Fritz Stefan, Reissfelder Christoph, Bussen Dieter
Deutsches End- und Dickdarmzentrum Mannheim, Bismarckplatz 1, 68165, Mannheim, Deutschland.
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Deutschland.
Chirurgie (Heidelb). 2024 Dec;95(12):970-977. doi: 10.1007/s00104-024-02168-w. Epub 2024 Sep 13.
Despite the introduction of the diagnosis-related groups (DRG) system, costs in the German healthcare system have risen continuously for years. In order to reduce costs the federal government is aiming to shift inpatient services to the outpatient sector. Outpatient services affect many areas of medicine, including proctological operations as these are common and can often be carried out on an outpatient basis.
The aim of the present work is to discuss which areas of proctology are suitable for outpatient treatment and which structural requirements are necessary.
The present article is intended to provide a narrative overview with reference to the literature on the topic of outpatient care in proctology. A literature search was carried out using the following keywords: outpatient care, selective sector-level remuneration, day care, proctological operations, AOP catalog and hybrid DRG.
In proctology, outpatient surgical care is implementable in many cases; however, not every patient is suitable for this. In addition to previous illnesses, patient compliance and the possibility of postoperative care from relatives must also be taken into account. In addition, emergency treatment must be guaranteed. Contraindications include severe heart and circulatory diseases as well as severe coagulation or organ dysfunction. Extensive abscesses, complex fistulas or sphincter reconstructions should be surgically treated in an inpatient setting. The prerequisite for successful outpatient care is to make the sector boundaries between outpatient and inpatient patient care more permeable and to adequately remunerate the interventions.
In addition to the surgical indications, the prerequisites for successful proctological operations are the correct assessment of the operational capability and compliance. From an organizational and economic perspective, better networking between outpatient and inpatient treatment and equal remuneration across the sector boundaries are crucial.
尽管引入了诊断相关分组（DRG）系统，但德国医疗体系的成本多年来持续上升。为了降低成本，联邦政府旨在将住院服务转移到门诊部门。门诊服务影响医学的许多领域，包括直肠科手术，因为这些手术很常见且通常可以在门诊进行。
本研究的目的是讨论直肠科哪些领域适合门诊治疗以及需要哪些结构要求。
本文旨在参考有关直肠科门诊护理主题的文献提供叙述性概述。使用以下关键词进行文献检索：门诊护理、选择性部门级薪酬、日间护理、直肠科手术、AOP目录和混合DRG。
在直肠科，门诊手术护理在许多情况下是可行的；然而，并非每个患者都适合。除了既往疾病外，还必须考虑患者的依从性以及亲属术后护理的可能性。此外，必须保证急诊治疗。禁忌症包括严重的心脏和循环系统疾病以及严重的凝血或器官功能障碍。广泛的脓肿、复杂的瘘管或括约肌重建应在住院环境中进行手术治疗。成功开展门诊护理的前提是使门诊和住院患者护理之间的部门界限更具渗透性，并对干预措施进行充分补偿。
除了手术适应症外，成功进行直肠科手术的前提是正确评估手术能力和依从性。从组织和经济角度来看，门诊和住院治疗之间更好的联网以及跨部门界限的平等薪酬至关重要。
