[2-year evaluation of a cooperation model between a surgical university clinic and a general hospital]. / 2-Jahresbilanz eines Kooperationsmodells zwischen einer Chirurgischen Universitätsklinik und einem Spital der Grundversorgung.

INTRODUCTION: On 1 January 1998 a cooperation between an university hospital and a peripheral general hospital was initiated with the aim of reducing waiting lists and health care costs. Surgical patients initially referred to the Department of Visceral and Transplantation Surgery of the University of Bern (Inselspital) were evaluated and selected in the outpatient clinic for an operation in the peripheral hospital Grosshöchstetten. The operation and postoperative care in Grosshöchstetten was performed by a team from the university department according to the standard concept also utilized at the university hospital. RESULTS: The 574 patients referred to the university and operated on in Grosshöchstetten during a 2-year period had a morbidity rate of 3.5%, a reoperation rate of 1.0% and a mortality rate of 0.15%. The mean hospital stay was 6.3 days. The quality evaluation performed by questionnaires to patients and physicians showed an overall satisfaction rate of 95%. The cooperation resulted in reduction of the overall costs in both hospitals, and the patients' involved health insurances profited from substantially lower costs per case. CONCLUSIONS: Health care costs in both hospitals as well as the waiting list at the university hospital were markedly reduced during this 2-years trial, with an overall satisfaction rate of 95%. This form of cooperation of an university with a peripheral hospital represents a new and valuable model for effective reduction of health care costs.

[Is appendectomy really performed too frequently? Results of the prospective multicenter study of the Swiss Society of General Surgery]. / Wird tatsächlich zu häufig appendektomiert? Resultate der prospektiven Multicenterstudie der Schweizerischen Gesellschaft für Allgemeinchirurgie (SGAC).

Scientific publications and provoking criticism from the lay press have recently pointed out, that appendices may be surgically removed too frequent and without indisputable necessity. In an attempt to verify these questionable statements, the Swiss Society for General Surgery (SGAC) initiated a prospective controlled multi center trial. From September 1997 to December 1998, hundred and twenty-five institutions documented 4603 appendectomies performed due to a suspected appendicitis. Histological investigation of all specimens revealed a 7% rate of normal appendices, 7.2% for patients with national health service (NHS) and 5.9% for patients with private insurances respectively. Compared to the results of the literature, where a frequency of normal appendices around 15% is judged as standard, these results are excellent. In 17.2% of the patients (15.9% NHS and 23.6% privately insured patients) an "appendicitis perforata" was observed. This percentage remains in the range reported by other authors. The analysis of time of admission (i.e. day or night) and the delay from admission to surgery shows a distribution independent to the insurance of the patients. Therefore, the planned appendectomy for patients with private insurances does not exist. A different choice of the surgical technique could be observed depending on the insurance status. In 30.4% of the private insured patients a laparoscopic appendectomy was performed as compared to 22.6% of patients with NHS. Surprisingly, an identical median hospitalization time can be observed for both groups (laparoscopic 5.5 days, open surgery 5.5 days).

[Quality control in patient education. Results of a patient survey about the patient education protocol of the Swiss Society of Surgery in 6 Swiss hospitals]. / Qualitätskontrolle der Patientenaufklärung. Resultate der Patientenbefragung über das Aufklärungsprotokoll der Schweizerischen Gesellschaft für Chirurgie (SGC) in sechs Schweizer Spitälern.

In the past years the number of malpractice suits due to lack of patient information has increased. Because there have been no generally accepted guidelines for preoperative patient information, the Swiss Society of Surgery has decided to work out an informative brochure tailored to the needs of patients. It takes into account that the need to know beforehand is increasing rapidly. In collaboration with the judiciary service of the Swiss Medical Federation all the items and points of legal relevance have been compiled to establish an informative brochure. Based on this protocol, patients in surgical departments of 6 Swiss community hospitals were asked before discharge to qualify the preoperative information offered to them. 2660 questionnaires were evaluated. The majority of patients considered the information regarding their diagnosis, the complications, risks, treatment and postoperative care, the sketches describing the operation and the overall degree of information as good or very good. Almost 60% of all patients stated that no alternative treatment had been discussed with them other than the planned procedure. In most of these patients operative procedures were chosen and carried out for which there were few or no other acceptable options. 2/3 of the patients asked for immediate preoperative written information, especially if they had malignant disease. Barely 4% of the patients were not reassured by the information provided to them. The fact that 2/3 of all patients re-read the informative protocol before the operation underlines how important it is to hand out a copy of the protocol to satisfy the informative needs of the patients. To our surprise the vast majority of patients uttered little concern about giving their signature to forms that were presented to them. Only 2% of the patients felt that giving a signature would cause them grave reservations. The informative protocol devised by the Swiss Society of Surgery is well adapted to the informative needs of the patients and allows for a structured conversation. It facilitates documentation and offers valid legal proof for the physician that he/she has provided adequate information.

[Ambulatory surgery clinic in a public general hospital. Organization and results]. / Tagesklinik an einem öffentlichen Spital der Grundversorgung. Organisation und Resultate.

In surgery a day care clinic is defined as an institution in which patients undergo elective operations the day of their admission and are discharged within 24 h after surgery. An important goal of day care surgery is to avoid unnecessary hospitalisations however providing the patient with the same quality of treatment and personal satisfaction. This presentation describes the patients selection, information and follow-up, the organization of the day care system, the computerized quality control and the medical outcome. Our experience is based on a 2-year period of day care surgery in a general community hospital. The results of 581 consecutively operated, not selected, patients are presented. Quality control was performed for all patients during their stay at the day care unit, and for 98.5% as follow-up control by the General Practitioners. The most frequent operations were: arthroscopies, meniscectomies, removals of implants after osteosynthesis, decompressions of peripheral nerves, large excisions of skin-tumors, bursectomies, reconstructions of torn ligaments, hernial repairs, strippings of varicose veins, hemorrhoidectomies and operations of the anal and genital region. We present the patients age, the type of anesthesia, the type of operation, eventual complications (in clinic, 24 hours after discharge and at the end of the treatment), the medical results as well as the costs of the after-treatment.

[Financial analysis of hospitalizations for adverse effects of drugs. The economic role of the Regional Pharmacovigilance Center]. / Analyse financière des hospitalisations pour effects indésirables. Rôle économique du Centre Régional de Pharmacovigilance.

Authors look at different methodological estimations of costs induced by hospitalizations for side effects of drugs: individual, global and budgetary estimations. Only the two last ones are possible today. Results are sufficient to demonstrate the economic importance of a Pharmacovigilance Centre for the Hospitals that have got such a structure.

[Ligament lesions of the knee--also a typical occupational injury]. / Bandläsionen am Knie--auch typische Arbeitsverletzungen.

Critical evaluation of 62 patients totalizing 63 operations with acute traumatic rupture of knee ligaments in a predominantly rural population. In 21 cases (30%) the lesions have been the result of typical work-injuries. A specific older group of patients was concerned (average age 50.2 years). 75% of these cases presented additional intrarticular lesions at operation. The postoperative evaluation 1-5 years later confirmed the heavy use of the knees in this rural population. We therefore strongly advocate an early primary repair of the ruptured ligaments of the knee especially in work-injuries and the use of a limited motion cast.

[What determines the prognosis following cholecystectomy: anamnesis, surgical findings, postoperative complications?]. / Was bestimmt die Prognose nach Cholezystektomie: Anamnese, Operationsbefunde, postoperative Komplikationen?

In 346 patients followed up 6, 12, 24 and 48 months after cholecystectomy the clinical results (VISICK and self-assessment) were very good in over 80%, 1% had symptoms due to organic disturbances and 15-20% had mostly mild symptoms (pain, fullness, food tolerance) without detectable causes. These functional disorders were found frequently in female patients with long preoperative history and frequent attacks of pain. Age of patient, character of pain, therapy before the operation, postoperative complications or change of body weight showed no correlation with later results. The results were almost always good in patients with acute pancreatitis or acute cholecystitis before the operation, or who underwent choledochotomy.

[Spiegeli's hernia]. / Die Spiegeli'sche Hernie

Spontaneous lateral ventral hernia (spigelian hernia) is briefly reviewed in the light of 7 patients with a total of 8 hernias. The relatively high incidence of spigelian hernia (5% of all abdominal hernias operated on in 1 year) suggests that this hernia type is not uncommon if borne in mind when diagnosing conditions with abdominal pain. Pain, tenderness and a palpable mass along the lateral edge of the rectus abdominis are the leading symptoms. Since the operation is simple and the postoperative period uneventful, operative treatment is strongly recommended. Accurate diagnosis with resultant surgery for this type of hernia spares the patient unnecessary examinations and totally relieves symptoms.