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

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48 PROCARE – phase 2 KCE reports 81For 108 of the 1058 patients that underwent surgery, no information was available onthe type of surgery.Above this, for 10 of the 734 patients undergoing sphincter-sparing surgery, noinformation was available on the occurrence of leakage of the anastomosis (totalmissings: 118/1071, 11%).Major leakage of the anastomosis is measurable for 53 centres using the prospectivedatabase. Thirty-two centres have no major leakages, while 9 centres have a score of10% or more. Thirty-seven and 35 centres have a score above the weighted (5%; 95%CI3 – 6%) and unweighted mean (4%; 95%CI 2 – 5%) respectively. Risk-adjustment(tumour localisation, presence of stoma at primary surgery) is necessary for the correctinterpretation of these results.For the administrative cohort no specific code is available for leakage of theanastomosis. The QI is therefore not measurable for these patients.Table 36. Number of patients that underwent sphincter-sparing surgery andhad a major leakage of the anastomosis, measured with prospectivePROCARE data.NPatients with rectal cancer 1071Patients with rectal cancer that underwent surgery 1058Patients with rectal cancer that underwent sphincter-sparing surgery and have information 724on leakage (denominator)Patients with major leakage (numerator) 33 (5%)Patients with minor leakage 22Inpatient or 30-day mortalityDEFINITIONNumerator: all patients with RC that underwent surgery and died in hospital and/orwithin 30 days after primary surgery.Denominator: all patients with RC that underwent surgery.Exclusion:• patients treated abroad• patients without a social security number• patients without a Belgian postal code• patients without a known incidence date or with an incidence date afterDecember 31 st 2006• patients with a surgery date after December 1 st 2006RESULTSInpatient or 30-day mortality in the prospective cohort is 3% (Table 37). For 7 patientsno social security number and Belgian postal code was available.Above this, for 26 of the 1064 patients with a social security number and Belgian postalcode that underwent surgery, no surgery date was available (total missings: 33/1071,3%).In theory, the QI can be underestimated, since some patients having had surgery beforeDecember 2 nd 2006 could have died in hospital after December 31 st 2006. However,this was manually checked and didn’t occur.In the administrative cohort, inpatient or 30-day mortality is 5% (281/5863). For 78 ofthe 7074 rectal cancer patients, no information was available on treatment. Above this,for 41 of the 5904 patients that underwent (resective) surgery, no information wasavailable on hospitalisation date (total missings: 119/7074, 2%).The inpatient or 30-day mortality is measurable for 54 centres using the prospectivedatabase. Thirty-seven centres have a score of 0%, while 7 centres have a score of 10%or more. Thirty-eight centres have a score above the weighted (3%; 95%CI 2 – 4%) andunweighted mean (3%; 95%CI 1 – 4%).
KCE Reports 81 PROCARE – phase 2 49Using the administrative database, this QI is measurable for 124 centres. Thirty-twocentres have a score of 0%, while in 14 centres the inpatient or 30-day mortalityexceeds 10%. Sixty-three centres have a score above the weighted (5%; 95%CI 4 – 6%)and unweighted mean (5%; 95%CI 4 – 6%).Importantly, extensive risk-adjustment (e.g. age, stage, comorbidities) is necessary forthe correct interpretation of these results.Table 37. Inpatient or 30-day mortality, measured with prospectivePROCARE data.NPatients with rectal cancer 1071Patients with social security number and Belgian postal code, and underwent surgery 1064Patients with surgery before December 2 nd 2006 (denominator) 693Patients that died in hospital or within 30 days after surgery (numerator) 20 (3%)Rate of intra-operative rectal perforationDEFINITIONNumerator: all patients with RC that underwent radical resection and had intra-operativerectal perforation.Denominator: all patients with RC that underwent radical resection.Exclusion:• patients not undergoing radical resectionRESULTSSeven percent of the PROCARE patients undergoing radical resection had a rectalperforation during surgery (Table 38). It was not possible to identify missing data, sincethe default value of the variable was ‘0’ (see appendix).Intra-operative rectal perforation is measurable for 56 centres using the prospectivedatabase. Twenty-five centres have a score of 0%, while 17 centres have a score of 10%or more. Thirty-five centres have a score above the weighted (7%; 95%CI 5 – 8%) andunweighted mean (6%; 95%CI 4 – 8%). Risk-adjustment (tumour localisation [includingdorsal – ventral], stage) is necessary for the correct interpretation of these results.The QI is not measurable for the administrative cohort, since no specific code exists forintra-operative rectal perforation.Table 38. Number of intra-operative rectal perforations, measured withprospective PROCARE data.NPatients with rectal cancer 1071Patients having radical resection (denominator) 1018Patients with intra-operative rectal perforation (numerator) 69 (7%)DiscussionUsing the prospective database, 5 of the 6 surgical QI are measurable (Table 39). Therate of stoma at 1 year after SSO is not measurable at present, but can be renderedmeasurable by asking specifically for the presence of a stoma at 1 year. Another solutionis to link the prospective database to the administrative databases, where this QI isalready measurable. However, in that case, ileo/colostomies should be distinguishedfrom urostomies, e.g. by excluding patients undergoing a Bricker’s procedure.Three QI are not measurable using the administrative databases due to the absence ofadministrative codes (for R0 resection, major leakage of the anastomosis and intraoperativeperforation). All three QI are measurable using the prospective database.As already stated, in the number of R0 resections the results of the pathology reportare not taken into account at present. Ideally, the real R0 should be used in the future,i.e. taking into account the pathology results and intra-operative perforation.
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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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