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

60 Volume Outcome KCE reports 113
5.2.7.3 Comparative analysis of literature and Belgian data
DEFINITION OF VOLUME
In Table 5.10, Belgian hospital volumes for oesophageal cancer surgery were compared
with international volume thresholds. It appears that 10 hospitals (14%) attain the
threshold issued by the US Agency for Healthcare Research and Quality, which is set at
6 oesophagectomies per annum. 29 The cut off of 13 procedures (in use by the US
Leapfrog Group) is only attained by 4 Belgian hospitals (5.7%). 126
When the same hospital thresholds are applied on Belgian surgeon volumes (because of
lack of proper surgeon volume thresholds), we find that 8 surgeons (8.3%) attain the
6/yr threshold and 6 surgeons attain the 13/yr cut off (see Table 5.12).
OUTCOME
In this KCE study, in-hospital and approximate 30-day mortality is 9.1% after
oesophagectomy for cancer. One-year and two-year mortality rates are, respectively,
30% and 45%. Median survival time was 29 months. Table 5.15 compares these Belgian
outcome data with those published in the studies that were selected.
• In the US study by Birkmeyer et al. for the years 1994 through 1999, the
observed mortality rate (in-hospital or within 30 days after surgery) varies
from 23.1% in very low volume hospital (19/yr). Unfortunately, Birkmeyer does not mention the
mortality over all hospitals. 115
• A retrospective review of 1 125 English patients who had surgery for
cardio-oesophageal cancer between 1992 and 1996 showed an overall 30day
mortality rate of 10.0% with a median survival of 14 months and a 5year
survival rate of 17.2%. Survival rate after one, two and three years
can be deduced from Figure 1 of the article and is respectively 54.8, 31.7
and 23.9%. 123
• Canadian administrative data from between 1994 and 1999 showed a 30day
mortality of 13.4% after oesophagectomy. 142
• The Swedish study by Rouvelas et al. which included all Swedish residents
with resectable oesophageal cancer in the period 1987-2000 found a 30day
mortality of 7.0% after oesophagectomy with curative intent. The
observed 1-year, 3-year and 5-year survival rate were respectively 56.1%,
32.0% and 25.2%. 127 Another study by Rouvelas and colleagues studied
oesophageal cancer surgery in a more recent period (2001-2005). This
study illustrates the improved survival in recent years: 30-day mortality
was only 3.0% while 90-day mortality was 7.9%. 148 A very similar patient
population was studied in the study carried out by Rutegard et al. where
postoperative mortality within 30 days of surgery amounted to only
2.8%. 124
• Clinical data from 903 oesophageal resections performed in 12 Dutch
hospitals between 1990 and 1999 showed an in-hospital mortality of 8.0%.
Median survival time was 21 months in low-volume hospitals and 22
months in high-volume hospitals. 152
This limited comparison leads us to conclude that the 9.1% approximate 30-day
mortality found in this study is very comparable to the one found in other studies.
Except for the Swedish mortality that is much lower. In relation to one- and two-year
survival, this study’s results seem higher than those seen elsewhere. A possible
explanation for this difference could be that patient selection (i.e. eligibility for surgery)
is more selective in Sweden.