Junginger T, Küchle R, Dutkowski P, Thumerer A
Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg Universität.
Z Arztl Fortbild Qualitatssich. 1998 Dec;92(10):705-14.
From April 1, 1993 to Dec. 31, 1997, the perioperative course of 5690 patients was recorded prospectively and postoperative morbidity and lethality was determined in the framework of a program for a systematic internal quality control. Goal of the program is the demonstration of treatment quality which possibly out quality improvement. The share of old and sicker patients was significantly increasing during the observation period. Morbidity and hospital lethality remained constant despite a rising necessity of postoperative intensive care. High risk surgery was performed on more patients in the university hospital than in non-university hospitals. The rate of postsurgical complications was lower, length of stay was equal (surgery for inguinal hernia) or lower (cholecystectomy). The rate of not indicated appendectomy could be lowered and morbidity and lethality in the treatment of esophagus carcinoma was lowered by the application of this concept. For the partial duodenopanceatectomy, the examination of the individual surgeon as a risk factor revealed a significant dependence on the experience of the surgeon. There was only a tendency of this effect demonstrable in medium or small surgery like colon resection of gastrectomy. The rate of continence preservation in rectal carcinoma was increased to 75% combined with a drop of perioperative morbidity and length of stay. The systematic internal quality control allows for the assessment of treatment quality and the fast recognition of weak spots. It is a suitable complementary tool for quality improvement in the framework of quality management in surgical patients. The extension of the concept by recording postoperative quality of life and long time results is planned.
1993年4月1日至1997年12月31日，前瞻性记录了5690例患者的围手术期过程，并在系统内部质量控制计划的框架内确定了术后发病率和死亡率。该计划的目标是展示可能超出质量改进的治疗质量。在观察期内，老年和病情较重患者的比例显著增加。尽管术后重症监护的必要性增加，但发病率和医院死亡率保持不变。大学医院进行高风险手术的患者比非大学医院多。术后并发症发生率较低，住院时间相同（腹股沟疝手术）或更短（胆囊切除术）。通过应用这一概念，可以降低不必要的阑尾切除术的发生率，并降低食管癌治疗中的发病率和死亡率。对于部分十二指肠切除术，将个体外科医生作为危险因素进行检查发现，其与外科医生的经验有显著相关性。在诸如结肠切除术或胃切除术等中型或小型手术中，仅能证明有这种效应的趋势。直肠癌保肛率提高到75%，同时围手术期发病率和住院时间下降。系统内部质量控制有助于评估治疗质量并快速识别薄弱环节。它是手术患者质量管理框架内质量改进的合适补充工具。计划通过记录术后生活质量和长期结果来扩展这一概念。
