Grote verschillen in prostaatbehandelingen in Nederland. Onervaren artsen die prostaat verwijderen zorgen voor blijvende incontinentie bij deel van de mannen waarvan prostaat werd verwijderd

1 maart 2024: Bron: Leidsch Dagblad en Proefschrift van Maike Schepens

"In ziekenhuizen met hoogste aantallen prostaatkankeroperaties heb je gemiddeld een 52 procent lagere kans op incontinentie dan in ziekenhuizen die veel lagere aantallen prostaatkankeroperaties doen." Dat blijkt uit de resultaten van een onderzoek dat Maike Schepens deed voor haar doctors titel.

"De uitkomsten per ziekenhuis lopen heel ver uiteen. In het ene ziekenhuis was negentien procent van de patiënten een jaar na prostaatkankeroperatie incontinent, terwijl in het slechtst presterende ziekenhuis 85 procent van de patiënten met luiers moesten rondlopen. Dat leidt tot een slechtere kwaliteit van leven voor individuele mannen en kost ook nog eens een hoop geld." Aldus Maike Schepens in een interview met het Leidsch Dagblad. Dit artikel is alleen voor abonnees maar u kunt de domeinnaam kopieëren naar archive.ph en daar het hele artikel lezen.

Maike haar studie is al gepubliceerd in december 20-23 in

Voor grafieken van de verschillen in Nederland zie Fig. 1, Fig. 2, Fig. 3

Hier afbeelding van Fig. 1

Fig. 1. Boxplots of the number of radical prostatectomy (RP) procedures per hospital per year showing the median, range, interquartile range, and number of hospitals performing RP.

Uit het studierapport gekopieerd:

3.4. Relatie tussen ziekenhuisvolume en Radicale prostaatverwijdering - Urine Incontinentie Risico ( RP-UI-risico)

Het uiteindelijke multivariabele model liet zien dat de ziekenhuisvolumecategorie onafhankelijk gecorreleerd was met de RP-UI-incidentie. Om precies te zijn: patiënten die RP ondergingen in HV1-HV2-ziekenhuizen hadden 52% minder kans op RP-UI dan patiënten in LV1-LV2-ziekenhuizen (adjusted odds ratio 0.48, 95% confidence interval 0.38–0.62; Table 3), terwijl patiënten die RP ondergingen in LV1-HV2-ziekenhuizen 29% minder kans hadden op RP-UI (aOR 0.71, 95% CI 0.55–0.92). Leeftijd (aOR 1.05, 95% CI 1.03–1.06) en lymfklierverwijdering (aOR 1.34, 95% CI 1.12–1.61) heeft ook bijgedragen aan het model (Table 3). Geen van de andere variabelen verbeterde dit kernmodel significant.

Maike Schepens haar proefschrift Measering Matters dat ze verdedigde op 29 februari 2024 is te downloaden via deze PDF maar is wel 187 pagina's lang.

Hier het abstract van haar studie:

https://doi.org/10.1016/j.euros.2023.09.014 Get rights and content

Under a Creative Commons license

open access

Abstract

Background

On the basis of previous analyses of the incidence of urinary incontinence (UI) after radical prostatectomy (RP), the hospital RP volume threshold in the Netherlands was gradually increased from 20 per year in 2017, to 50 in 2018 and 100 from 2019 onwards.

Objective

To evaluate the impact of hospital RP volumes on the incidence and risk of UI after RP (RP-UI).

Design, setting, and participants

Patients who underwent RP during 2016–2020 were identified in the claims database of the largest health insurance company in the Netherlands. Incontinence was defined as an insurance claim for ≥1 pads/d.

Outcome measurements and statistical analysis

The relationship between hospital RP volume (HV) and RP-UI was assessed via multivariable analysis adjusted for age, comorbidity, postoperative radiotherapy, and lymph node dissection.

Results and limitations

RP-UI incidence nationwide and by RP volume category did not decrease significantly during the study period, and 5-yr RP-UI rates varied greatly among hospitals (19–85%). However, low-volume hospitals (≤120 RPs/yr) had a higher percentage of patients with RP-UI and higher variation in comparison to high-volume hospitals (>120 RPs/yr). In comparison to hospitals with low RP volumes throughout the study period, the risk of RP-UI was 29% lower in hospitals shifting from the low-volume to the high-volume category (>120 RPs/yr) and 52% lower in hospitals with a high RP volume throughout the study period (>120 RPs/yr for 5 yr).

Conclusions

A focus on increasing hospital RP volumes alone does not seem to be sufficient to reduce the incidence of RP-UI, at least in the short term. Measurement of outcomes, preferably per surgeon, and the introduction of quality assurance programs are recommended.

Patient summary

In the Netherlands, centralization of surgery to remove the prostate (RP) because of cancer has not yet improved the occurrence of urinary incontinence (UI) after surgery. Hospitals performing more than 120 RP operations per year had better UI outcomes. However, there was a big difference in UI outcomes between hospitals.

Author contributions: Maike H.J. Schepens had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Schepens, van Hooff, van Limbeek.

Acquisition of data: Schepens, van der Galiën.

Analysis and interpretation of data: Schepens, van Hooff, van Limbeek.

Drafting of the manuscript: Schepens.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: van der Galiën, van Limbeek, van Hooff, Schepens.

Obtaining funding: None.

Administrative, technical, or material support: None.

Supervision: None.

Other: None.

Financial disclosures: Maike H.J. Schepens certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.

Funding/Support and role of the sponsor: None.

Acknowledgments: We thank Ferdinand Roelfsema and Barbara Kolff van Oosterwijk for critical reviews of the manuscript.

Appendix A. Supplementary data

The following are the Supplementary data to this article:

Download : Download Word document (15KB)

Supplementary Table 1

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