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

206 Volume Outcome KCE reports 113
Table 7.37 shows that 99% of these 10 690 stays are situated in MDC 08
(musculoskeletal system).
Table 7.37: Hip fracture surgery: List of the major diagnostic categories
(MDC)
COUNT PERCENT
08 Diseases and Disorders of the Musculoskeletal System & Connective Tissue 10545 98.64
25 Multiple Significant Trauma 130 1.22
00 Residual Group 15 0.14
Total 10690 100.0
All APR-DRGs of MDC 08, as presented in Table 7.38, are surgical of nature. A surgical
APR-DRG for trauma was assigned in most of the cases: APR-DRG 308 in 68% of the
stays and APR-DRG 301 in another 31%. Less than 1% belongs to another APR-DRG.
Table 7.38: Hip fracture surgery: All APR-DRGs from MDC 08-Diseases &
disorders of the musculoskeletal system
COUNT PERCENT
308-HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT FOR TRAUMA / 8 - P 7194 68.22
301-MAJOR JOINT & LIMB REATTACH PROC OF LOWER EXTREMITY FOR TRAUMA
/ 8 - P
3264 30.95
300-BILATERAL & MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY / 8 - P 51 0.48
305-AMPUTATION FOR MUSCULOSKELET SYSTEM & CONN TISSUE DISORDERS / 8
- P
7 0.07
320-OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES / 8 7 0.07
- P
313-KNEE & LOWER LEG PROCEDURES EXCEPT FOOT / 8 - P 6 0.06
315-SHOULDER, ELBOW & FOREARM PROCEDURES / 8 - P 5 0.05
316-HAND & WRIST PROCEDURES / 8 - P 3 0.03
306-MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY / 2 0.02
8 - P
304-DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK / 8 - P 1 0.01
310-BACK & NECK PROCEDURES EXCEPT DORSAL & LUMBAR FUSION / 8 - P 1 0.01
312-SKIN GRFT & WND DEBRID EXC OPN WND, FOR MS & CONN TIS DIS, EXC 1 0.01
HAND / 8 - P
314-FOOT PROCEDURES / 8 - P 1 0.01
318-REMOVAL OF INTERNAL FIXATION DEVICE / 8 - P 1 0.01
950-EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS / 0 - P 1 0.01
10545 100.0
For reasons of homogeneity, it was decided to discard bilateral procedures (APR-DRG
300 = 51 stays) and amputations (APR-DRG 305 = 7 stays). Subsequently, another 33
stays were discarded due to data irregularities.
A last filter was applied on the 10 454 remaining stays in order to exclude patients who
were selected more than once (number = 215) or who were readmitted for hip
fracture surgery within 90 days in the period 2004-2005 (number = 305). This was done
to avoid confusion in identifying and allocating adverse events. The final population
included 9 934 stays.
Results of definition: 9 934 stays with a proximal femur fracture were
selected.
7.3.4 Definition of volume
Table 7.39 shows that 113 hospitals surgically treated 88 hip fractures on average, in
2004. One hospital performed 225 procedures, the second in volume accounting for
222 procedures. Three quarters of the hospitals treated 116 hip fractures or less.
Table 7.39: Hip fracture surgery: Summary measures of volume per hospital
Number Minimum Mean 25th Pctl 50th Pctl 75th Pctl Maximum
113 7.0 87.9 52.0 78.0 116.0 225.0