Avond vol internationale auditvergelijkingen voor en door medisch specialisten
Woensdagavond 20 juni 2018, DoubleTree by HiltonBekijk artikel
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.