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

196 Volume Outcome KCE reports 113
RELATION BETWEEN HOSPITAL VOLUME AND REVISION RATE AT 1
YEAR
Results of logistic regression presented in Table 7.30 show that the effect of a volume
increase of the procedures of a hospital on the revision rate within 1 year is very small
and non statistically significant neither before (-0.81%; -3.52%, 1.9%), nor after
adjustment for the case-mix differences (-1%; -3.74, 1.75). There is thus no indication of
a relationship between hospital volume and risk for revision after TKR.
Table 7.30: Total knee arthroplasty: Results of regression: relative effects of
10% increase volume of hospital on revision rate within 1 year
Model without adjustment for case mix Effect 1 95% CI
Hospital volume (increase of 10%) -0.81 -3.52 1.90
Model with adjustment for case mix Effect1 95% CI
Hospital volume (increase of 10%) -1.00 -3.74 1.75
Odds Ratio 95% CI
Sex (male vs. female) 0.55 0.34 0.9
Age (increase of 1 year) 0.96 0.94 0.98
Charlson score (increase of 1 category) 1.21 0.96 1.51
715 vs. other PDX 2.12 0.53 8.39
1 Effect of 10% increase in volume of surgeon on the odds of revision within 1 year
7.2.6.2 Analysis by surgeon
90-DAY COMPLICATION (ANY) RATE, BY SURGEON
The funnel plot distribution of the relationship between the complication rate within 90
days and the volume of interventions by surgeon is presented in Figure 7.12. About 9
surgeons were located outside the 95% limits and may therefore be considered as
outliers that need further investigation. The most preoccupying points were two
surgeons with a 34.6% (27/78) and 36% (8/22) 90-day complication rate. The surgeon
with the highest experience was located inside the limits, below the national average.
Figure 7.12: Total knee arthroplasty: Funnel plot of the 90-day complication
rate, by surgeon