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Ambulante Nebenschilddrüsenoperationen im deutschen System – Möglich und sinnvoll?

Outpatient parathyroid gland operations in the German system—Feasible and useful?

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Zusammenfassung

Hintergrund

In Deutschland sind 2019 etwa 7500 Eingriffe an Nebenschilddrüsen (NSD) stationär durchgeführt worden (Statistisches Bundesamt 2020, https://www.destatis.de/DE/). Der Katalog ambulant durchführbarer Operationen beinhaltet auch im Jahr 2023 keine NSD-Operationen.

Fragestellung

Unter welchen Voraussetzungen ist es möglich, NSD-Eingriffe ambulant sicher durchzuführen?

Material und Methoden

Publizierte Daten zur ambulanten NSD-Chirurgie wurden hinsichtlich der zugrunde liegenden NSD-Erkrankung, der durchgeführten Eingriffe und patientenspezifischer Voraussetzungen ausgewertet.

Ergebnisse

Ersteingriffe beim lokalisierten sporadischen primären Hyperparathyreoidismus (pHPT) scheinen für eine ambulante Durchführung geeignet, sofern die betroffenen Patienten die generellen Voraussetzungen für eine ambulante Operation erfüllen. Die hier in der Regel durchgeführten fokussierten Parathyreoidektomien (PTX) oder unilateralen Explorationen können in Lokal- oder Allgemeinanästhesie durchgeführt werden und haben ein sehr niedriges Risiko für postoperative Komplikationen. Die Organisation des Operationstages sowie die postoperative Versorgung der Patienten sollten durch einen standardisierten Ablaufplan detailliert festgelegt werden. Die Vergütung einer ambulanten PTX ist allerdings im deutschen ambulanten Operationskatalog nicht vorgesehen und damit derzeit finanziell nicht adäquat abbildbar.

Diskussion

Bei selektionierten Patienten, die sich einem limitierten Ersteingriff bei pHPT unterziehen, könnte eine ambulante Operation erfolgen. Allerdings müssten die derzeitigen Abrechnungsmodalitäten entsprechend überarbeitet werden, damit diese ambulanten Eingriffe wirtschaftlich abbildbar werden.

Abstract

Background

In 2019 approximately 7500 procedures were carried out for parathyroid diseases in Germany (Statistisches Bundesamt 2020, https://www.destatis.de/DE/). All operations were performed as inpatient procedures. The catalogue of outpatient procedures for 2023 does not include operations on the parathyroid glands.

Objective

Which conditions are prerequisites for parathyroid surgery on an outpatient basis?

Material and methods

Published data on outpatient parathyroid surgery were analyzed with respect to the underlying disease, procedures performed and patient-specific circumstances.

Results

Initial operations for localized sporadic primary hyperparathyroidism (pHPT) seem to be suitable for outpatient surgery, provided that affected patients fulfil the general prerequisites for an outpatient operation. The procedures focused parathyroidectomy and unilateral exploration can be carried out using local or general anesthesia and have a very low risk for postoperative complications. The organization of the day of the operation and the postoperative treatment of the patient should be organized within a detailed standard of procedure. The remuneration for an outpatient parathyroidectomy is not included in the German outpatient surgery catalogue and is therefore currently not adequately financially reimbursed.

Conclusion

In selected patients a limited initial intervention for primary hyperparathyroidism can be safely performed on an outpatient basis; however, the present German reimbursement modalities have to be revised so that the cost of these outpatient operations can be adequately covered.

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Authors and Affiliations

  1. Klinik für Visceral‑, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg, Baldingerstr., 35043, Marburg, Deutschland

    Elisabeth Maurer & Detlef K. Bartsch

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  1. Elisabeth Maurer
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  2. Detlef K. Bartsch
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Correspondence to Elisabeth Maurer.

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E. Maurer und D.K. Bartsch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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D.K. Bartsch, Marburg

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Maurer, E., Bartsch, D.K. Ambulante Nebenschilddrüsenoperationen im deutschen System – Möglich und sinnvoll?. Chirurgie 94, 580–585 (2023). https://doi.org/10.1007/s00104-023-01846-5

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