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

200 Volume Outcome KCE reports 113
7.2.7.3 Comparative analysis of literature and Belgian data
DEFINITION OF VOLUME
As shown in Table 7.23, Belgian hospitals had a mean annual elective TKR volume of 97
in 2004; median is 78; 75 th Percentile is 120. Table 7.24 shows that Belgian orthopaedic
surgeons performed on average 23 elective TKR in 2004; median is 12; 75 th Percentile is
30 TKR per year. These summary measures are very similar to those for elective total
hip replacement (see page 49). When we compare the highest volume hospitals for
elective THR (Figure 5.1) with those for elective TKR (Figure 6.2), the same hospital
IDs turn up on the horizontal axis. This means that Belgian hospitals with a high annual
volume of THR, often also have a high volume of elective TKR.
In the selected primary studies and the systematic review, we did not find any
information on the annual TKR volume of hospitals or surgeons in other countries.
OUTCOME
Again we have to acknowledge the fact that the Belgian MCD do not capture clinically
relevant outcome measures such as loss of dependence, loss of mobility or residual
pain.
Table 7.34: Total knee arthroplasty: complication rate: comparison of
Volume-Outcome KCE study with scientific literature
IN-HOSPITAL
KCE study Hervey Coyte Kreder Katz
COMPLICATIONS Volume outcome 2003 1999 2003 2004
Complications during index admission
Death 0.15% 0.21% 0.4%
Deep venous thrombosis 0.41% 0.48%
Pulmonary embolism 0.46% 0.37%
Deep wound infection 0.06% 0.25%
Complications within 90 days from index admission
Death 0.5% 0.6%
Deep venous thrombosis 0.42%
Pulmonary embolism 0.63% 0.8%
Deep wound infection 0.31% 0.4%
AMI 0.20% 0.8%
Pneumonia 0.56% 1.4%
Complications within 1 year (or more) after index admission
Revision within 1 year 0.98% 0.8%
Revisions within 500 days (1.36
0.2% (*)
year)
1.6% (*)
(*) Coyte et al used two methods to estimate the revision rate: based on a group of patients with
the longest time to revision and based on a group with the shortest time.
In-hospital outcome after total knee replacement
In-hospital outcome in the KCE study was first compared with the study by Hervey on
1997 data. 328 See Table 7.34. Hervey’s complication rates were very similar to the ones
that were found in the MCD data except for deep wound infection. This difference can
probably be explained by the use of different codes. Hervey et al. identified the
infections by means of ICD-9-CM codes 998.59 “Postoperative wound infection” and
686.9 “Postoperative wound infection knee (skin)” while we used 996.66 “Infection and
inflammatory reaction due to internal joint prosthesis”. The latter code was an
exclusion criterion in the Hervey study. Kreder et al. reported an in-hospital mortality
of 0.4%, but this is perhaps related to the fact that it concerns older data i.e. TKR
performed between 1993 and 1996. 329