Böhmer A B, Defosse J, Geldner G, Mertens E, Zwissler B, Wappler F
Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Ostmerheimer Str. 200, 51109, Köln, Deutschland,
Anaesthesist. 2014 Mar;63(3):198-208. doi: 10.1007/s00101-014-2288-9. Epub 2014 Feb 19.
The joint recommendations of the German Societies of Anaesthesiology and Intensive Care Medicine, Surgery and Internal Medicine on preoperative evaluation of adult patients prior to elective, non-cardiac surgery published in November 2010 were the first practical and comprehensive guidelines for preoperative evaluation available to anesthetists in Germany.
This study was carried out to analyze the state of implementation of these guidelines into clinical practice as well as changes in strategies for assessing perioperative risk from the viewpoint of anesthesia personnel in Germany.
A 25-item questionnaire concerning general characteristics of workplaces, cognizance, reasonability and convenience of the joint recommendations was developed as an online survey. Furthermore, changes in strategies for preoperative evaluation were polled.
A total of 1,840 anesthetists completed the questionnaire. The results showed that 84.2 % were acquainted with the joint recommendations, 57.3 % evaluated them as completely reasonable and 18.2 % as partly reasonable. A total of 71.4 % indicated that the joint recommendations were implemented completely or partly in their department strategies for preoperative evaluation. From the viewpoint of personnel, anamnesis and physical examination were performed more frequently by 25.7 % while routine diagnostic testing was ordered less frequently by 39.1 %. Advantages by implementing the joint recommendations (e.g. simplification for medical staff and patients, decrease of costs, reduction of radiological examinations) were seen by 45.5 %. Problems, such as increasing expenditure of time and personnel due to implementation were mentioned by 20.3 %.
The joint recommendations are well known and positively rated among anesthetists in Germany responding to the questionnaire reflecting an effective implementation process over the last 2 years. The anesthetists who completed the questionnaire stated that the use of the recommendations leads to a more reasonable approach in preoperative risk evaluation which contributes to an increase in patient safety and satisfaction.
德国麻醉学与重症医学学会、外科学会和内科学会于2010年11月发布的关于成年患者择期非心脏手术术前评估的联合建议，是德国麻醉医生可获得的首份实用且全面的术前评估指南。
本研究旨在从德国麻醉人员的角度分析这些指南在临床实践中的实施情况，以及围手术期风险评估策略的变化。
编制了一份包含25个项目的问卷，内容涉及工作场所的一般特征、对联合建议的认知、合理性和便利性，并开展在线调查。此外，还对术前评估策略的变化进行了调查。
共有1840名麻醉医生完成了问卷。结果显示，84.2%的人知晓联合建议，57.3%的人认为其完全合理，18.2%的人认为部分合理。共有71.4%的人表示联合建议在其科室的术前评估策略中得到了全部或部分实施。从人员角度来看，25.7%的人更频繁地进行病史采集和体格检查，而39.1%的人减少了常规诊断检查的开具。45.5%的人认为实施联合建议有优势（如简化医护人员和患者的流程、降低成本、减少放射学检查）。20.3%的人提到了实施过程中存在的问题，如时间和人力成本增加。
联合建议在回复问卷的德国麻醉医生中广为人知且评价积极，反映出过去两年有效的实施过程。完成问卷的麻醉医生表示，使用这些建议可使术前风险评估方法更加合理，有助于提高患者安全性和满意度。
