Tol Johanna A M G, Broekman Mariëtte C, Brauers Marcel A L, van Gulik Thomas M, Busch Olivier R C, Gouma Dirk J
Academisch Medisch Centrum, Afd. Chirurgie, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(49):A4918.
To evaluate the reliability of data registration in calculating the hospital standardised mortality ratio (HSMR).
Retrospective, descriptive.
Data were collected from a research database on all patients who had undergone a partial pancreatoduodenectomy for pancreatic cancer in 2009 and 2010 at our hospital. These data were compared with information about these same patients recorded in the Dutch National Medical Registry (LMR), obtained from the medical administration department of our hospital. The differences between these 2 databases were evaluated on the basis of 3 variables: mortality, main diagnosis and secondary diagnoses (differentiated into complications and co-morbidities). Using the Charlson index, the co-morbidity score from both registries was calculated per patient.
A total of 118 patients had been registered in the research database. Of these patients, 103 appeared in the LMR data; 15 had not been registered in this database. There were no differences in patient characteristics or mortality (2.5%) between the registries. In the LMR, the main diagnosis of 5 patients had been incorrectly recorded. This database contained information on 136 complications and 51 co-morbidities, of which 35 comorbities had been correctly recorded. The research database contained information on 188 complications and 99 comorbidities on these same patients. In the research database, comorbidity comprised 34% of all secondary diagnoses; in the LMR, 19% (p < 0.001). The median score on the Charlson index was 0 for all patients in the LMR and 3 in the research database (p < 0.001).
Comorbidities in patients with pancreatic carcinoma who undergo a resection are being inadequately recorded in the LMR. This results in insufficient correction in the case mix and a low score on the Charlson index, which could result in an incorrect HSMR.
评估数据登记在计算医院标准化死亡率（HSMR）中的可靠性。
回顾性、描述性研究。
从研究数据库收集2009年和2010年在我院因胰腺癌接受部分胰十二指肠切除术的所有患者的数据。将这些数据与从我院医疗管理部门获得的荷兰国家医疗登记处（LMR）记录的这些相同患者的信息进行比较。基于三个变量评估这两个数据库之间的差异：死亡率、主要诊断和次要诊断（分为并发症和合并症）。使用查尔森指数，计算每个患者在两个登记处的合并症评分。
研究数据库中共登记了118例患者。其中，103例出现在LMR数据中；15例未登记在该数据库中。两个登记处的患者特征或死亡率（2.5%）没有差异。在LMR中，5例患者的主要诊断记录错误。该数据库包含136例并发症和51例合并症的信息，其中35例合并症记录正确。研究数据库包含这些相同患者的188例并发症和99例合并症的信息。在研究数据库中，合并症占所有次要诊断的34%；在LMR中为19%（p<0.001）。LMR中所有患者的查尔森指数中位数为0，研究数据库中为3（p<0.001）。
LMR对接受切除术的胰腺癌患者合并症的记录不充分。这导致病例组合校正不足，查尔森指数得分较低，可能导致HSMR计算错误。
