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Qualitätsindikatoren für die metabolische und Adipositaschirurgie

Evidenzbasierte Entwicklung eines Indikatorensets für die Ergebnis‑, Indikations- und Strukturqualität

Quality indicators for metabolic and bariatric surgery in Germany

Evidence-based development of an indicator panel for the quality of results, indications and structure

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Zusammenfassung

Ein von der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie eingesetztes Expertengremium wurde beauftragt ein Qualitätsindikatorenset zur Erfassung der Ergebnis‑, Indikations- und Strukturqualität für die metabolische/bariatrische Chirurgie zu entwickeln. Als entscheidende Vorgaben sollten hierzu die aktuell verfügbare Evidenz (systematische Literaturrecherche), die bisherigen Ergebnissen des nationalen Registers der Fachgesellschaft (Studien‑, Dokumentations- und Qualitätszentrum [StuDoQ] | Metabolische und bariatrische Erkrankungen [MBE]) und spezifische sozioökonomische Aspekte (schwer limitierter Zugang zur metabolischen/bariatrischen Chirurgie in Deutschland) dienen. Diese Qualitätsvorgaben sollen perspektivisch in die nationale Leitlinie und die Zertifizierungsordnung einfließen. Es wurde festgestellt, dass sich Mortalität, MTL30, schwere interventionspflichtige Komplikationen (Clavien-Dindo ≥ 3b) aufgrund ihrer Relevanz, Wissenschaftlichkeit und Praktikabilität als Indikatoren zur Bestimmung der chirurgischen Ergebnisqualität eignen. Zur Bestimmung der Prozessqualität der langfristig notwendigen strukturierten Nachsorge wurde eine Mindestquote zur systematischen Erfassung der Lebensqualität im Langzeitverlauf festgelegt. Da intestinale Bypassverfahren in einer höheren Rate zur Remission eines vorbestehenden Typ-2-Diabetes führen, sollten diese Verfahren entsprechenden Patienten angeboten werden und auch zur Anwendung kommen. Die auf Basis der Literatur und der StuDoQ-Registerdaten vorgeschlagenen Referenzwerte sind als präliminär zu betrachten und müssen im weiteren Validierungs- und Implementierungsprozess der Qualitätsindikatoren (QI) reevaluiert und ggf. angepasst werden. Eine Risikoadjustierung ist perspektivisch geplant. Das StuDoQ|MBE bietet sowohl zur Erfassung der QI als auch zur Ermittlung relevanter Risikoadjustoren die geeignete Infrastruktur.

Abstract

An expert committee was appointed by the German Society for General and Visceral Surgery to develop a panel of appropriate quality indicators to collate the quality of results, indications and structure in metabolic and bariatric surgery. This entailed assimilating the available evidence (systematic literature search), results from the national registry of the society (StuDoQ|MBE) and specific socioeconomic aspects (e. g. severely limited access to metabolic and bariatric surgery in Germany). These quality parameters were to be incorporated into the national guidelines and the rules of procedure for certification in the future. The committee concluded that mortality, MTL30 and severe complications needing intervention (Clavien-Dindo ≥ 3b) are suitable indicators to measure surgical outcome quality due to their relevance, scientific soundness and practicability. As a systematic follow-up is mandatory after bariatric surgery, a minimum follow-up quota is now required using reported quality of life data as an indicator of process quality. As intestinal bypass procedures have been shown to be superior in the treatment of type 2 diabetes, these procedures should be offered to eligible patients and also be performed. The proposed threshold values based on the results of the available literature and StuDoQ registry are to be considered as preliminary and need to be validated and adjusted if necessary in the future. The StuDoQ|MBE is considered a valuable tool to gather this information and also represents the appropriate infrastructure for the collation of relevant risk adjustors.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Oberdürrbacherstr. 2, 97080, Würzburg, Deutschland

    F. Seyfried

  2. Haus der Bundespressekonferenz, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Berlin, Deutschland

    H.-J. Buhr & C. Klinger

  3. Chirurgische Klinik München Bogenhausen, München, Deutschland

    T. P. Huettel

  4. Adipositas Klinik, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland

    B. Herbig

  5. Krankenhaus Nordwest, Frankfurt am Main, Deutschland

    S. Weiner

  6. Kreisklinik Altötting, Altötting, Deutschland

    C. Jurowich

  7. Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Bereich Bariatrische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    A. Dietrich

  8. IFB AdipositasErkrankungen Universitätsmedizin Leipzig, Leipzig, Deutschland

    A. Dietrich

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  1. F. Seyfried
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  2. H.-J. Buhr
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  3. C. Klinger
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  4. T. P. Huettel
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  5. B. Herbig
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  6. S. Weiner
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  7. C. Jurowich
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  8. A. Dietrich
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Correspondence to F. Seyfried.

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Interessenkonflikt

F. Seyfried, H.-J. Buhr, C. Klinger, T. P. Huettel, B. Herbig, S. Weiner, C. Jurowich und A. Dietrich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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C. Jurowich und A. Dietrich teilen sich die Letztautorenschaft.

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Seyfried, F., Buhr, HJ., Klinger, C. et al. Qualitätsindikatoren für die metabolische und Adipositaschirurgie. Chirurg 89, 4–16 (2018). https://doi.org/10.1007/s00104-017-0563-4

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