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Minimum quantity regulation: German OR teams often need more experience


Hospital Report: Minimum quantities required for certain operations
"Practice makes perfect": This old saying also applies to medical personnel. New studies show that the more often an intervention takes place, the better the treatment results for the patient. Experts call for the minimum quantity regulation for clinics to be tightened.

There is a lot of surgery in Germany
In recent years it has been repeatedly criticized that too much and too quickly is operated on in German clinics. Patients are therefore advised to seek a second medical opinion before surgery in case of doubt. In addition, people who are going to have surgery should ask which clinic should do it best. Because not all hospitals have enough experience, as experts report.

Tightening the minimum quantity regulation
A study by the clinic and polyclinic for urology at the University Hospital Carl Gustav Carus Dresden showed a few months ago that recommendations regarding the minimum number of operations that a clinic should have performed are often not followed.

For some interventions - in the case of the Dresden study it was about prostate cancer surgery - in many clinics there is no experience.

A tightening of the minimum quantity regulation could improve the situation. "Many healthcare systems abroad already use mandatory minimum quantity catalogs to centralize complicated operations," said study leader Dr. Johannes Huber in a communication from the Dresden University Hospital.

"In Germany, such a regulation has so far only existed for six procedures such as liver and kidney transplants, surgical interventions on the coronary arteries or in operations on the pancreas and esophagus," says the doctor.

Other experts also believe that something should change. The AOK health insurance company is committed to expanding the minimum quantity regulations in inpatient care. These stipulate how often a particular treatment must be carried out in a clinic.

Extension to inpatient services
“To protect patients, the minimum quantity regulations urgently need to be expanded to include additional inpatient services. In addition to hip replacement, these include thyroid and breast cancer surgery or obstetrics, ”said Martin Litsch, Chairman of the AOK Federation, in a message on the occasion of the presentation of the current 2017 hospital report.

The report, which is presented by the AOK Scientific Institute (WIdO) and the AOK Federal Association, contains new analyzes of scientific studies, which show, among other things, that the more often an intervention is performed, the better the treatment results for the patient.

Increased risk for patients
Scientists and professional societies also recommend further minimum quantity regulations. They relate, for example, to hip replacement in osteoarthritis, for which the connection between the frequency of treatment and the result of treatment is particularly clear, according to the health insurance company.

According to this, 134,000 AOK patients received a new hip joint in 1,064 hospitals for osteoarthritis in the years 2012 to 2014. A fifth of the clinics performed a maximum of 38 operations per year.

The risk of hip replacement surgery within a year was more than twice as high for patients in these hospitals as for those who underwent surgery in the fifth of the clinics with the highest number of cases. 211 or more hip surgeries that could be planned took place in such centers.

Many clinics do not adhere to the guidelines
But even if there are minimum quantity requirements, many hospitals in Germany do not meet them, as the report shows by operations on the esophagus and pancreas.

In 2014, around 700 hospitals performed around 12,000 pancreatic surgeries, so almost half of the hospitals did not reach the minimum of ten. Almost three-quarters of all clinics had surgery on the esophagus.

“We need transparency about which clinics do not meet the minimum quantities. By law, these services are not to be paid for by the health insurance companies. To implement this path, we need significantly more courage and will from all those involved, ”said Litsch.

Gaps in the system
As the health insurance company continues to write, one of the gaps in the system is that micro-suppliers can continue to offer their services within the framework of exemptions, even though they do not meet the minimum quantities.

“Whether a house with small quantities has done good or bad work in individual cases is not statistically assessable and contradicts the basic principle of minimum quantities. This endangers patient care, ”said Jürgen Klauber, Managing Director of WIdO and co-editor of the hospital report.

"If there is a minimum quantity, this must be the yardstick for all clinics, just as speed limits in road traffic have no exceptions."

Shorter surgery times and lower complication rates
Prof. Dr. Hartwig Bauer, former general secretary of the German Society for Surgery, sees further gaps in the minimum quantity regulation: “There is a positive correlation between treatment frequency and result not only at the clinic level, but also in the specialization of the surgeon himself. His experience can be seen in shorter terms Operating times and thus lower complication rates. But this knowledge is not implemented in Germany. "

In addition, compliance with guidelines and the organizational structure of the hospital are important. “Naturally, a coordinated, practiced process chain always goes hand in hand with higher quantities,” says Bauer. "We have long known what to do, only we have to do what we know." (Ad)

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