H Siebert

Deutsche Gesellschaft für Unfallchirurgie, Germany

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Publications (31)21.46 Total impact

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    ABSTRACT: Hintergrund Der Beitrag zeigt einen Vergleich der im Verfahren der externen stationären Qualitätssicherung erfassten zwei Patientengruppen, die zwischen 1993 und 1997 einerseits und zwischen 2005 und 2009 andererseits erfasst wurden. Ergebnisse Der Vergleich der zwei Patientengruppen zeigt folgende Entwicklung im stationären Patientengut bei Schenkelhalsfraktur: eine Fallzahlzunahme pro Jahr (4229 vs. 5842); das Durchschnittsalter verändert sich nicht, jedoch steigt der Anteil älterer Patienten in den Altersgruppen > 70 Jahren an; eine deutliche Verkürzung der stationären Verweildauer (27,73 vs. 18,49 Tage), eine Erhöhung der Erkrankungsschwere (nach der ASA-Klassifikation) bei gleichzeitiger Abnahme der Komplikationsraten (11,1 % vs. 7,6 %). Die Sterblichkeit im Krankenhaus blieb unverändert bei 5,3 %. Gleichzeitig hat die Anzahl der Krankenhäuser abgenommen, die Patienten mit einer Schenkelhalsfraktur behandeln (166 auf 150). Gleichzeitig hat die Anzahl der Patienten pro Krankenhaus und Jahr von 23,6 auf 41,3 Fälle zugenommen. Schlussfolgerung Die Art der operativen Versorgung hat sich verändert: während in den 1990er Jahren viele Patienten noch eine Totalendoprothese bei Schenkelhalsfraktur erhielten, dominiert in den 2000er Jahren die Hemiprothese. Osteosynthesen sind im Verlauf zurückgegangen. Als Fazit zeigt die Studie eine erhebliche Leistungsverdichtung in der Unfallchirurgie, aber trotz allem eine deutliche Verbesserung der Behandlungsqualität, gemessen an den Komplikationsraten.
    No preview · Article · Oct 2014 · Der Unfallchirurg
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    ABSTRACT: In Deutschland werden Patienten mit einen Schenkelhalsbruch noch in einem zu hohen Anteil verzögert operiert. So wurden im Jahr 2008 15,4% der Patienten mit einer Verzögerung von >48 h nach der Aufnahme operiert. Dies führt vermehrt zu chirurgischen und allgemeinen Komplikationen sowie Dekubitalulzera.Mögliche Gründe, die zu einer verzögerten Operation führen, werden in einer bundesweiten Studie untersucht.Anhand der bundesweiten Daten der externen stationären Qualitätssicherung aus dem Jahr 2008 werden die Gründe für die >48 h nach Krankenhausaufnahme durchgeführten Operationen explorativ untersucht und der gemeinsame Einfluss mittels eines multiplen logistischen Regressionsmodells analysiert.Häufiger verzögert operiert werden Patienten, die am Freitag oder Samstag stationär aufgenommen werden, Patienten mit höherer ASA-Klassifikation, Männer, Patienten mit malignen Erkrankungen in der Vorgeschichte, bei Vorliegen einer Infektionskrankheit und herzkranke Patienten. Häufiger innerhalb der ersten 48 h operiert wird bei verschobenen Frakturen, bei Hypertonie oder im Falle einer ebenfalls vorliegenden psychischen Erkrankung. Die Fallzahl pro Krankenhaus hat keinen durchgängigen Einfluss auf den Operationszeitpunkt. Während in der Woche kein signifikanter Unterschied zwischen den Fachabteilungen feststellbar ist, werden Patienten mit Aufnahmetag Freitag oder Samstag in der Allgemeinen Chirurgie häufiger verzögert operiert als in Fachabteilungen der Unfallchirurgie oder Orthopädie.Es liegen medizinische und nicht medizinische Gründe für eine verzögerte Operation bei Schenkelhalsfraktur vor. Durch Studien ist belegt, dass eine verzögerte Operation bei Schenkelhalsfraktur den Patienten schadet. Organisatorische Gründe, die eine umgehende Operation z. B bei Aufnahme am Freitag oder Samstag verhindern, sollten daher durch Verbesserungen der Krankenhausorganisation und der Personalausstattung beseitigt werden. Hierzu kommen Maßnahmen einzelner Krankenhäuser oder eine Zusammenarbeit mehrerer Krankenhäuser in Frage. Ziel sollte es sein, eine flächendeckende und zeitnahe Versorgung auf höchstem Niveau auch am Wochenende zu gewährleisten.
    No preview · Article · Jan 2014 · Der Unfallchirurg
  • P C Strohm · H Siebert

    No preview · Article · Oct 2013 · Der Unfallchirurg
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    P.C. Strohm · H. Siebert

    Preview · Article · Oct 2013 · Der Unfallchirurg
  • H Siebert · P Biberthaler

    No preview · Article · Jun 2013 · Der Unfallchirurg
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    ABSTRACT: Problem In Germany a disproportionate number of patients with a femoral neck fracture still experience a delay in surgery. In 2008 delays of more than 48 h after admission occurred for 15.4 % of patients. This leads to increases in surgical and general complications as well as pressure sores. Objective Possible reasons that lead to delayed operations were investigated in a nationwide study. Data and methods Using nationwide data from the German inpatient external quality assurance program from the year 2008 the reasons for performing operations later than 48 h after hospital admission were examined both exploratory and analytically using a multiple logistic regression model considering combined effects. Results Surgery was more frequently delayed for patients who were admitted to hospital on Friday or Saturday, patients with a higher American Society of Anesthesiologists (ASA) classification, men, patients with malignant diseases, in the presence of infectious diseases and patients with heart disease. Operations carried out within the first 48 h were more frequent with displaced fractures and in the presence of hypertension or mental illness. The volume per hospital had no consistent effect on the time delay of surgery. During the week no significant differences between the departments were detected. On Friday or Saturday surgery was delayed more often when patients were admitted to a department of general surgery than to a department of trauma surgery or orthopedics. Conclusions There are medical and non-medical reasons for delayed surgery of femoral neck fractures. Studies have confirmed that delayed surgery for femoral neck fracture harms the patients. Organizational reasons which prevent an immediate operation, e.g. admission on Friday or Saturday, should therefore be eliminated by improvements in hospital organization and staffing. These can be measures of individual hospitals or of several hospitals in cooperation. The target should be to ensure a comprehensive and timely provision of the highest quality care even at the weekend.
    No preview · Article · Jan 2013 · Der Unfallchirurg
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    ABSTRACT: In Germany, orthopedic and trauma surgery rank first in the number of alleged malpractice claims amongst all medical disciplines. Thus, the German Association of Trauma and Orthopedic Surgery, together with the Bavarian Chamber of Physicians, set out to identify potential predictors of approved malpractice claims to improve process quality. In a case-control study, 164 cases of approved malpractice claims were matched according to age and gender to 336 controls of rejected claims, based on the 2004 to 2006 dataset of the Bavarian Chamber of Physicians. Potential predictors of acceptance of an alleged incident were modeled by uni- and multivariate logistic regression analysis. The final model explained 71% of the probability of acceptance of an asserted claim. It contained three medical consequences (i.e. delayed healing, reoperation, and loss of motion), one specific entity (i.e. fracture) and one socio-demographic variable (i.e. professional driver) as independent predictors of acceptance. Insufficient or lacking explanation of the planned procedure to patients or relatives and / or lacking informed consent (odds ratio [OR] 2.33, 95% confidence interval [CI]1.23-4.43), as well as inappropriate, low-quality, or erroneously interpreted imaging (OR 1.90, 95% CI 1.06-3.41) independently contributed to the likelihood of acceptance of a legal claim. Strict adherence to the principles of surgical quality assurance in terms of transparent patient information and joint informed consent procedures, as well as intransigent radiological imaging are mandatory to foster surgeon-patients-relationships and to avoid later legal claims.
    No preview · Article · Sep 2011 · Der Unfallchirurg
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    ABSTRACT: In Germany, orthopedic and trauma surgery rank first in the number of alleged malpractice claims amongst all medical disciplines. Thus, the German Association of Trauma and Orthopedic Surgery, together with the Bavarian Chamber of Physicians, set out to identify potential predictors of approved malpractice claims to improve process quality. In a case-control study, 164 cases of approved malpractice claims were matched according to age and gender to 336 controls of rejected claims, based on the 2004 to 2006 dataset of the Bavarian Chamber of Physicians. Potential predictors of acceptance of an alleged incident were modeled by uni- and multivariate logistic regression analysis. The final model explained 71% of the probability of acceptance of an asserted claim. It contained three medical consequences (i.e. delayed healing, reoperation, and loss of motion), one specific entity (i.e. fracture) and one socio-demographic variable (i.e. professional driver) as independent predictors of acceptance. Insufficient or lacking explanation of the planned procedure to patients or relatives and / or lacking informed consent (odds ratio [OR] 2.33, 95% confidence interval [CI]1.23–4.43), as well as inappropriate, low-quality, or erroneously interpreted imaging (OR 1.90, 95% CI 1.06–3.41) independently contributed to the likelihood of acceptance of a legal claim. Strict adherence to the principles of surgical quality assurance in terms of transparent patient information and joint informed consent procedures, as well as intransigent radiological imaging are mandatory to foster surgeon-patients-relationships and to avoid later legal claims.
    Full-text · Article · Sep 2011 · Der Unfallchirurg
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    Full-text · Article · Feb 2011 · Der Unfallchirurg
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    ABSTRACT: On August 30, 2010, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned as authors and published in this Journal [Gesundheitswesen 2010; 72: 739-748]. The present paper focuses on methodological issues of economic evaluation of health care technologies. It complements the Memorandum III "Methods for Health Services Research", part 2. First, general methodological principles of the economic evaluations of health care technologies are outlined. In order to adequately reflect costs and outcomes of health care interventions in the routine health care, data from different sources are required (e. g., comparative efficacy or effectiveness studies, registers, administrative data, etc.). Therefore, various data sources, which might be used for economic evaluations, are presented, and their strengths and limitations are stated. Finally, the need for methodological advancement with regard to data collection and analysis and issues pertaining to communication and dissemination of results of health economic evaluations are discussed.
    No preview · Article · Dec 2010 · Das Gesundheitswesen
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    ABSTRACT: Purpose Within a prospective, multicenter cohort study we investigated whether operative treatment of scaphoid bone fractures leads to earlier return to previous activity levels. Methods Only isolated, acute, complete, stable and non-displaced fractures of the mid-third of the scaphoid bone were included. A total of 94 patients with the same number of fractures were recruited. In the operative group, fractures were fixed with a cannulated screw and had postoperative splint immobilization for a maximum of 1 week. In the conservative group a short arm cast was applied until fracture union was achieved. Both groups were followed for 6 months. Results By 15 weeks patients receiving surgical treatment had returned significantly earlier to their full time work and home activities and achieved significantly better results for functional status, pain, and overall satisfaction. However, after screw fixation, complication rates concerning union and secondary operative management were higher. Conclusion Operative treatment primarily facilitates earlier return to previous activity levels, as well as better functional status, less pain and higher patient satisfaction, but conservative treatment seems to be safer and associated with a lower complication rate.
    No preview · Article · Oct 2010 · Der Unfallchirurg
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    ABSTRACT: Within a prospective, multicenter cohort study we investigated whether operative treatment of scaphoid bone fractures leads to earlier return to previous activity levels. Only isolated, acute, complete, stable and non-displaced fractures of the mid-third of the scaphoid bone were included. A total of 94 patients with the same number of fractures were recruited. In the operative group, fractures were fixed with a cannulated screw and had postoperative splint immobilization for a maximum of 1 week. In the conservative group a short arm cast was applied until fracture union was achieved. Both groups were followed for 6 months. By 15 weeks patients receiving surgical treatment had returned significantly earlier to their full time work and home activities and achieved significantly better results for functional status, pain, and overall satisfaction. However, after screw fixation, complication rates concerning union and secondary operative management were higher. Operative treatment primarily facilitates earlier return to previous activity levels, as well as better functional status, less pain and higher patient satisfaction, but conservative treatment seems to be safer and associated with a lower complication rate.
    No preview · Article · Oct 2010 · Der Unfallchirurg
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    ABSTRACT: An increasing lack of young fellowship trainees in operative medicine, particularly in orthopaedics and traumatology and the various options to counteract this problem during the phases until the individual decision for residency and the fellowship program is made, were the focus of part I. The present part concentrates on residency and the fellowship phase including the individual perspectives after successful training. With respect to an attractive and highly qualified training in orthopaedics and traumatology, three essential points are to be made: a timely general framework, the establishment of a clinic-specific management of training and a general evaluation of training in the sense of a benchmarking system. A flexible work schedule including structural entities, such as an in-hospital day care facility for children, a structured and reliable curriculum of training according to a model curriculum to be adapted to the corresponding training unit including options of rotation to other facilities of training and the integration of nationwide education and mentoring programs represent further elements of an attractive training program. Thus the quality of training will become a decisive criterion of selection. The fellowship program for specialized traumatology inevitably leads to limitations of the whole spectrum of the field with an increasing specialization. In the future the contents of fellowship training will need a well-considered adaptation to the clinical needs and realities in the light of the emerging national trauma network program. A wide field of activity will open up to specialists in orthopaedics and traumatology with a focus on special traumatology considering the rapid changing field of hospital and outpatient care. Thus a systematic and creative reorganization of the residency and fellowship phases will overcome any problem of attractiveness.
    No preview · Article · Jul 2010 · Der Unfallchirurg
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    ABSTRACT: An increasing lack of young fellowship trainees in operative medicine, particularly in orthopaedics and traumatology and the various options to counteract this problem during the phases until the individual decision for residency and the fellowship program is made, were the focus of part I. The present part concentrates on residency and the fellowship phase including the individual perspectives after successful training. With respect to an attractive and highly qualified training in orthopaedics and traumatology, three essential points are to be made: a timely general framework, the establishment of a clinic-specific management of training and a general evaluation of training in the sense of a benchmarking system. A flexible work schedule including structural entities, such as an in-hospital day care facility for children, a structured and reliable curriculum of training according to a model curriculum to be adapted to the corresponding training unit including options of rotation to other facilities of training and the integration of nationwide education and mentoring programs represent further elements of an attractive training program. Thus the quality of training will become a decisive criterion of selection. The fellowship program for specialized traumatology inevitably leads to limitations of the whole spectrum of the field with an increasing specialization. In the future the contents of fellowship training will need a well-considered adaptation to the clinical needs and realities in the light of the emerging national trauma network program. A wide field of activity will open up to specialists in orthopaedics and traumatology with a focus on special traumatology considering the rapid changing field of hospital and outpatient care. Thus a systematic and creative reorganization of the residency and fellowship phases will overcome any problem of attractiveness.
    Full-text · Article · Jun 2010 · Der Unfallchirurg
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    ABSTRACT: The lack of clinical residents especially in the surgical domains, including orthopaedics and trauma surgery, is not only omnipresent but also a topic of lively discussions. This lack originates from sociopolitical and healthcare policy issues as well as from a loss of attractiveness of all surgical disciplines. The loss is caused by the high workload and disadvantageous working hours especially in those disciplines with a high rate of emergencies, e.g. trauma surgery. Moreover, it is caused by the poorly structured and unpredictable period of residency. In order to anticipate the bottleneck in supply due to the lack of trainees, a number of structural and contextual measures have to be taken to improve both undergraduate und postgraduate surgical training. Due to the numerous facets of the topic the first part of this analysis refers to the period until the trainee decides on the field of training.A basic insight into the field of orthopaedics and trauma surgery can already be offered far before the period of medical studies itself. During undergraduate medical education the existing structures should be modified, the characteristics of the discipline should be emphasized and the charm of combining theory and practical skills should be highlighted in order to enhance student's perception of the discipline. This might begin during preclinical training and should be continued throughout clinical training and elective courses (basic wound care, TEAM approach, AO course for students and seminars for M.D. candidates). Contextual and structural improvements of the practical year are indispensable to arouse students' interest in our discipline. These options conjoined with the actual offers for students provided by our scientific society, such as guided tours during the annual congress, travelling grants and the recently inaugurated summer school, might provide the basis for clearly structured information and offer a distinct stimulus to apply for residency in our field.
    No preview · Article · Jun 2010 · Der Unfallchirurg
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    ABSTRACT: To investigate whether operative treatment leads to earlier return to previous activity level, 94 patients with the same number of isolated, acute, complete, stable and non-displaced fractures of the scaphoid mid-third were involved in a prospective, multicenter cohort study. Fractures were either fixed with a cannulated screw or immobilized with a short arm cast, and followed for 6 months. By 15 weeks, patients receiving surgical treatment returned significantly earlier to their full time work and home activities, as well as achieved significantly better results for functional status, pain, and overall satisfaction. However, complication rates concerning union and secondary operative management were higher. Operative treatment therefore primarily facilitates earlier return to previous activity level, as well as better functional status, less pain and higher patient satisfaction, yet conservative treatment seems to be safer and associated with a lower complication rate.
    No preview · Article · Nov 2009 · Archives of Orthopaedic and Trauma Surgery
  • A.D. Bonk · R. Hoffmann · H. Siebert · C. Wölfl
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    ABSTRACT: Durch gesundheitspolitische und strukturelle Wandlungsprozesse sowie durch den neuen „Facharzt für Orthopädie und Unfallchirurgie“ ändert sich das Arbeitsumfeld unfallchirurgischer Kliniken in Deutschland. Daher führte der Berufsständische Ausschuss der Deutschen Gesellschaft für Unfallchirurgie im Mai 2008 eine Umfrage zur Versorgungsrealität an 729 unfallchirurgischen Kliniken und Abteilungen durch. Die Auswertung der rund 90.000 erfassten Variablen, die im Folgenden dargestellt wird, spiegelt die geänderte Situation der Traumaversorgung wieder. Veränderte Versorgungsstrukturen werden beleuchtet und eine Verdichtung der Arbeit an den befragten Kliniken dargestellt. Insbesondere auf den Mangel an qualifizierten Bewerbern, der als Hauptgrund nicht besetzter Stellen angegeben wurde, wird weiter eingegangen. Due to revised conditions of medical care in Germany, in particular the introduction of the newly designated specialist for orthopaedics and trauma surgery, the working conditions in trauma surgical clinics in Germany has changed. In May 2008 the professional committee of the German Trauma Society conducted a survey at the 729 trauma surgical clinics and departments in order to establish the true level of care at these particular sites. The results of the 90,000 variables presented in the following article, reflect the changes in trauma care as well as in the medical care structures and emphasize the increased work load. In particular the lack of qualified candidates underlines the main explanation for vacant posts and is also evaluated in this article.
    No preview · Article · Oct 2009 · Der Unfallchirurg
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    ABSTRACT: According to international and national studies and clinical guidelines, patients with medial hip neck fracture should receive surgery as soon as medically reasonable after hospitalization, preferably within 48 h. Analysis of the German quality registry data of 2006 showed, however, that in 13 out of the 16 federal states less than 85% of patients were operated on within 48. Delayed surgery was found especially during the weekend. The objective of the study was to examine whether German data confirm that a short preoperative waiting time after hip fracture improves the outcome. The study was commissioned by the Federal Joint Committee (G-BA) and was jointly performed by the German Society for Accident Surgery (DGU) and the National Institute for Quality in Healthcare (BQS). The analysis is based on the data of the nationwide quality registry of the years 2004-2006. Out of a total of 129,075 patients with a medial hip neck fracture 22,171 received operative treatment later than 48 h after hospital admission. Comparable study groups were constructed with the help of a propensity score (1-to-1 matching). Study and control groups only differed in terms of delay of surgery. The comparison concerning the outcomes was made with the Fisher exact test (bilateral). In the group of patients with a delay of surgery longer than 48 h significantly higher rates of surgical complications (OR 1.10), general complications (OR 1.09) and pressure ulcers (1.27) were observed (all p<0.001). The in-hospital mortality showed no significant difference (OR 0.96, p=0.302). Patients with medial hip neck fracture should receive operative treatment without delay, if no medical contra-indications for immediate surgery. In particular appropriate organizational measures should be taken to ensure an early surgical treatment even during weekends.
    No preview · Article · Sep 2009 · Der Unfallchirurg
  • A D Bonk · R Hoffmann · H Siebert · C Wölfl
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    ABSTRACT: Due to revised conditions of medical care in Germany, in particular the introduction of the newly designated specialist for orthopaedics and trauma surgery, the working conditions in trauma surgical clinics in Germany has changed. In May 2008 the professional committee of the German Trauma Society conducted a survey at the 729 trauma surgical clinics and departments in order to establish the true level of care at these particular sites. The results of the 90,000 variables presented in the following article, reflect the changes in trauma care as well as in the medical care structures and emphasize the increased work load. In particular the lack of qualified candidates underlines the main explanation for vacant posts and is also evaluated in this article.
    No preview · Article · Sep 2009 · Der Unfallchirurg
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    ABSTRACT: The combination of kyphoplasty and fixateur interne is an essential therapy with osteoporotic unstable fractures. Material costs of 5500 Euro are not sufficiently covered by returns through DRG I09. Thus operations are often performed in 2 stages, an initial one and a second 30 days later. This means more strain for the patient and partly also loss of correction. Therefore in 2008 we requested the InEK that codes for one-and two-segmental implantation of material in a vertebrae with preceding restoration of vertebral height (5-839.a0 and 5-839.a1) combined with a percutaneous dorsal operation with a screw-rod system in the future would be represented by I19B in G-DRG system with returns of 11,110,40 Euro. Prerequirement is coding of kyphoplastiy as main procedure and percutaneous implantation of a fixateur with procedure 5-835.5. Some procedures in orthopedic surgery implying technical improvements and rising implant costs are not sufficiently rewarded. Thus is make sense to inform InEK by corresponding proposals.
    No preview · Article · Sep 2009 · Der Unfallchirurg

Publication Stats

117 Citations
21.46 Total Impact Points

Institutions

  • 2009-2014
    • Deutsche Gesellschaft für Unfallchirurgie
      Germany
    • Klinikverbund Südwest
      Sindelfingen, Baden-Württemberg, Germany
  • 2009-2013
    • Deutsche Gesellschaft für Orthopädie und Unfallchirurgie e.V.
      Berlín, Berlin, Germany
  • 2010
    • University of Rostock
      • Unfall- und Wiederherstellungschirurgie
      Rostock, Mecklenburg-Vorpommern, Germany
  • 2005-2010
    • Universitätsklinikum Düsseldorf
      • Klinik für Unfall- und Handchirurgie
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2008-2009
    • Heinrich-Heine-Universität Düsseldorf
      • Klinik für Unfall- und Handchirurgie
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2005-2009
    • Diakonie-Klinikum Schwäbisch Hall gGmbH
      Hall, Baden-Württemberg, Germany