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

64 Volume Outcome KCE reports 113
Key points on volume outcome association for oesophageal cancer
surgery
• A total of 1 401 patients were hospitalized in 2004 (retrieved in MCD 2004)
with a diagnosis of malignant neoplasm of oesophagus or cardia. 27% of
those patients underwent a resection of the oesophagus.
• The population studied consisted of those 329 patients with
oesophagectomy and whose data could be linked to IMA databases.
• In 80% of the cases, information on tumour could be retrieved in the BCR
database. Data on stage was available for 68% of stays. Low-volume as well
as high-volume hospitals missed data on stage; there seemed to be no
association between percentage of linkage with BCR and hospital volume.
• These interventions were performed in 72 centres by 99 surgeons. 10
hospitals and 8 surgeons had a volume higher or equal to 6 interventions per
year (the current AHRQ criteria in US).
• Two-year mortality was 45%. Regression models were fitted to assess the
association between hospital or surgeon volume with this outcome. The
following factors were taken into account in all analyses: sex, age, principal
diagnosis (oesophagus or cardia), Charlson score (co morbidity), tumour
stage and tumour histology (adenocarcinoma or squamous cell carcinoma).
• Based on the study of systematic reviews, it was concluded that there is
evidence for an inverse relation between hospital volume and mortality for
oesophageal cancer surgery. Two minimal hospital volume thresholds were
retained from the literature search: a lower threshold of 6
oesophagectomies per annum and an upper threshold of 13
oesophagectomies per annum.
• In contrast to scientific literature, however, Belgian data did not show an
inverse relationship between volume of centres and 2-year mortality:
respectively 43.8% in centre with less than 6 interventions per year and
45.4% in centres with at least 6 interventions per year.
• The literature review also concluded that there is inverse relationship
between surgeon volume and mortality.
• As well, Belgian data suggest an inverse association (not statistically
significant) between the volume of surgeons and 3 months mortality: 13.5%
for surgeons with less than 6 interventions per year and 6.4% for surgeons
with at least 6 interventions per year. Results at two years were consistent.
• Several years of observations are required to increase precision of effects.
• Because data were not retrieved or not available in the databases, the
following characteristics could not be used for risk adjustment: use of (neo)
adjuvant therapy (chemo- or radiation therapy), acuity of admission (elective
versus urgent), intention of surgery (palliative versus curative).