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

KCE Reports 113 Volume Outcome 57
RELATION BETWEEN SURGEON VOLUME AND 2-YEAR MORTALITY
RATE
When international hospital volume thresholds (AHRQ or Leapfrog) are applied on
surgeons, low volume surgeons (1-5/year) have 13.5% 3 month mortality rate and a
46.8% 2-year mortality rate while high volume (≥ 6/year) surgeons have a 6.4% 3 month
mortality and a 41.3% mortality rate (Table 5.12). Survival curve is presented in
Figure 5.7. Percentage of are also presented based on the leapfrog cut off (13/year)
Table 5.12: Oesophageal cancer surgery: mortality per surgeon based on
international volume thresholds
International cut
off
AHRQ cut
off
Leapfrog
cut off
Surgeon
volume
category
Number
surgeons
Number
cases
3-months
mortality
Number
deaths
2-year
mortality
% Number
deaths
6/year 1-5/year 88 156 21 13.5 73 46.8
≥ 6/year 8 140 9 6.4 58 41.3
13/year 1-12/year 90 170 21 12.4 78 45.9
≥ 13/year 6 126 9 7.1 53 42.1
Figure 5.7: Oesophageal cancer surgery: Survival curve by volume of
surgeons (based on AHRQ cut off 6/year
Table 5.13 present results using the AHRQ threshold. As shown in Table 5.13, results
of logistic regression (with adjustment for clustering of patients within centres as
explained in Chapter 3 on page 30 (section 3.6.1.3) suggest that high volume surgeons
have a lower 2-year mortality than low volume surgeons (without reaching statistical
significance), after adjustment for patients and tumour characteristics: the odds ratio
and 95%CI is 1.30 (0.88, 0.91)
%