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

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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). %
KCE Reports 113 Volume Outcome 75 Table 5.28: Pancreatic cancer surgery: Correlation-corrected logistic regression (GEE) estimates of determinants of 2-year mortality Model without adjustment for case mix Factor OR 95%CI Hospital Volume 1-10/year vs ≥11/year 1.31 0.71 2.42 Model with adjustment for patient characteristics (MCD data) Hospital Volume 1-10/year vs ≥11/year 1.29 0.85 1.94 Sex male vs female 1.24 0.79 1.95 Age increase of 1 yr 1.03 1.00 1.06 Principal Diagnosis Duodenum vs Pancreas 1.23 0.40 3.79 Extrahepatic bile ducts or Ampulla of Vater versus Pancreas 0.37 0.20 0.69 Charlson score 1.07 0.80 1.43 Model with adjustment for patient and tumour characteristics (MCD and BCR data) Hospital Volume 1-10/year vs ≥11/year 1.25 0.83 1.89 Sex male vs female 1.37 0.85 2.20 Age increase of 1 yr 1.04 1.00 1.08 Principal Diagnosis Duodenum vs Pancreas 1.06 0.36 3.16 Extrahepatic bile ducts or Ampulla of Vater versus Pancreas 0.35 0.16 0.77 Charlson score increase of 1 1.08 0.80 1.45 Stage unknown 1.31 0.57 3.05 IV 1.85 0.57 5.97 III 6.09 1.83 20.20 II 2.22 1.03 4.76 Sensitivity analyses with the log of volume as predictor showed effects borderline statistically significant (results not shown).
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