Het volume van chirurgische ingrepen en de impact ervan op ... - KCE
Het volume van chirurgische ingrepen en de impact ervan op ... - KCE
Het volume van chirurgische ingrepen en de impact ervan op ... - KCE
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54 Volume Outcome <strong>KCE</strong> reports 113<br />
RELATION BETWEEN HOSPITAL VOLUME AND 2-YEAR MORTALITY<br />
RATE<br />
Analyses were performed with international thresholds i.e. 6 oes<strong>op</strong>hagectomies/year<br />
issued by the US Ag<strong>en</strong>cy for Healthcare Research and Quality (AHRQ). Descriptive<br />
results using the 13/year threshold issued by the US Leapfrog Group are also<br />
pres<strong>en</strong>ted. 29, 126 Table 5.11 contains results from a logistic regression mo<strong>de</strong>l (with GEE<br />
adjustm<strong>en</strong>t for clustering of pati<strong>en</strong>ts within hospitals) used to examine the relation<br />
betwe<strong>en</strong> hospital <strong>volume</strong> and 2-year mortality following oes<strong>op</strong>hageal cancer surgery.<br />
The first mo<strong>de</strong>l was performed without adjustm<strong>en</strong>t for case mix. These results are<br />
equival<strong>en</strong>t to the perc<strong>en</strong>tages pres<strong>en</strong>ted in the previous table: the data suggest that<br />
there is no differ<strong>en</strong>ce betwe<strong>en</strong> the two groups 0.87 95%CI (0.55, 1.38)<br />
In the second mo<strong>de</strong>l, an adjustm<strong>en</strong>t was ma<strong>de</strong> for pati<strong>en</strong>t characteristics which were<br />
retrieved from the MCD data i.e. sex, age, principal diagnosis and Charlson score. This<br />
adjustm<strong>en</strong>t barely changes the results of the <strong>volume</strong> effect on 2-year mortality<br />
In addition, the third mo<strong>de</strong>l also adjusted for tumour characteristics such as stage and<br />
histology of the oes<strong>op</strong>hageal cancer. Again this adjustm<strong>en</strong>t does not change the <strong>impact</strong><br />
of the <strong>volume</strong> category on the 2-year mortality: odds ratio and 95% CI 0.89 (0.57, 1.40).<br />
In this mo<strong>de</strong>l, pati<strong>en</strong>ts with a higher Charlson score have a higher mortality rate (OR =<br />
1.44, 95%CI 1.10-1.88). Disease stage also proves to be an important predictor of 2year<br />
mortality. Pati<strong>en</strong>ts with stage 3 and stage 4 disease have significant higher 2-year<br />
mortality than those with stage 1 disease. Tumour histology, however, is not a statically<br />
significant predictor of mortality.<br />
Table 5.10: Oes<strong>op</strong>hageal cancer surgery: 2-year mortality per hospital based<br />
on international <strong>volume</strong> thresholds<br />
Cut off Hospital <strong>volume</strong><br />
category<br />
Number<br />
c<strong>en</strong>tres<br />
Number<br />
cases<br />
2-year mortality<br />
Number<br />
<strong>de</strong>aths<br />
AHRQ cut off 6/year 1-5/year 60 146 64 43.8<br />
≥ 6/year 10 183 83 45.4<br />
Leapfrog cut off 13/year 1-12/year 66 194 88 45.4<br />
≥ 13/year 4 135 59 43.7<br />
%
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