Department of Surgery, Kantonsspital Olten, Switzerland.
Swiss Med Wkly. 2012 Jul 19;142:w13617. doi: 10.4414/smw.2012.13617. eCollection 2012.
To ensure a high quality of care in surgery, many surgical departments in Switzerland are members of the working group for quality assurance in surgery (AQC). The purpose of this study was to assess the value of the AQC database as a tool for quality assurance and a source for scientific studies. We had two hypotheses. Firstly that the percentage of laparoscopic appendectomies would have increased over time without an increase in the complication rate and secondly that these procedures would primarily have been performed by residents.
All appendectomies performed at the Kantonsspital Olten between 2001 and 2006 were prospectively recorded in the AQC database.
684 appendectomies were performed. We recorded a clear increase in the use of laparoscopic interventions from 51 to 81%. Ninety three percent of these appendectomies were performed by residents or junior faculty members. The main complication were surgical site infection in 3.6% of the open procedures as compared to none in laparoscopic procedures (p <0.001). Intra-abdominal abscess formation was recorded in 2.7% of laparoscopic procedures as compared to 1.8% in open surgery (p = 0.608). The overall complication rate in the study was 5.4% with no statistical difference between open (6.5%) and laparoscopic (4.7%) surgery (p = 0.305).
The study clearly shows that the AQC-database offers a wide variety of possibilities for quality assurance and scientific analyses. Our data demonstrate that laparoscopic procedures clearly increased from 2001 to 2006. Appendectomies were mainly performed by residents and junior faculty members. Laparoscopic appendectomy is a safe procedure with a low complication rate and should be applied as a teaching operation during the surgical training.
为了确保手术的高质量，瑞士许多外科部门都是外科质量保证工作组（AQC）的成员。本研究的目的是评估 AQC 数据库作为质量保证工具和科学研究来源的价值。我们有两个假设。首先，腹腔镜阑尾切除术的比例会随着时间的推移而增加，而并发症发生率不会增加；其次，这些手术主要由住院医师完成。
在 2001 年至 2006 年间，在 Kantonsspital Olten 进行的所有阑尾切除术均在 AQC 数据库中进行前瞻性记录。
共进行了 684 例阑尾切除术。我们记录到腹腔镜干预的使用明显增加，从 51%增加到 81%。这些阑尾切除术的 93%是由住院医师或初级教员完成的。主要并发症是开放性手术中 3.6%的手术部位感染，而腹腔镜手术中无此类并发症（p<0.001）。腹腔镜手术中记录到腹腔脓肿形成 2.7%，而开放性手术中为 1.8%（p=0.608）。研究中的总并发症发生率为 5.4%，开放性手术（6.5%）和腹腔镜手术（4.7%）之间无统计学差异（p=0.305）。
该研究清楚地表明，AQC 数据库为质量保证和科学分析提供了广泛的可能性。我们的数据表明，腹腔镜手术从 2001 年到 2006 年明显增加。阑尾切除术主要由住院医师和初级教员完成。腹腔镜阑尾切除术是一种安全的手术，并发症发生率低，应作为外科培训期间的教学操作。
