[Risk scores and outcomes after cholecystectomy: a comparison between a university hospital and a short-stay clinic--a prospective observational study]. / Risikoprofil und Ergebnisqualität nach Cholezystektomie--Ein Vergleich zwischen einer Universitäts- und Praxisklinik.

BACKGROUND: This study was designed to compare the risks of morbidity and mortality of patients in a surgical department of an academic medical centre and a short-stay clinic. Furthermore, economic and patient-related parameters were assessed. METHODS: A number of 50 respectively 33 consecutive patients scheduled for a cholecystectomy were included in this prospective study. Data were collected well-assorted against the POSSUM score, the duration of the operation, complications and the length of stay as well as quality of life and patient satisfaction. RESULTS: No differences among patients of the two hospitals became apparent as they were referenced against the POSSUM score, nor were any discrepancies in expected respectively ex-post complications upon cholecystectomy observed. The continuance of the operative procedure was found to be significantly lengthened in the university hospital as compared with the non-academic clinic (120.1 +/- 34.3 min vs. 65.6 +/- 16.3 min; p < 0.001). The difference in durability splits up in 1.2 days pre-operatively versus 2.4 days post-operatively. In return, the post-operative pain therapy was esteemed much better in the university hospital. CONCLUSION: The POSSUM score is a reliable tool to assess morbidity and mortality in surgical patients. The scores were found to be equal for patients in a university hospital and those in a short-stay clinic. Complications likewisely were equally low in both hospitals. The longer duration of the operation and the higher length of stay revealed structural benefits of the smaller unit. Advantages of the academic centre were found in the standards for pain therapy. The present study is taken both as a reference and as a basis for a fundamental process-redesign to the benefit of involved parties e. g. patients, relatives, staff in the university hospital.

[Quality management in surgery--an overview of methods and possibilities]. / Qualitätsmanagement in der Chirurgie. Uberblick über Methoden und Möglichkeiten.

Numerous methods of assessing quality in health care have been presented over the last years. Since the German health care reform of 2000 introduced a legal obligation to quality assurance, hospitals have to meet that condition. However, no specific system of quality assurance was implicated. Therefore, many potential users search for systems suiting their own needs. However, German hospitals can benefit from international experience in quality management. Accreditation, visitation, excellence schemes, and certification seem to be the dominant methods. Every method is worthy of hospital evaluation. Certifications illustrate the quality system view without regard to profession, while excellence schemes evaluate the development of quality management in hospitals. Accreditation portrays a specific hospital as a whole, while visitations follow the professional perspective of quality assurance. Depending on the perspective and aims, there are advantages and disadvantages in each method. Finally, a combination of two may also be helpful. Indeed, no "role model" exists yet for assessing quality in health care. These methods of quality management are applicable especially in surgery, because a variety of standard outcome parameters such as length of stay, duration of procedure, and complication and relapse rates are already available.

Spiral CT angiography for preoperative planning in patients with epigastric tumors: comparison with arteriography.

PURPOSE: Spiral CT angiography (CTA) was performed on 22 patients for the preoperative assessment of epigastric tumors in comparison with intraarterial angiography. METHODS: One hundred fifty milliliters of contrast material was administered with a flow of 4 ml/s. After a delay of 30 s, a spiral CT examination of the epigastrium was performed (slice thickness 3 mm, table feed 6 mm/s). Axial images were reconstructed at 2 mm increments. Postprocessing was performed with a maximum intensity projection and shaded surface display imaging program. Plain film arteriography was performed via a catheter inserted transfemorally and placed into the epigastric arteries. The following parameters were evaluated: visualization of the arteries and the portal vein and involvement of these vessels by disease. RESULTS: The vessels (22/22 = 100%) and variations (1/22 = 4.5%) were clearly identified with both techniques. Involvement was diagnosed by angiography 15 times compared with 22 findings by CTA. CONCLUSION: Concerning vessel anatomy, the correlation between both techniques was excellent and vessel involvement showed good correlation, especially when using the axial slices additionally. CTA has the potential to become a minimally invasive diagnostic tool for preoperative planning in epigastric tumors.