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

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44 PROCARE – phase 2 KCE reports 81As mentioned above (see page 28), the number of patients with an R0 resection isprobably overestimated, since the results of the pathology report are not taken intoaccount in the variable used to register R0 resections (see appendix). Ideally, the realR0 should be used in the future, taking into account the pathology results (e.g. onpCRM) and intra-operative perforation.This QI is not measurable for the administrative cohort, since no administrative codeexists for R0 resections.Table 32. Number of patients that underwent radical resection and had anR0 resection, measured with prospective PROCARE data.cStageI II III I-IIIPatients with rectal cancer 107 160 357 624Patients with rectal cancer that underwent radical resection andinformation on type of resection (denominator)96 157 349 602Patients with R0 resection (numerator) 94 143 325 562 (93%)Patients with R1 or R2 resection 2 5 12 19Patients with uncertain resection 0 9 12 21Proportion of APR and Hartmann’s proceduresDEFINITIONNumerator: all patients with RC that underwent radical resection and had an APR orHartmann’s procedure.Denominator: all patients with RC that underwent radical resection.Exclusion:• patients not undergoing radical resectionRESULTSIn the prospective cohort, 18% of the patients that had radical resection underwent anAPR, while 2% had a Hartmann’s procedure (Table 33). For 19 of the 1018 patients thathad radical resection (2%), no information was available on the type of reconstruction.In the administrative cohort, 38% of the patients that had radical resection underwentan APR or Hartmann’s procedure (Table 34). Importantly, some patients hadadministrative codes for more than one surgical procedure: for the analysis only thefirst procedure was taken into account. For 78 patients, no information was available onthe received treatment (1%).Figure 11 provides an overview of APR and Hartmann’s procedures per participatingcentre using the prospective database (weighted mean: 20%, 95%CI 18 – 23%;unweighted mean: 26%, 95%CI 20 – 31%). Seven centres (of which 6 included 5 or lesseligible patients) did not perform APR or Hartmann’s procedures. In 8 centres, at least50% of the radical resections are APR or Hartmann’s procedures.Figure 12 provides an overview of APR and Hartmann’s procedures per centre usingthe administrative database. Two centres (both with 1 eligible patient) have a score of0%, while in 2 centres (both with ≤3 eligible patients) all radical resections are APR orHartmann’s procedures. Fifty-five and 68 centres have a score above the weighted (38%;95%CI 37 – 39%) and unweighted mean (40%; 95%CI 37 – 43%) respectively.Risk-adjustment (e.g. tumour localisation) is necessary for the correct interpretation ofthese results.
KCE Reports 81 PROCARE – phase 2 45Table 33. Number of patients that underwent radical resection and had anAPR or Hartmann’s procedure, measured with prospective PROCARE data.NPatients with rectal cancer 1071Patients with rectal cancer that underwent surgery 1058Patients with rectal cancer that underwent radical resection and information on type of 999reconstruction (denominator)Patients with APR (numerator– part 1) 180 (18%)Patients with Hartmann’s procedure (numerator – part 2) 24 (2%)Table 34. Number of patients that underwent radical resection and had anAPR or Hartmann’s procedure, measured with administrative data.NPatients with rectal cancer 7074Patients with rectal cancer that underwent radical resection (denominator) 5472Patients with APR or Hartmann’s procedure (numerator) 2053 (38%)Figure 11. Per-centre-analysis (n = 56) of APR and Hartmann’s procedure(prospective cohort) $ .Proportion (%)10090807060504030201001009080706050403020100Number of patients (N)$ The weighted mean is presented with a red bar, the unweighted mean is presented with a bluehorizontal line. The grey bars represent the QI value per centre, while the blue dots representthe number of patients per centre. These results are preliminary, and cannot be used to judge thequality of care.
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35. Etude relative aux coûts poten
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