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

KCE Reports 113 Volume Outcome 77
DESCRIPTION OF DIFFERENCES IN CHARACTERISTICS ACCORDING TO
THE VOLUME CATEGORY OF THE SURGEON
The majority of surgeons are below the international cut off of 6 interventions per year.
Three categories were defined below that cut off (1/year: 60 surgeons, 2/year and 3-
5/year). Table 5.29 show that surgeon performing at least 6 pancreatic cancer have a 2year
mortality rate lower than 50%, while surgeons who perform less than 6
procedures per year have a 2-year mortality rate of above 55%. Patients who are
treated by low-volume surgeons seem a bit older and have more co morbidities (i.e.
more patients with Charlson score ≥ 3). The highest volume surgeons (>10
procedures/year) have operated more patients with malignant neoplasm of extrahepatic
bile ducts or ampulla of Vater (which have a better survival rate as seen in Table 5.25).
Finally, distribution of the tumour stages among the surgeon categories does not seem
to be related to the volume.
Table 5.29: Pancreatic cancer surgery: Differences in case-mix and outcomes
by surgeon volume
Surgeon volume
1/yr 2/yr 3-5/yr 6-10/yr >10/yr All
Number surgeons 60 23 17 5 4 109
Number stays 60 45 62 42 78 287
Gender %male 51.7 55.6 56.5 61.9 56.4 56.1
Mean 66.9 65.0 66.5 63.2 63.3 65.0
Age Std 8.6 11.3 9.5 12.2 10.7 10.4
Charlson ≥ 3 % 18.3 17.8 12.9 11.9 2.6 11.8
Charlson
Mean 1.2 1.0 1.1 0.9 0.6 0.9
Std 1.6 1.5 1.4 1.6 0.9 1.4
Severity index (APR-DRG)
1 % 1.7 2.2 3.2 2.4 1.3 2.1
Principal Diagnosis (MCD)
2 % 10.0 6.7 3.2 9.5 2.6 5.9
3 % 23.3 24.4 14.5 23.8 26.9 22.6
4 % 65.0 66.7 79.0 64.3 69.2 69.3
Duodenum tumour % 5.0 2.2 11.3 4.8 6.4 6.3
Extrahepatic bile
ducts or ampulla of
Vater tumour % 16.7 13.3 11.3 14.3 28.2 17.8
Pancreas tumour % 78.3 84.4 77.4 81.0 65.4 76.0
Length of stay Median 25.5 24.0 21.5 25.0 22.5 23.0
In-hospital +
approximate 30day
mortality % 10.0 6.7 11.3 7.1 6.4 8.4
2-year mortality % 55.0 60.0 59.7 45.2 42.3 51.9
Stage
0-I % 28.9 13.8 26.7 4.2 25.5 22.2
II % 51.1 65.5 57.8 62.5 56.4 57.6
III % 13.3 3.4 11.1 16.7 1.8 8.6
IV % 6.7 17.2 4.4 16.7 16.4 11.6