Onlangs publiceerde The Annals of Thoracic Surgery een artikel met data uit de DLCA (longkanker), geschreven door onder andere meerdere (voormalig) DICA-medewerkers:
National Comparison of Hospital Performances in Lung Cancer Surgery: The Role Of Casemix Adjustment
Beck N., Hoeijmakers F., van der Willik E.M., Heineman D.J., Braun J., Tollenaar R.A.E.M., Schreurs W.H., Wouters M.W.J.M.
Hieronder staat een samenvatting (EN); lees het volledige artikel in The Annals of Thoracic Surgery (EN)
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.
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.
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%.
The between-hospital variation in casemix of patients undergoing surgery for NSCLC emphasizes the importance of proper adjustment when comparing hospitals on outcome indicators.