Elektive Kolonresektionen in Deutschland
ABSTRACT HintergrundDie „Fast-Track“-Rehabilitation im Rahmen elektiver Kolonresektionen ist ein multimodales, perioperatives Behandlungskonzept,
das chirurgische und anästhesiologische Aspekte kombiniert. Dadurch wird die Rate allgemeiner Komplikationen vermindert und
eine rasche Rekonvaleszenz ermöglicht. Die hier vorgestellte Umfrage untersucht die Verbreitung und die Anwendung dieses Konzeptes
MethodenIm Januar 2006 erhielten 1270 anästhesiologische Abteilungen einen Fragebogen, in dem das übliche anästhesiologische Vorgehen
anhand einer konventionellen Sigmaresektion beschrieben werden sollte.
ErgebnisseDie Rücklaufrate betrug 385 (30,3%). Es wird eine präoperative Nahrungskarenz bezüglich fester Kost von 12h vor dem Eingriff
in 52% und von 6h in 44% der Kliniken eingehalten; bezüglich der Aufnahme von Flüssigkeiten beträgt die Karenzzeit 6h in
47% und 2h 41% in der Kliniken. Eine Prophylaxe gegen postoperative Übelkeit und Erbrechen („postoperative nausea and vomiting“,
PONV) führen 33% der Befragten durch. Propofol (68%) ist das führende Narkotikum. Fentanyl (56%) und Sufentanil (48%) sind
die am weitesten verbreiteten Analgetika. Es nutzen 75% der anästhesiologischen Abteilungen epidurale Analgesien.
SchlussfolgerungIn Deutschland orientiert sich die anästhesiologische Versorgung im Rahmen elektiver Kolonresektionen in weiten Teilen an
den evidenzbasierten Empfehlungen zur „Fast-Track“-Chirurgie.
BackgroundFast-track rehabilitation after elective colon resection is an interdisciplinary multimodal procedure, which combines surgical
and anesthesiological aspects. This leads to an improved and accelerated recovery and avoids perioperative complications.
This survey focuses on the extent and use of such concepts in Germany.
MethodsIn January 2006, a questionnaire was sent to 1270 anesthesiology departments in Germany in which they were asked to describe
the standard anesthesia procedures based on a conventional sigmoid resection.
ResultsThe response rate was 385 out of 1270 (30.3%). Preoperative fasting of solid food 12h before the operation was practiced
in 52% and for 6h in 44% of the clinics. For fluid intake the fasting time was 6h in 47% and 2h in 41%. Prophylactic measures
for postoperative nausea and vomiting (PONV) were administered in 33% of clinics. Propofol (68%) was the leading narcotic,
fentanyl (56%) and sufentanil (48%) were the most commonly used intraoperative analgesics and 75% of clinics used epidural
ConclusionIn Germany the anesthesiological treatment after elective colon surgery adheres broadly to the evidence-based recommendations
for fast-track concepts.
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ABSTRACT: The German Social Act V section sign 12 is aimed towards competition, efficiency and quality in healthcare. Because surgical departments are billing standard diagnosis-related group (DRG) case costs to health insurance companies, they claim best value for money for internal services. Thus, anaesthesia concepts are being closely scrutinized. The present analysis was performed to gain economic arguments for the strategic positioning of regional anaesthesia procedures into clinical pathways. Surgical procedures, which in 2005 had a relevant caseload in Germany, were chosen in which regional anaesthesia procedures (alone or in combination with general anaesthesia) could routinely be used. The structure of costs and earnings for hospital services, split by types and centres of cost, as well as by underlying procedures are contained in the annually updated public accessible dataset (DRG browser) of the German Hospital Reimbursement Institute (InEK). For the year 2005 besides own data, national anaesthesia staffing costs are available from the German Society of Anaesthesiology (DGAI). The curve of earnings per DRG can be calculated from the 2005 InEK browser. This curve intersects by the cost curve at the point of national mean length of stay. The cost curve was calculated by process-oriented distribution of cost centres over the length of stay and allows benchmarking within the national competitive environment. For comparison of process times data from our local database were used. While the InEK browser lacks process times, the cost positions 5.1-5.3 (staffing costs anaesthesia) and the national structure adjusted anaesthesia staffing costs 2005 as published by the DGAI, were used to calculate nationwide mean available anaesthesia times which were compared with own process times. Within the portfolio diagram of lengths of stay for each DRG and process times most procedures are located in the economic lower left, in particular those with high case mix (length of stay and anaesthesia times below reimbursement relevant national mean). The driver of increased earnings is shortening length of stay. Our use of regional anaesthesia is 5 to 10-fold higher than national benchmarks and may contribute to our advantageous position in national competition. The annual increases in profit per DRG range between EUR 1,706 and EUR 467,359 and compensate by far the investment of regional anaesthesia derived pain management, besides the advantage of increased patient satisfaction and avoidance of complications. Regional anaesthesia is a considerable value driver in clinical pathways by shortening length of stay. The present analysis further demonstrates that time for regional block performance is covered by anaesthesia reimbursement within the DRG costing schedule.Der Anaesthesist 05/2009; 58(5):459-68. · 0.74 Impact Factor
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ABSTRACT: Background: Insufficient nutrition in surgical patients increases perioperative morbidity, mortality, length of stay and therapy costs. Therefore, guidelines declare the integration of nutrition into the overall management as one of the key aspects of perioperative care. This study was conducted to evaluate the current clinical practice of clinical nutrition in surgical departments in Germany. Methods: In 2009 German Surgical Society (DGCH) members in leading positions were surveyed with a standardised online questionnaire concerning their perioperative nutritional routines in elective surgery. Results: From the addressed physicians n = 156 (6.24 %) answered. Of those, 86.9 % consider the nutritional status of their patients. Only 6 % use standardised nutritional screening tools. Short preoperative fasting for solid and liquid food is practiced by 65 % and 40 %, respectively. After the operation, 65 % allow intake of clear fluids on the day of surgery and 78 % initiate solid food on the day of surgery or the first postoperative day. Oral nutritional supplements are given only "sometimes" or "rarely" by 53.9 % of the respondents. Conclusion: The low response rate may imply the dilemma that the evidence-based benefit of perioperative nutrition does not meet sufficient interest. Even in case of a positive selection of "pro-nutrition respondents", standardised preoperative malnutrition screening is also rare. Aspects such as shorter perioperative fasting are already practiced more progressively. However, still greater efforts are needed to promote guideline-based clinical nutrition in surgical care in Germany.Zentralblatt für Chirurgie 11/2011; 138(6). DOI:10.1055/s-0031-1283777 · 1.19 Impact Factor