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Minimum quantity requirement German OP teams often need more experience
"Practice makes perfect": This old adage also applies to medical personnel. New studies show that the more frequently an intervention takes place, the better the results of the treatment for the patient. Experts call for tightening the minimum system requirements for clinics.
There is a lot of surgery in Germany
In recent years it has been repeatedly criticized that in German hospitals too much and too fast surgery. Patients are therefore advised to obtain a second medical opinion in case of doubt before surgery. In addition, people who are undergoing surgery should inquire in which clinic this is best done. Because not all hospitals have enough experience, as experts report.
The more operations a doctor has performed with his team, the better the patient's treatment outcomes. Experts therefore call for a tightening of the minimum volume regulations for clinics. (Image: BillionPhotos.com/fotolia.com) Stricter minimum quantity regulation
A few months ago, a study by the Clinic and Polyclinic for Urology at the University Hospital Carl Gustav Carus Dresden showed that recommendations regarding the minimum amount of operations a clinic should have performed are often not observed.
For some interventions - in the case of the Dresden study it was about prostate cancer operations - the experience is lacking in many clinics.
A tightening of the minimum quantity regime could improve the situation. "Many healthcare systems abroad are already using mandatory minimum volume catalogs to centralize complicated operations," said study leader Dr. Johannes Huber in a communication from the Dresden University Hospital.
"In Germany, there are such a rule but only for six procedures such as liver and kidney transplants, surgery on the coronary arteries or operations of the pancreas and esophagus," said the physician.
The fact that this should change, according to other experts. Thus, the health insurance AOK is committed to expanding the minimum volume regulations in inpatient care. These specify how often a particular treatment must be performed in a clinic.
Extension to inpatient services
"The minimum volume regulations must urgently be extended to other inpatient services to protect patients. In addition to the hip replacement, these include, for example, thyroid and breast cancer surgery or obstetrics, "said Martin Litsch, CEO of the AOK-Bundesverband, in a statement on the occasion of the presentation of the current Hospital Report 2017.
The report, presented by the Scientific Institute of the AOK (WIdO) and the AOK Federal Association, contains new analyzes on scientific investigations, which among other things show that the treatment results are better for the patient the more often an intervention takes place.
Increased risk for patients
Even scientists and professional societies recommend further minimum quantity regulations. They refer, for example, to the hip joint replacement in osteoarthritis, for which the relationship between the frequency of treatment and the treatment result according to the health insurance shows particularly clearly.
According to the study, between 2012 and 2014, 134,000 AOK patients received a new hip joint in 1,064 osteoarthritis hospitals. One fifth of the clinics had a maximum of 38 operations per year.
The risk of a new hip operation within a year was more than twice as high for patients in these hospitals as for the patients who operated in the fifth of the clinics with the highest number of cases. In such centers 211 or more plannable hip surgeries took place.
Many clinics do not comply with the specifications
But even if there are minimum requirements, these are not complied with in many clinics in Germany, as evidenced by the report on operations on the esophagus and the pancreas.
In 2014, around 700 hospitals performed around 12,000 pancreas surgeries, so just under half of the hospitals did not reach the minimum level of ten. In the surgery on the esophagus, it was almost three quarters of all clinics.
"We need transparency about which clinics do not meet the minimum volumes. By law, these benefits from the health insurance then not to pay. In implementing this path, we need significantly more courage and will from all involved, "says Litsch.
Gaps in the system
As the health insurance continues to write, one of the gaps in the system is also that micro-suppliers can continue to offer their services under exemptions, although they do not meet the minimum quantities.
"Whether a house with very small amounts has done a good or a bad job in a particular case is not statistically evaluable and contradicts the basic principle of minimum quantities. This endangers the care of the patients, "explained Jürgen Klauber, Managing Director of WIdO and co-editor of the Hospital Report.
"If a minimum quantity exists, that must be the bar for all clinics, as well as speed limits in the traffic knows no exceptions."
Shorter surgery times and lower complication rates
Prof. Dr. Hartwig Bauer, former Secretary General of the German Society of Surgery, sees further gaps in the minimum volume requirement: "The positive correlation between treatment frequency and outcome is not only at the hospital level, but also in the specialization of the surgeon himself. His experience shows in shorter terms Operating times and thus lower complication rates. But this knowledge is not implemented in Germany. "
In addition, adherence to guidelines and the organizational structure of the hospital are important. "A coordinated, well-trained process chain naturally always involves higher volumes," says Bauer. "We already know what to do, only we have to do what we know." (Ad)