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

KCE Reports 113 Volume Outcome 199
RELATION BETWEEN SURGEON VOLUME AND REVISION RATE AT 1
YEAR
Logistic regression results for the revision rate are presented in Table 7.33. There was
an effect of -3.72% (-5.94%, -1.5%) on the revision rate when the volume of surgeon
increased by 10%. When we adjusted for case-mix, this effect was slightly reduced to -
3.65%, but it remained statistically significant.
Table 7.33: Total knee arthroplasty: Results of regression: relative effects of
10% increase volume of surgeon on revision rate within 1 year
Model without adjustment for case mix Effect 1 95% CI
Surgeon volume (increase of 10%) -3.72 -5.94 -1.50
Model with adjustment for case mix Effect1 95% CI
Surgeon volume (increase of 10%) -3.65 -5.86 -1.44
Odds Ratio 95% CI
Sex (male vs. female) 0.56 0.35 0.91
Age (increase of 1 year) 0.96 0.94 0.98
Charlson score (increase of 1 category) 1.14 0.83 1.55
715 vs. other PDX 2.31 0.55 9.75
1 Effect of 10% increase in volume of surgeon on the odds of revision within 1 year
7.2.7 Discussion
7.2.7.1 External validation of the definition of the procedure
We analyzed about 11 000 stays out of 14 000 stays (revisions included) identified in the
MFD or MCD with a code of knee arthroplasty (see Table 7.19). When we take into
account a yearly increase in numbers, our number corresponds well with the annual
number of stays observed in the MCD between 1997 and 2002, which was around
10 000 (revisions included) in the KCE report by Jacques et al.. 246
7.2.7.2 Summarized results of literature review
The systematic literature search identified seven systematic reviews in which the VOA
for TKR was studied. 1, 5, 59, 60, 62, 64, 68 In all, these systematic reviews identified 16 primary
studies of which 5 were published between 2002 and 2004, 325-329 and 10 between 1995
and 1999. 309, 317, 321, 330-336 This number was considered sufficient for the discussion.
The best systematic review is the meta-analysis by Stengel et al. because it is quite
recent (2004) and of good quality (see Appendix 7). 68 Stengel et al. meta-analysed data
from 5 articles of which 4 included risk-adjustment. 309, 317, 326, 328, 329 They analyzed the
effect of hospital volume on in-hospital mortality, 90-day mortality, overall complication
rate, infection rate and DVT rate. The results of these analyses are described in
Appendix 10, and are mentioned in the discussion below.
On the basis of all seven systematic reviews, it was concluded in Chapter 2 (see Table
2.2 on page 19) that there is an inverse relation between hospital volume and in-hospital
mortality. For post-operative complications, on the other hand, there were conflicting
results in relation to the association with hospital volume. The term “conflicting results”
is used because there is a mix of primary studies that indicate a positive relation with
volume and others that indicate a negative relation with volume. Since there was only
one low-quality systematic review which studied the revision rate, these results could
not be summarized in the evidence table in Appendix 10. 62