Assurance de qualité pour le cancer rectal – phase 2 ...

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34 PROCARE – phase 2 KCE reports 81Proportion of patients undergoing elective surgery that hadpreoperative complete large bowel-imagingDEFINITIONNumerator: all patients with RC that underwent elective surgery and had totalcolonoscopy and/or barium x-ray before surgery.Denominator: all patients with RC that underwent elective surgery.Exclusion:• patients not treated with surgery• patients with urgent or emergency surgeryRESULTSIn the PROCARE cohort, 81% of the RC patients undergoing elective surgery hadpreoperative complete large bowel-imaging (LBI) (Table 21). Of the patients that didn’tundergo LBI, 85% provided at least one reason, of which stenosis was the mostimportant reason (60% of patients) (Table 22).For 33 of the 1058 patients that underwent surgery, no information was available on theelective character of the surgery. Above this, for 3 of the 1003 patients undergoingelective surgery, no information was available on preoperative imaging (total missings:36/1071, 3%).The preoperative complete LBI is measurable for 55 centres using the prospectivedatabase. Twelve centres have a score of 100%. Thirty-three centres have a scoreabove the weighted (81%; 95%CI 79 – 84%) and unweighted mean (80%; 95%CI 75 –85%).For the administrative cohort, the QI is not measurable, since patients undergoingelective surgery cannot be selected accurately (see appendix).Ignoring this selection bias and thus allowing an underestimation (by not excludingurgent surgery between 8 am and 21 pm on working days), 59% of patients hadpreoperative complete LBI.Table 21. Number of patients undergoing elective surgery that hadpreoperative complete large bowel-imaging, measured with prospectivePROCARE data.NPatients with rectal cancer 1071Patients with rectal cancer that underwent surgery 1058Patients with rectal cancer that underwent elective surgery1003(denominator)Patients undergoing preoperative complete large bowel-imaging 811 (81%)(numerator)Table 22. Reasons for not undergoing preoperative large bowel-imaging,measured with prospective PROCARE data * .%Tumour stenosis 60Insufficient bowel preparation 8Intolerance of the patient 8Technical reasons 6Other 11No reason 15* More than one reason is possible per patient.
KCE Reports 81 PROCARE – phase 2 35Proportion of patients in whom a TRUS and pelvic CT and/or pelvicMRI was performed before any treatmentDEFINITIONNumerator: all patients with RC that underwent treatment and had a TRUS and pelvicCT and/or MRI before treatment.Denominator: all patients with RC that underwent treatment.Exclusion:• patients that didn’t receive treatmentRESULTSThirty-four percent of RC patients undergoing treatment received a TRUS and pelvicCT/MRI in the PROCARE cohort (Table 23). Of the 1067 patients receiving treatment,8 patients had no data on pre-treatment imaging (1%).The pre-treatment TRUS and pelvic CT/MRI is measurable for 56 centres using theprospective database. Eleven centres have a score above 50%, while 10 centres score0%. Of these 10 centres, 7 centres included less than 5 eligible patients. Seventeen and24 centres have a score above the weighted (34%; 95%CI 31 – 37%) and unweightedmean (28%; 95%CI 22 – 35%) respectively. Risk-adjustment (tumour localisation [low –mid – upper], tumour stenosis) is necessary for the correct interpretation of theseresults.In the administrative cohort, this QI is not measurable due to an absence of a specificcode for pelvic CT and MRI.Table 23. Number of patients in whom a TRUS and pelvic CT and/or pelvicMRI was performed before any treatment, measured with prospectivePROCARE data.NPatients with rectal cancer 1071Patients with rectal cancer that received treatment (denominator) 1067Patients in whom a TRUS and pelvic CT/MRI was performed before any treatment 366 (34%)(numerator)Proportion of patients with cStage II-III RC that have a reportedcCRMDEFINITIONNumerator: all patients with cStage II-III RC that underwent surgery and that have areported cCRM.Denominator: all patients with cStage II-III RC that underwent surgery.Exclusion:• patients with cStage other than II and III• cStage II and III patients not treated with surgeryRESULTSOf the patients with cStage II-III that underwent surgery, 26% have a reported cCRM inthe PROCARE cohort (Table 24). For 330 patients the cStage was unknown (totalmissings: 330/1071, 31%). Again, unavailability of the cCRM in the PROCARE registrydoes not always mean that the measurement was not carried out.The reported cCRM is measurable for 51 centres using the prospective database. Twocentres have a score of 100%, while 27 centres have a score of 0%. Twelve and 14centres have a score above the weighted (26%; 95%CI 22 – 30%) and unweighted mean(19%; 95%CI 11 – 28%) respectively.The QI is not measurable for the administrative cohort, since no administrative codeexists for the (documentation of the) cCRM.
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Dépôt légal : D/2008/10.273/39
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35. Etude relative aux coûts poten
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