Strong deviations in treatment quality in prostate surgery

AOK: Great differences in treatment quality between clinics
Relatively many men develop prostate cancer during their lifetime and then require a prostate operation. Depending on the selected clinic, the quality of the treatment may vary significantly, reports the AOK. Help is provided by the AOK Hospital Navigator, where people can find a suitable hospital quickly and clearly. However, lawmakers are also required to set the framework for improvements in the quality of treatment.

"Prostate cancer, with 26 percent of new cases, is the most common cancer among men in Germany," according to the AOK. As is often the case, patients require prostate surgery. However, the gap between the clinics is very high in terms of the "quality of the treatment results," continues the AOK. In some hospitals complications were more than twice as common as in the best clinics. The AOK Hospital Navigator should provide an overview here.

The quality of prostate surgery in the individual clinics varies significantly. (Image: horizont21 / fotolia.com)

Choosing the right clinic is crucial
According to the health insurer, the quality of care assessment in the AOK Navigator is based on the so-called "Quality Assurance with Routine Data" (QSR) and stands for the treatment methods of Radical Prostatectomy, Prostate Removal in Prostate Cancer and Benign Prostate Syndrome Enlargement of the prostate available. The quality differences between the different clinics to be determined here are quite questionable and illustrate how important the selection of the right hospital is in case of appropriate interventions.

Complications are much more common in some clinics
According to its own statement, the AOK has evaluated over 44,100 cases from 2011 to 2013 from more than 420 clinics for the evaluation of the operative treatment of Benign Prostate Syndrome (BPS). A total complication rate of 17.9 per cent had occurred, with complications including, for example, re-operations on the prostate, urethra or ureter during hospitalization or up to one year thereafter, as well as general complications such as pulmonary embolisms or heart attacks. Discomfort with bladder emptying after a prostate operation as well as incontinence or impotence were not taken into consideration because there is no data basis for this, reports the AOK. According to the health insurer, a detailed examination of the quality of treatment in the hospitals showed that in the best quarter of hospitals with a maximum of 13.2 percent complications a significantly lower complication rate occurred than in the worst quarter of the hospitals (at least 22.5 percent of the patients affected ).

Different complication rate Signs for actual quality differences
In radical prostatectomy (RPE) too, the AOK finds massive differences in the quality of treatment at the individual clinics. The evaluation of 15,500 cases from 220 hospitals showed a total complication rate of 19.3 percent, although the top quarter of the clinics showed complications only in 12.6 percent of the treatments, while the worst quarter had a complication rate of at least 27.4 percent. Here, problematic courses of treatment were more than twice as frequent. The different complication rates are a sign of actually existing differences in quality, reports the AOK.

Regional frequency of intervention varies greatly
According to the AOK, there are also striking regional differences in the frequency of interventions. For example, BPS operations would be more frequent in southern Germany than in the north. A comparison of the 96 regional planning regions in Germany shows that in the region with the highest rate, 2.7 times more often than in the region with the lowest rate of prostate surgery due to BPS, according to the AOK. For the RPE, the difference is even more pronounced. "In the region with the highest rate, the procedure is performed around three times more often than in the region with the lowest rate," emphasizes the AOK. Here uniform standards for the selection of suitable treatment methods seem urgently needed. (Fp)