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

82 Volume Outcome KCE reports 113
VOLUME OUTCOME ASSOCIATION
The present study suggests that patients treated in hospital performing less than 11
interventions per year (the AHRQ cut off) have a higher 2-year mortality, taking into
account patient and tumour characteristics, than patients operating in hospitals
performing at least 11 interventions per year (56.1% vs 48.2%, OR and 95% CI 1.25
(0.83, 1.89). This association did not reach statistical significance.
With respect to the relationship between surgeon volume and 2-year mortality, our
study showed that patients operated by surgeons performing less than 6 interventions
per year (the AHRQ cut off) have a higher risk of mortality, taking into account patient
and tumour characteristics (OR 1.51 (95% CI 1.06, 2.16)).
These results are a confirmation of what we found in the literature review.
Key points on volume outcome association for peripancreatic cancer
surgery
• A total of 1 842 patients were hospitalized in 2004 (retrieved in MCD 2004)
for a diagnosis of malignant neoplasm of pancreas (or peripancreas). 17% of
these patients underwent a pancreatectomy.
• The population studied consisted of those 301 patients with pancreatectomy
and whose data could be linked to IMA databases.
• In 80% of the cases, information on tumour could be retrieved in the BCR
database. Data on stage was available for 67% of stays. There was a good
agreement between the diagnosis in MCD and the tumour location in BCR.
• These interventions were performed in 74 centres by 112 surgeons. Five
hospitals and four surgeons had a volume higher than 11 interventions per
year (the US AHRQ and Leapfrog cut off).
• Two-year mortality was 53%. Regression models were fitted to assess the
association between hospital or surgeon volume and outcome. The following
factors were taken into account in all analyses: sex, age, principal diagnosis
(pancreas or peripancreas), Charlson score (co morbidity) and tumour
stage.
• Based on the study of systematic reviews, it was concluded that there is
evidence for an inverse relation between hospital volume and mortality for
pancreatic cancer surgery. One minimal hospital volume threshold was
retained from the literature search i.e. 11 pancreatic resections per annum.
• The present study suggests that patients treated in hospital performing less
than 11 interventions per year (the AHRQ cut off) have a higher 2-year
mortality than patients operating in hospitals performing at least 11
interventions per year (56.1% vs 48.2%, OR and 95% CI 1.25 (0.83, 1.89).
• The literature review also concluded that there is inverse relationship
between surgeon volume and mortality.
• Our findings were in agreement with literature: there was a statistically
significant inverse association between the volume of surgeons and the 2year
mortality: 58% for surgeons performing less than 6 interventions per
year and 43% for surgeons performing at least 6 interventions per year (OR
and 95% CI 1.51 (1.06, 2.16).
• Data from two years are required to have more precise estimates.
• Because data were not retrieved or not available in the databases, the
following characteristics could not be used for risk adjustment: use of (neo)
adjuvant therapy (chemo- or radiation therapy), acuity of admission (elective
versus urgent), intention of surgery (palliative versus curative), type of
surgical resection (total or partial resection).