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

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66 Volume Outcome KCE reports 113 Table 5.18: Pancreatic cancer surgery: Primary data selection in MCD 2004 SELECTION 1 SELECTION 2 SELECTION 3 ICD-9-CM (principal and secondary) diagnosis code 1520 Malignant neoplasm of duodenum 1561 Malignant neoplasm of extrahepatic bile ducts 1562 Malignant neoplasm of ampulla of Vater 157x Malignant neoplasm of pancreas STAYS SELECTED = 4 640 stays ICD-9-CM procedure code NIHDI procedure code 5251 Proximal pancreatectomy 242023 Duodeno-pancreatectomy. 5252 Distal pancreatectomy 242045 Left-hemipancreatectomy with pancreatico-jejunal anastomosis, or as good as total 5253 Radical subtotal pancreatectomy 5259 Other partial pancreatectomy 526 Total pancreatectomy 527 Radical pancreaticoduodenectomy pancreatectomy ((95%). 242060 Left-hemipancreatectomy or enucleation of pancreatic tumour or extirpation of a pancreatic sequestrum. STAYS SELECTED STAYS SELECTED = 593 stays = 560 stays TOTAL STAYS SELECTED= 4 949 stays (selection 1 OR selection 2 OR selection 3) 5.3.3 Definition of procedure 5.3.3.1 Primary hospital stays in Minimal Clinical Data 2 531 of the 4 949 selected hospital stays had a principal diagnosis of malignant neoplasm of duodenum (4.3% i.e. 109 stays), of extrahepatic bile ducts (7.4% i.e. 186 stays), of ampulla of Vater (4.4% or 110 stays) or of pancreas (84.0% i.e. 2 126 stays). As shown in Table 5.19, only 322 stays (12.7% of 2 531 stays) corresponding to 320 patients (17.4% of 1 824 patients) had a procedure for peripancreatic cancer surgery as described above. Table 5.19: Pancreatic cancer surgery: Principal diagnosis and percentage of cancer surgery (per stay and per patient) Principal diagnosis Total Stays with Total Patients with number pancreatic number pancreatic cancer hospital stays cancer surgery patients surgery Nbr % Nbr % 1520 Malignant neoplasm of duodenum 109 24 22.0 87 24 27.6 1561 Malignant neoplasm 186 of extrahepatic bile ducts 16 8.6 146 16 11.0 1562 Malignant neoplasm of ampulla of Vater 110 36 32.7 85 36 42.4 157 Malignant neoplasm of pancreas 2 126 246 11.6 1 526 244 15.99 Total 2 531 322 12.7 1 842 320 17.37 The APR-DRGs of these 322 stays are described in Table 5.20.
KCE Reports 113 Volume Outcome 67 To create a study population of patients which is as homogenous as possible, we retained only the 311 stays (corresponding to 309 patients) that are included in the APR-DRGs 220 “Major stomach, oesophageal & duodenal procedures” and 260 “Pancreas, liver & shunt procedures”. Table 5.20: Pancreatic cancer surgery: All APR-DRGs of stays with a principal diagnosis of a malignant neoplasm of duodenum, of extrahepatic bile ducts or of pancreas AND with surgical resection of the pancreas APR-DRG Number Percent 004-TRACHEOSTOMY EXCEPT FOR FACE, MOUTH & NECK DIAGNOSES / p3 - P 2 0.62 220-MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES / 6 - P 19 5.90 221-MAJOR SMALL & LARGE BOWEL PROCEDURES / 6 - P 1 0.31 223-MINOR SMALL & LARGE BOWEL PROCEDURES / 6 - P 1 0.31 229-OTHER DIGESTIVE SYSTEM PROCEDURES / 6 - P 3 0.93 260-PANCREAS, LIVER & SHUNT PROCEDURES / 7 - P 292 90.68 261-MAJOR BILIARY TRACT PROCEDURES / 7 - P 3 0.93 264-OTHER HEPATOBILIARY & PANCREAS PROCEDURES / 7 - P 1 0.31 TOTAL 322 100.00 Results of definition: 311 stays with pancreatic cancer surgery were selected in the Minimal Clinical Data. These stays concerned 309 individual patients and 74 centres. 5.3.3.2 Linkage with data from IMA and BCR First, the Minimal Clinical Data (MCD) were linked with the Common Sickness Funds Agency (IMA) database. As shown in Table 5.21, 96.8% of 311 MCD stays could be linked with IMA data. Second, 79.8% of the original 311 MCD stays were linked to BCR data on the basis of ICD-10 codes C17.0, C24.0, C24.1 and C25. Originally, we planned to limit the data to those records with a histopathologically confirmed pancreatic cancer (ICD-10 code C25). However, as shown in Table 5.22, this would have resulted in a substantial decrease in number of records since only 188 MCD stays with ICD-9-CM code 157 could be linked with BCR data with ICD-10 code C25. A second reason to include all peripancreatic cancer diagnoses instead of limiting the data to the pancreas cancers only is the consistency between the diagnoses in the two databases. Table 5.22 illustrates, for example, how 13 out of 16 stays in MCD with diagnosis “malignant neoplasm of extrahepatic bile ducts” correspond with the same diagnosis in the BCR. This proofs that our original concern that the final diagnosis (based on the histopathologic examination of the tumour) would be different from the clinical diagnosis encoded in the MCD, was unfounded. Because of our broad selection in relation to the type of cancer that is surgically treated with a pancreatectomy, it is more correct to label these cancers as peripancreatic cancers. Third, information on tumour stage in the BCR was available for 207 patients with peripancreatic cancer. These account for 66.6% of the initial 311 stays in the MCD selection. This percentage varies strongly among the hospitals as is shown in Figure 5.9 where the red columns indicate the number of procedures for which stage is missing. Table 5.21: Pancreatic cancer surgery: Percentage of linkage of MCD data with data from IMA and BCR Number % Number of stays in MCD selection 311 100 Linkage with IMA 301 96.8 Linkage with BCR 248 79.8 Linkage with BCR and data about stage 207 66.6
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