Zusammenfassung
Wegen einer gestiegenen Bedeutung der Patientensicherheit und einer qualitativ hochwertigen Patientenbehandlung untersuchten zahlreiche Studien die Beziehung zwischen der Menge der erbrachten Prozeduren sowohl auf institutioneller als auch individueller Ebene im Hinblick auf die erzielten Ergebnisse. Obwohl bei großen operativen Eingriffen wie der Koronarchirurgie, der Pankreasresektion und der Ösophagektomie eine Korrelation der Ergebnisse mit der Fallzahl besteht, ist das Volumen wahrscheinlich mehr ein Ersatzparameter für individuelle Faktoren wie Erfahrung und strukturelle Aspekte. Generell ist die Beziehung zwischen Fallzahl und Ergebnis in der onkologischen Chirurgie überzeugender als in der kardiovaskulären Chirurgie, wobei eine adäquate Risikoadjustierung bei der Interpretation der Studienergebnisse eine wichtige Rolle spielt. Exakte Schwellenwerte können gegenwärtig nicht festgelegt werden und bleiben spekulativ. Es ist schwierig, vor dem Hintergrund der in den Studien erzielten Ergebnisse praktische Veränderungen zu implementieren, da die Ursachen und die Kausalität der Beziehung zwischen Volumen und Ergebnis nach wie vor unzureichend verstanden sind. Die simple Beschränkung auf das Volumen zur Qualitätsmessung ist nicht ausreichend, kann aber als Basis für zukünftige Studien verstanden werden, um anhand spezifischerer Faktoren die chirurgische Qualität zu definieren.
Abstract
Due to an increasing interest in patient safety and quality health care, many studies attempt to show a relationship between procedural volume at the institutional and individual level and patient outcome. Despite the correlation between number of surgeons and institutional volume in major operative procedures such as coronary artery bypass graft, pancreatic resection, and esophagectomy, these parameters are likely to be proxy for individual factors such as experience and structural aspects. In general the relationship between case numbers and results is more convincing in cancer surgery than for cardiovascular procedures, and risk adjustment may play an important role for interpreting results of the various studies. Exact thresholds cannot be determined and thus remain speculative. It appears difficult to implement practical changes based on the observations, because the etiology and causality of the relationship between volume and outcome are still not understood. The simple focus on volume does not apply to measurements of quality but can be a starting point for further studies to identify more specific factors associated with surgical quality.
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Übersetzung durch Prof. Dr. Joachim Jähne und Dr. Patrick von Parpart, Klinik für Allgemein- und Visceralchirurgie, Schwerpunkt für endokrine und onkologische Chirurgie, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover.
Bei der Übersetzung wurde auf eine größtmögliche Texttreue zum Originaltext geachtet. Einige Formulierungen wurden bewusst ohne Übersetzung aus dem Originaltext übernommen. Zum besseren Verständnis wurden kleinere semantische Veränderungen vorgenommen.
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Greenberg, C., Zinner, M. Chirurgische Fallzahl. Chirurg 78, 1028–1036 (2007). https://doi.org/10.1007/s00104-007-1425-2
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DOI: https://doi.org/10.1007/s00104-007-1425-2
Schlüsselwörter
- Chirurgische Fallzahl
- Institutionelle Fallzahl
- Individuelle Fallzahl
- Schwellenwerte des Volumens
- Korrelation zwischen Volumen und Ergebnis