Albert A, Sergeant P, Ennker J
Abteilung für Herz-, Thorax-, und Gefässchirurgie, Universitätsklinikum Düsseldorf.
Dtsch Med Wochenschr. 2009 Oct;134 Suppl 6:S214-9. doi: 10.1055/s-0029-1241914. Epub 2009 Oct 15.
The strength of coronary bypass operations depends on the preservation of their benefits regarding freedom of symptoms, quality of life and survival, over decades. Significant variability of the results of an operative intervention according to the hospital or the operating surgeon is considered a weakness in the procedure. The external quality insurance tries to reach a transparent service providing market through hospital ranking comparability. Widely available information and competition will promote the improvement of the whole quality. The structured dialog acts as a control instrument for the BQS (Federal Quality Insurance). It is launched in case of deviations from the standard references or statistically significant differences between the results of the operations in any hospital and the average notational results. In comparison to the external control the hospital internal control has greater ability to reach a medically useful statement regarding the results of the treatment and to correct the mistakes in time. An online information portal based on a departmental databank (DataWarehouse, DataMart) is an attractive solution for the physician in order to get transparently and timely informed about the variability in the performance.The individual surgeon significantly influences the short- and long-term treatment results. Accordingly, selection, targeted training and performance measurements are necessary.Strict risk management and failure analysis of individual cases are included in the methods of internal quality control aiming to identify and correct the inadequacies in the system and the course of treatment. According to the international as well as our own experience, at least 30% of the mortalities after bypass operations are avoidable. A functioning quality control is especially important in minimally invasive interventions because they are often technically more demanding in comparison to the conventional procedures. In the field of OPCAB surgery, the special advantages of the procedure can be utilised to reach a nearly complete avoidance of postoperative stroke through combining the procedure with aorta no-touch technique. The long-term success of the bypass operation depends on the type of bypass material in additions to many other factors. Both internal mammary arteries are considered the most durable.Using an operation preparation check contributes to the operative success.
冠状动脉搭桥手术的优势在于，在数十年间，它能持续为患者带来症状缓解、生活质量提高和生存期延长等益处。然而，根据医院或手术医生的不同，手术干预结果存在显著差异，这被视为该手术的一个弱点。外部质量保险试图通过医院排名的可比性，打造一个透明的医疗服务市场。广泛的信息传播和竞争将推动整体医疗质量的提升。结构化对话作为联邦质量保险（BQS）的一种控制手段，当出现与标准参考值的偏差，或任何一家医院的手术结果与平均记录结果存在统计学显著差异时，便会启动。与外部控制相比，医院内部控制在就治疗结果得出具有医学参考价值的结论以及及时纠正错误方面，能力更强。基于科室数据库（数据仓库、数据集市）的在线信息门户，为医生提供了一个极具吸引力的解决方案，使其能够透明、及时地了解手术效果的差异情况。个体外科医生对短期和长期治疗结果有显著影响。因此，进行外科医生的选拔、针对性培训以及手术效果评估是很有必要的。内部质量控制方法包括严格的风险管理和对个别病例的失败分析，旨在识别并纠正系统和治疗过程中的不足之处。根据国际经验以及我们自己的经验，冠状动脉搭桥手术后至少30%的死亡是可以避免的。有效的质量控制在微创干预中尤为重要，因为与传统手术相比，微创干预在技术上往往要求更高。在非体外循环冠状动脉搭桥（OPCAB）手术领域，通过将该手术与主动脉免接触技术相结合，可以充分利用该手术的特殊优势，几乎完全避免术后中风。除了许多其他因素外，搭桥手术的长期成功还取决于搭桥材料的类型。双侧乳内动脉被认为是最耐用的。使用手术准备检查表有助于手术成功。
