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ID: 400 (Conflict of Interest: K)

Laparoskopische Cholezystektomie bei Frauen – Ergebnisse der bundesweiten Qualitätssicherung 2010 - 2014

D.Borchert1, T.Breitkreuz2, J.Schoepe3
1AMEOS Klinikum Haldensleben, Haldensleben
2Aqua Institut, Göttingen
3Universitätsklinikum des Saarlandes, Homburg

Einleitung

Until 2015 the german healthcare system employed a mandatory collection of perioperative quality assurance (QA) data for cholecystectomy for hospitals regulated by Code of Social Law part V §108. The governing body (Gemeinsamer Bundesausschuß, G-BA) stopped data collection until further notice for reasons of developing quality assurance. We present the data of the last five years of these surveillance data.

Material und Methoden

QA data are presented over five years whereas data have so far been published yearly only. An official application in 2013 led to approval for data inquiry from the data repository via a SPSS syntax. The SPSS syntax was tested, refined and run repeatedly to assure stable results. Data reported here include female patients only, operated on via laparoscopic cholecystectomy with or without intraoperative revision of the choledochus duct (OPS operation and procedure code 5-511.11/12) excluding NOTES procedures (natural orifice transluminal endoscopic surgery). Preoperative, intraoperative and postoperative data are presented as numbers, percentage of numbers, mean values and standard deviation (SD).

Ergebnisse

Female patients in this analysis showed a stable mean age of 53.5 years (SD 17.6) over five years. Over five years there were 504431 cholecystectomies in women with the OPS code 5-511/12. Compared to 2010, case numbers had steadily increased in 2014. There were 6000 cases more in 2014 then in 2010. Preoperative diagnostic methods have not changed over five years apart from a small increase in computed tomography. Preoperative clinical features of patients show an increase of inflammatory signs and symptoms. The numbers of intraoperative laparoscopic revision of the choledochus duct decreases further. According to the preoperative increase in signs and symptoms of inflammation, intraoperative findings of inflammation increased too (hydrops, acute cholecystitis, empyema). Numbers of postoperative complications like pneumonia, pulmonary embolism, thrombosis and urinary tract infection remained stable. But numbers of re-interventions (endoscopic, laparoscopic or open surgery) increased. In contrast hospital stay decreased further over the last five years. All cause mortality remained stable at 0.25% per annum.

Schlussfolgerung

Results of the german QA survey for cholecystectomy show changes in several items over the last five years. Numbers of cases operated on increased over five years whereas age mean did not. Concomitant there is a rising number of female patients with increased perioperative risk. The increased rate of re-intervention procedures is a possible effect of increased perioperative risk. In contrast, typical perioperative complications remain stable. This could be interpreted as an improvement in perioperative management. There was no effect on all-cause mortality from increase of perioperative risk. Laparoscopic cholcystectomy ist he most frequent surgical procedure in female patients in germany in general surgery. Hence laparoscopic cholecystectomy is an indicator surgical procedure for QA. Mandatory data collection allows assessement of the patient population. Development of the patient population influences health politics decision. Halt of QA data collection for indicator procedures should be discussed by surgeons.

2010 2011 2012 2013 2014

age

mean (SD) 53,6 (17,6) 53,6 (17,6) 53,5 (17,6) 53,4 (17,7) 53,4 (17,7)
acute inflammation clinical N (%) 24044 (24,8) 25087 (24,8) 25678 (25,5) 26557 (26,0) 27816 (26,9)
intraoperative hydrops N (%) 14946 (15,4) 16075 (15,9) 16424 (16,3) 17288 (16,9) 17619 (17,1)
intraoperative cholecystitis N (%) 25151 (25,9) 26386 (26,1) 26709 (26,5) 28062 (27,5) 28755 (27,8)
postoperative complications N (%) 1382 (1,4) 1481 (1,5) 1449 (1,4) 1457 (1,4) 1441 (1,4)
Re-Intervention N (%) 1086 (1,1) 1138 (1,1) 1447 (1,4) 1467 (1,4) 1623 (1,6)
Demographic, pre-, intra- and postoperative data in female laparoscopic cholecystectomy