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

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