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

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46 Volume Outcome KCE reports 113 5.2 OESOPHAGEAL CANCER SURGERY 5.2.1 General description of procedure As shown in Table 5.1, 1 140 new oesophageal and cardia cancer cases were reported in Belgium in 2004. Surgical removal of the oesophagus (i.e. oesophagectomy) is considered standard treatment for patients with resectable oesophageal cancer. Although recent Belgian guidelines recommend that oesophagectomy should not be performed with palliative intent in patients with oesophageal cancer, it is sometimes a 119, 121 way to relieve symptoms but only in carefully selected patients. 5.2.2 Primary data selection in MCD 2004 First selection of data was based on ICD-9-CM diagnostic and procedure codes as 93, 122 proposed by Dimick et al. and by Christian et al., and on NIHDI procedure codes. Following the recommendations of the Belgian College of Oncology and the example of others who published on the volume-outcome association in oesophageal cancer surgery, patients with the diagnosis of cardia tumour (i.e. the proximal part of the 93, 119, 121, 123, 124 stomach) were explicitly included. This selection resulted in a total of 4 565 stays (Table 5.2). This selection is too broad since it also includes patients with a secondary diagnosis of malignant neoplasm of oesophagus. This implies that patients with oesophageal cancer as pre-existing condition are also included (see section 4.2.1, page 39). The definition of the population studied (i.e. patients with a principal diagnosis of malignant neoplasm of oesophagus or cardia, with a surgical resection of the oesophagus) will be defined in the next section. Table 5.2: Oesophageal cancer surgery: Primary data selection in MCD 2004 SELECTION 1 SELECTION 2 SELECTION 3 ICD-9-CM (principal or ICD-9-CM procedure NIHDI procedure code secondary) diagnosis code code 150x Malignant neoplasm 4240 Oesophagectomy, not 228023 Thoracic or thoracoabdominal of oesophagus otherwise specified oesophagectomy or gastrooesophagectomy, at one surgery time. 1510 Malignant neoplasm 4241 Partial oesophagectomy 228185 Subtotal oesophagectomy until the of cardia level of the aortic arch, with restoration of continuity. 4242 Total oesophagectomy STAYS SELECTED = 4 476 stays STAYS SELECTED STAYS SELECTED = 370 stays = 436 stays TOTAL STAYS SELECTED= 4 565 stays (selection 1 OR selection 2 OR selection 3)
KCE Reports 113 Volume Outcome 47 5.2.3 Definition of procedure 5.2.3.1 Primary hospital stays in Minimal Clinical Data A total of 2 084 of the 4 565 selected hospital stays had a principal diagnosis of malignant neoplasm of oesophagus (74% i.e. 1 545 stays) or cardia (26% i.e. 539 stays). As shown in Table 5.3, 378 stays (18.1% of 2 084 stays) corresponding to 377 patients (26.9% of 1 401 patients) had a procedure for oesophageal cancer surgery as described above (with the addition of the ICD-9-CM procedure 43.99 “Oesophagogastrectomy NOS” which is also to be considered as oesophageal cancer surgery, but was not present in our initial selection). Table 5.3: Oesophageal cancer surgery: Principal diagnosis and percentage of cancer surgery (per stay and per patient) Principal diagnosis Total Stays with Total Patients with Number oesophageal Number oesophageal hospital stays cancer surgery patients cancer surgery Nbr Pct Nbr Pct 150 Malignant neoplasm of oesophagus 1 545 245 15.9 1 005 244 24.3 151 Malignant neoplasm of cardia 539 133 24.7 396 133 33.6 Total 2 084 378 18.1 1 401 377 26.9 The APR-DRGs of these 378 stays are described in Table 5.4. Although all these 378 stays had a principal diagnosis of malignant neoplasm of oesophagus or cardia and a surgical resection of the oesophagus, they were not all classified in the APR-DRG 220 “Major stomach, oesophageal & duodenal procedures”. In some cases, for example, where a tracheostomy was performed, the APR-DRG changed into 004. To create a study population of patients which is as homogenous as possible, it was decided to retain only the 343 stays (corresponding to 342 patients) that are included in the APR-DRG 220. APR-DRG Table 5.4: Oesophageal cancer surgery: All APR-DRGs of stays with a principal diagnosis of a malignant neoplasm of the oesophagus or cardia AND with surgical resection of the oesophagus Number Percent 004-TRACHEOSTOMY EXCEPT FOR FACE, MOUTH & NECK DIAGNOSES / p3 - P 33 8.73 220-MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES / 6 - P 343 90.74 222-MINOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES / 1 0.26 6 – P 226-ANAL & STOMAL PROCEDURES / 6 - P 1 0.26 TOTAL 378 100.00 Results of definition: 343 stays with oesophageal cancer surgery were selected in the Minimal Clinical Data. These stays concerned 342 individual patients and 72 centres.
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73. Financiering van het zorgprogra
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