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Prämedikationsvisite

Kosten sparen auf Kosten des Patienten?

Premedication visits

Economising at the cost of the patient?

  • Trends und Medizinökonomie
  • Published:
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Zusammenfassung

Mit der Zunahme des Lebensalters ist für Patienten die Zunahme eines Operationsrisikos verbunden. Daher müssen Risikopatienten frühzeitig identifiziert sowie einer perioperativen Diagnostik und Therapie kardialer Vorerkrankungen zugeführt werden. Hierzu existieren Risikoindizes (Goldman-Score, Eagle-Kriterien) und Richtlinien der American Heart Association (AHA/ACC). Grundlage ist die Einstufung des Patienten anhand des Operationsrisikos und der Vorerkrankungen. Wird eine weitere, häufig invasive Therapie geplant, so ist der Zeitraum, um den die Operation verschoben werden kann, entscheidend. Zum Nachweis kardialer Risikoreduktion müssen extrakardiale Operationen um mindestens 3 Monate verschoben werden. Ist dieser Zeitraum nicht einzuhalten, kann eine Risikominimierung in vielen Fällen durch eine β-Blocker-Therapie erreicht werden. Eine Arbeitsgruppe des Marburger Klinikums hat zu diesem Thema eigene Lösungsstrategien entwickelt, die im Folgenden ausgeführt werden.

Abstract

The older the patient, the higher the risk of perioperative cardiac complications. Therefore, patients at risk have to be identified and the appropriate diagnostic or therapeutic measures initiated. The most important factor in this context is whether a planned surgery can be postponed. Several strategies have been developed (e.g. Goldman index, Eagle criteria) and the American Heart Association (AHA/ACC) has produced guidelines concerning perioperative diagnosis and therapy of cardiac risk patients. The common goal of these strategies is always the risk classification of the patient by combining the operative risk and the risk factors of the patient. The further procedure (diagnostic or therapeutic measures) is based on the risk classification. If further invasive therapy proves to be necessary, the determining factor is the period of time for which the operation can be delayed. This appears to be about 3 months but if this is not possible the outcome could be improved with a β-blocker therapy in advance. A working group from the university hospital in Marburg has developed a strategy for risk classification and further diagnostic and therapeutic measures as outlined in this article.

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Authors and Affiliations

  1. Klinik für Anästhesie und Intensivmedizin, Klinikum der Philipps-Universität Marburg

    C. D. Kratz, K. M. Kerwat, C. Olt, H. Wulf &  G. Geldner

  2. Klinik für Innere Medizin, Kardiologie, Klinikum der Philipps-Universität Marburg

    M. Christ & B. Maisch

  3. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Klinikum der Philipps-Universität Marburg

    A. Zielke & A. Hellinger

  4. Klinik für Anästhesie und Intensivmedizin, Klinikum der Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg

    G. Geldner

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  1. C. D. Kratz
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  2. M. Christ
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Correspondence to G. Geldner.

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Kratz, C.D., Christ, M., Maisch, B. et al. Prämedikationsvisite. Anaesthesist 53, 862–870 (2004). https://doi.org/10.1007/s00101-004-0709-x

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