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

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192 Volume Outcome KCE reports 113 Table 7.26 shows that the most frequent complication observed during hospitalization (initial or readmissions) within 90 days after admission was a complication due to internal joint prosthesis with 1.06% (0.88,% 1.27%), followed by 0.82% mechanical complication (0.66%, 1 %). As explained in the chapter on total hip arthroplasty (see page 174), there may be some overlap between categories, and some patients experienced different complications or are readmitted more than once. Therefore, a global outcome category was created to group all patients who encountered any of the above complications within 90 days after the initial TKR, with the exception of AMI and pneumonia. 3.20% (2.88%, 3.55%) of the patients (number = 353) encountered at least one of the above mentioned post-operative complications within 90 days after the initial total knee arthroplasty admission. AMI and pneumonia were left out of this global complication rate for two reasons: to be consistent with the definition for total hip arthroplasty and because AMI and pneumonia are more generic complications that are not particular for this orthopaedic intervention. Table 7.26: Total knee arthroplasty: Outcomes measured during hospital (re)admission within 90 days of index admission COMPLICATION WITHIN 90 DAYS Number number % total outcome outcome Deep venous thrombosis 11 017 46 0.42 Pulmonary embolism 11 017 69 0.63 Deep wound infection 11 017 34 0.31 Mechanical complication 11 017 90 0.82 Dislocation of knee 11 017 14 0.13 Other complication due to prosthesis 11 017 117 1.06 Any of the above complications * Other complications: 11 017 353 3.20 Acute myocardial infarction 11 017 22 0.20 Pneumonia 11 017 62 0.56 * a patient may have more than one complication, but these are counted only once 7.2.5.3 Revision rate at 12 months Revision rates at 12 months were retrieved by identifying the readmissions with an ICD-9-CM procedure code 8155 or an NIHDI procedure code 293462 (see Table 7.19). Table 7.27 shows that less than 1% of the patients needed a revision in the year after the operation (0.98%). Since we disposed of a 12-month follow-up for all patients, there was no need to estimate the rate of revision by the Kaplan-Meier method. Revision rate at 36 months, as is done in scientific literature, was not calculated because data were not available. Table 7.27: Total knee arthroplasty: Revision rate at 12 months Number number % 95% CI total outcome outcome Readmission for revision at 12 months 11 017 108 0.98 0.80 1.18
KCE Reports 113 Volume Outcome 193 7.2.6 Volume outcome relationship 7.2.6.1 Analysis by hospital 90-DAY COMPLICATION (ANY) RATE, BY HOSPITAL Figure 7.10 shows the association between the volume of interventions by hospital and the rate of complication within 90 days. The horizontal line represents the overall 90day complication rate over all hospitals i.e. 3.2%. Three hospitals are located outside the variability limits and a fourth one is isolated far from the funnel plot. This latest hospital belonged to the third tertile with 141 TKR patients of whom 36 (25.5%) encountered a complication within 90 days (35 with a code 996.7x complication due to the internal device and one with a code 996.4 mechanical complication of the device). Such a manifest outlier would need to be further investigated by means of an audit. Figure 7.10: Total knee arthroplasty: Funnel plot of the 90-day complication rate, by hospital
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