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

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194 Volume Outcome KCE reports 113 REVISION RATE AT 1 YEAR, BY HOSPITAL The funnel plot of the relationship between revision rate at 1 year and hospital volume is presented in Figure 7.11. Three medium-sized hospitals fall outside the limits of variability. They have a TKR volume of, respectively, 78, 79 or 80 interventions. The revision rate for their patients was 5.1%, 6.3%, 7.5%. Figure 7.11: Total knee arthroplasty: Funnel plot of the revision rate at 1 year, by hospital DESCRIPTION OF DIFFERENCES IN CHARACTERISTICS ACCORDING TO THE VOLUME CATEGORY OF THE HOSPITAL The differences in case-mix in function of the volume of total knee arthroplasty performed per hospital are presented in Table 7.28. More women were operated than men (72% versus 28%), especially in small hospitals (having performed 53 TKR or less in 2004). Mean age of patients was similar between the three groups. The percentage of high Charlson index score was the highest in medium-sized hospitals (53.6% versus 44.8% for small-sized hospitals and 47.8% for large sized ones). The revision rate within 1 year was highest when the index admission hospital was a medium-sized hospital. Remember that the highest rates were observed in 3 of those hospitals (see Figure 7.11). Complication rates within 90 days of small-sized hospitals were relatively higher than those of the two other categories of hospitals.
KCE Reports 113 Volume Outcome 195 Table 7.28: Total knee arthroplasty: Case mix description by volume category of hospital Tertile based on volume ≤53 TKR >53 and >104 TKR ≤104 TKR Number hospitals 38 38 38 114 Number stays 1322 2922 6773 11017 Male % 29.8 26.4 28.2 27.9 Age Mean 70.1 69.7 69.5 69.6 Std 9.8 9.6 9.7 9.7 Charlson index score Mean 0.5 0.5 0.5 0.5 Std 1.0 1.0 1.0 1.0 Charlson ≥ 3 % 44.8 53.6 47.8 49.0 Principal diagnosis 715 Osteoarthrosis % 96.1 94.8 97.9 96.9 736 Other acquired deformities of limbs % 0.4 3.1 0.4 1.1 Other principal diagnosis % 3.6 2.1 1.7 2.0 Severity index (APR-DRG) for stays with principal diagnosis 715 1270 2771 6631 10672 1 % 45.3 54.8 48.0 49.4 2 % 43.9 38.2 44.9 43.1 3 % 10.0 6.2 6.6 6.9 4 % 0.8 0.8 0.5 0.6 Complication rate (any) within 90 days % 3.7 3.1 3.1 3.2 Revision rate at 1 year % 1.0 1.3 0.9 1.0 RELATION BETWEEN HOSPITAL VOLUME AND 90-DAY COMPLICATION (ANY) Table 7.29 shows the results in terms of effects of the logistic regression aiming at explaining the 90-day complication rate (any). Without adjusting for case-mix, a 10% volume increase is associated with a neglible decrease in the odds of complication of - 0.63% (-3.37%, 2.11%). Males present better odds than female patients and the Charlson score does influence the complication rate. Table 7.29: Total knee arthroplasty: Correlation-corrected logistic regression (GEE) estimates of determinants of 90-day complication Model without adjustment for case mix Effect1 95% CI Hospital volume (increase of 10%) -0.63 -3.37 2.11 Model with adjustment for case mix Effect1 95% CI Hospital volume (increase of 10%) -0.36 -2.99 2.28 Odds Ratio 95% CI Sex (male vs. female) 0.73 0.56 0.94 Age (increase of 1 year) 0.99 0.97 1.00 Charlson score (increase of 1 category) 1.39 1.20 1.60 715 vs. other PDX 0.60 0.36 1.00 1 Effect of 10% increase in volume of surgeon on the odds of complication within 90 days All
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