 Other & unspecified disorders of joint 11 0.09 730 Osteomyelitis, periostitis, & other infections involving bone 11 0.09 170 Malignant neoplasm of bone & articular cartilage 8 0.07 718 Other derangement of joint 7 0.06 198 Secondary malignant neoplasm of other specified sites 2 0.02 712 Arthropathy associated with infections 2 0.02 722 Spondylosis & allied disorders 2 0.02 905 Late effects of musculoskeletal & connective tissue injuries 2 0.02 V54 Other orthopaedic aftercare 2 0.02 015 Tuberculosis of bones & joints 1 0.01 172 Malignant neoplasm of connective & other soft tissue 1 0.01 213 Benign neoplasm of bone & articular cartilage 1 0.01 696 Psoriasis & similar disorders 1 0.01 732 OSTEOCHONDROPATHIES 1 0.01 754 Certain congenital musculoskeletal deformities 1 0.01 805 Fracture of vertebral column without mention of spinal cord injury 1 0.01 812 Fracture of humerus 1 0.01 813 Fracture of radius & ulna 1 0.01 TOTAL 12260 100
KCE Reports 113 Volume Outcome 189 The final step in the selection was to discard 962 patients who had undergone two TKR 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 TKR in 2004-2005. The volume per hospital was thus derived from a strict selection of stays, assuming the consecutive steps in the selection were distributed evenly across all hospitals. Results of definition: 11 017 stays with one elective total knee replacement were selected (for 11 017 patients). 7.2.4 Definition of volume Table 7.23 shows that 114 hospitals performed 97 elective total knee arthroplasty on average. One hospital performed 557 procedures, the second in volume accounting for 424 procedures. Three quarters of the hospitals performed 120 elective TKR or less. Table 7.23: Total knee arthroplasty: Summary measures of volume per hospital Number Minimum Mean 25th Pctl 50th Pctl 75th Pctl Maximum 114 4.0 96.6 46.0 78.0 120.0 557.0 Figure 7.8: Total knee arthroplasty: volume per hospital Table 7.24 gives information on the number of elective TKR per surgeon. For surgeons who work in several hospitals, a sum was made of all their TKR. In 2004, 488 orthopaedic surgeons performed at least one TKR. The mean number of TKR per surgeon is 23, while the median 12 is. The maximum was 290 elective TKR. Three quarters of surgeons performed 30 elective TKR or less. Table 7.24: Total knee arthroplasty: Summary measures of volume per surgeon Number Minimum Mean std 25th Pctl 50th Pctl 75th Pctl Maximum 488 1.0 22.6 28.6 5.0 12.0 30.0 290.0
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73. Financiering van het zorgprogra
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