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

74 Volume Outcome KCE reports 113
RELATION BETWEEN HOSPITAL VOLUME AND 2-YEAR MORTALITY
RATE
Table 5.27 shows the results analyses which were performed with the international cut
29, 126
off of 11 procedures per year (AHRQ and Leapfrog threshold).
Table 5.27: Pancreatic cancer surgery: mortality per hospital based on
international volume thresholds
International cut
off
AHRQ cut
off
Hospital
volume
category
Number
centres
Number
patients
3-months
mortality
Number
deaths
2-year
mortality
% Number
deaths
11/year 1-10/year 68 187 23 12.3 105 56.1
≥11/year 5 114 11 9.6 55 48.2
Table 5.28 shows results from the logistic regression model (with GEE to adjust for
clustering of patients within hospitals) used to examine the relation between hospital
volume and 2-year mortality following peripancreatic cancer surgery.
The first model was performed without adjustment for case mix and suggest that the
odd of 2 year mortality is 30% higher in hospitals with less than 11 interventions per
year than in hospital with at least 11 interventions per year: odds ratio and 95% CI: 1.31
(0.71, 2.42) This result did not reach statistical significance.
In the second model, an adjustment was made for patient characteristics which were
retrieved from the MCD data i.e. sex, age, principal diagnosis and Charlson score. This
adjustment does not affect the results of the volume effect (odss ratio and 95% CI 1.29
(0.85, 1.94)) Patients with a duodenum tumour have a higher mortality than those with
a pancreas tumour, although not statistically significant (OR = 1.23, 95%CI 0.40-3.79).
Patients with a malignant neoplasm of extrahepatic bile ducts or ampulla of Vater have a
significant better survival rate than those with a malignant neoplasm of pancreas (OR =
0.37, 95%CI 0.20-0.69).
The third model also adjusted for tumour characteristics such as stage and histology of
the peripancreatic cancer. This adjustment barely affects the effect of volume: OD and
95% CI 1.25 (0.83, 1.89).
%