Make care count
Er zijn 2 publicaties over de DLCA-S verschenen in het Annals of Thoracic Surgery:
Dutch Lung Surgery Audit: A National Audit Comprising Lung and Thoracic Surgery Patients.
Berge MT, Beck N, Heineman DJ, Damhuis R, Steup WH, van Huijstee PJ, Eerenberg JP, Veen E, Maat A, Versteegh M, van Brakel T, Schreurs WH, Wouters MW.
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National Comparison of Hospital Performances in Lung Cancer Surgery: The Role Of Casemix Adjustment.
Beck N, Hoeijmakers F, van der Willik EM, Heineman DJ, Braun J, Tollenaar RAEM, Schreurs WH, Wouters MWJM.
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Lees hieronder de samenvattingen:
Dutch Lung Surgery Audit: A National Audit Comprising Lung and Thoracic Surgery Patients.
Background
The nationwide Dutch Lung Surgery Audit (DLSA) started in 2012 to monitor and evaluate the quality of lung surgery in the Netherlands as an improvement tool. This outline describes the establishment, structure and organization of the audit by the Dutch Society of Lung Surgeons (NVvL) and the Dutch Society of Cardiothoracic Surgeons (NVT), in collaboration with the Dutch Institute for Clinical Auditing (DICA). In addition, first four-year results are presented.
Methods
The NVvL and NVT initiated a web-based registration including weekly updated online feedback for participating hospitals. Data verification by external data managers is performed on regular basis. The audit is incorporated in national quality improvement programs and participation in the DLSA is mandatory by health insurance organizations and the National Healthcare Inspectorate.
Results
Between 1 January 2012 and 31 December 2015, all hospitals performing lung surgery participated and a total of 19,557 patients were registered from which almost half comprised lung cancer patients. Nationwide the guideline adherence increased over the years and 96.5% of lung cancer patients were discussed in preoperative multidisciplinary teams. Overall postoperative complications and mortality after non-small cell lung cancer surgery were 15.5% and 2.0%, respectively.
Conclusions
The audit provides reliable benchmarked information for caregivers and hospital management with potential to start local, regional or national improvement initiatives. Currently, the audit is further completed with data from non-surgical lung cancer patients including treatment data from pulmonary oncologists and radiation oncologists. This will ultimately provide a comprehensive overview of lung cancer treatment in The Netherlands.
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National Comparison of Hospital Performances in Lung Cancer Surgery: The Role Of Casemix Adjustment.
Background
When comparing hospitals on outcome indicators, proper adjustment for casemix (a combination of patient- and disease characteristics) is indispensable. This study examines the need for casemix adjustment in evaluating hospital outcomes for Non-Small Cell Lung Cancer (NSCLC) surgery.
Methods
Data from the Dutch Lung Cancer Audit for Surgery was used to validate factors associated with postoperative 30-day mortality and complicated course with multivariable logistic regression models. Between-hospital variation in casemix was studied by calculating medians and interquartile ranges for separate factors on hospital level and the ‘expected’ outcomes per hospital as a composite measure.
Results
8040 patients, distributed over 51 Dutch hospitals were included for analysis. Mean observed postoperative mortality and complicated course were 2.2% and 13.6% respectively. Age, ASA-classification, ECOG performance score, lung function, extent of resection, tumor stage and postoperative histopathology were individual significant predictors for both outcomes of postoperative mortality and complicated course. A considerable variation of these casemix factors between hospital-populations was observed, with the expected mortality and complicated course per hospital ranging from 1.4 to 3.2% and 11.5 to 17.1%.
Conclusions
The between-hospital variation in casemix of patients undergoing surgery for NSCLC emphasizes the importance of proper adjustment when comparing hospitals on outcome indicators.
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