ABSTRACT
From April 1, 1993 to Dec. 31, 1997, the perioperative course of 5690 patients was recorded prospectively and postoperative morbidity and lethality was determined in the framework of a program for a systematic internal quality control. Goal of the program is the demonstration of treatment quality which possibly out quality improvement. The share of old and sicker patients was significantly increasing during the observation period. Morbidity and hospital lethality remained constant despite a rising necessity of postoperative intensive care. High risk surgery was performed on more patients in the university hospital than in non-university hospitals. The rate of postsurgical complications was lower, length of stay was equal (surgery for inguinal hernia) or lower (cholecystectomy). The rate of not indicated appendectomy could be lowered and morbidity and lethality in the treatment of esophagus carcinoma was lowered by the application of this concept. For the partial duodenopanceatectomy, the examination of the individual surgeon as a risk factor revealed a significant dependence on the experience of the surgeon. There was only a tendency of this effect demonstrable in medium or small surgery like colon resection of gastrectomy. The rate of continence preservation in rectal carcinoma was increased to 75% combined with a drop of perioperative morbidity and length of stay. The systematic internal quality control allows for the assessment of treatment quality and the fast recognition of weak spots. It is a suitable complementary tool for quality improvement in the framework of quality management in surgical patients. The extension of the concept by recording postoperative quality of life and long time results is planned.
