Zusammenfassung
Qualitätsindikatoren (QI) sind per Definition indirekte Messwerte für Qualität. Die Auswahl für den Bereich Pankreaschirurgie richtete sich nach klinischer Relevanz und Beeinflussbarkeit, wissenschaftlicher Evidenz sowie Praktikabilität der Erhebung. Hinsichtlich der Ergebnisqualität wurden als essenziell die Krankenhausmortalität, der Kompositendpunkt MTL30 (Mortalität-Transfer-Liegedauer) und Majorkomplikationen (Clavien-Dindo-Grade 3b und 4) gewählt. Bezüglich der Strukturqualität wurde das Vorhandensein einer interventionellen Radiologie mit ständiger Verfügbarkeit als essenziell bewertet. Zur Evaluation von Zielwerten für QI wurden zwei Strategien angewandt: systematische Literaturrecherche und Auswertung der aktuellen Zahlen des StuDoQ(Studien‑, Dokumentations- und Qualitätszentrum)|Pankreas-Registers der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) der Jahre 2014 bis 2016. Die Ergebnisse werden im Rahmen der folgenden Darstellung dargelegt.
Abstract
Quality indicators are by definition indirect measures of quality. The selection for the field of pancreatic surgery was based on the clinical relevance and controllability, scientific evidence and the practicability of data acquisition. In terms of outcome quality, hospital mortality, the composite endpoint MTL30 (mortality-transfer-length of stay), and major complications (Clavien-Dindo classification grades 3b and 4) were chosen as being essential. With respect to structural quality, the presence of interventional radiology with constant availability was considered essential. To evaluate target values two strategies were used: a systematic literature search and evaluation of the current numbers from the German Society for General and Visceral Surgery (DGAV) StuDoQ|Pancreas registry for the years 2014–2016. The results are presented in the following consensus statement.
Literatur
Alsfasser G, Kittner J, Eisold S, Klar E (2012) Volume-outcome relationship in pancreatic surgery: the situation in Germany. Surgery 152:S50–S55. https://doi.org/10.1016/j.surg.2012.05.011
Alsfasser G, Leicht H, Günster C et al (2016) Volume-outcome relationship in pancreatic surgery. Br J Surg 103:136–143. https://doi.org/10.1002/bjs.9958
Amini N, Spolverato G, Kim Y, Pawlik TM (2015) Trends in hospital volume and failure to rescue for pancreatic surgery. J Gastrointest Surg 19:1581–1592. https://doi.org/10.1007/s11605-015-2800-9
Ärztliches Zentrum für Qualität in der Medizin (ÄZQ) (2009) Manual Qualitätsindikatoren. Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Neukirchen
Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Bilimoria KY, Bentrem DJ, Lillemoe KD et al (2009) Assessment of pancreatic cancer care in the United States based on formally developed quality indicators. J Natl Cancer Inst 101:848–859. https://doi.org/10.1093/jnci/djp107
Buettner S, Gani F, Amini N et al (2016) The relative effect of hospital and surgeon volume on failure to rescue among patients undergoing liver resection for cancer. Surgery 159:1004–1012. https://doi.org/10.1016/j.surg.2015.10.025
Clavien PA, Barkun J, Oliveira ML de, Vauthey JN, Dindo D, Schulick RD, Santibañes E de et al (2009) “The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience.” Annals of Surgery 250(2):187–196
Dale W, Hemmerich J, Kamm A et al (2014) Geriatric assessment improves prediction of surgical outcomes in older adults undergoing pancreaticoduodenectomy: a prospective cohort study. Ann Surg 259:960–965. https://doi.org/10.1097/SLA.0000000000000226
Dindo D, Demartines N, Clavien P‑A (2008) Classification of surgical complications. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Eshuis WJ, van Eijck CHJ, Gerhards MF et al (2014) Antecolic versus retrocolic route of the gastroenteric anastomosis after pancreatoduodenectomy: a randomized controlled trial. Ann Surg 259:45–51. https://doi.org/10.1097/SLA.0b013e3182a6f529
Grützmann R, Rückert F, Hippe-Davies N et al (2012) Evaluation of the International Study Group of Pancreatic Surgery definition of post-pancreatectomy hemorrhage in a high-volume center. Surgery 151:612–620. https://doi.org/10.1016/j.surg.2011.09.039
Hata T, Motoi F, Ishida M et al (2016) Effect of hospital volume on surgical outcomes after pancreaticoduodenectomy: a systematic review and Meta-analysis. Ann Surg 263:664–672. https://doi.org/10.1097/SLA.0000000000001437
Kalish BT, Vollmer CM, Kent TS et al (2013) Quality assessment in pancreatic surgery: what might tomorrow require? J Gastrointest Surg 17:86–93. https://doi.org/10.1007/s11605-012-2052-x
Keck T, Wellner UF, Bahra M et al (2016) Pancreatogastrostomy versus Pancreatojejunostomy for RECOnstruction after PANCreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial. Ann Surg 263:440–449. https://doi.org/10.1097/SLA.0000000000001240
Kimura W, Miyata H, Gotoh M et al (2014) A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg 259:773–780. https://doi.org/10.1097/SLA.0000000000000263
Klauber J, Geraedts M, Friedrich J, Wasem J (2017) Krankenhaus-Report 2017: Schwerpunkt: Zukunft gestalten. Schattauer, Stuttgart (Mit Online-Zugang)
Krautz C, Nimptsch U, Weber GF et al (2017) Effect of Hospital Volume on In-hospital Morbidity and Mortality Following Pancreatic Surgery in Germany. Ann Surg. https://doi.org/10.1097/SLA.0000000000002248
Mise Y, Vauthey J‑N, Zimmitti G et al (2015) Ninety-day postoperative mortality is a legitimate measure of hepatopancreatobiliary surgical quality. Ann Surg. https://doi.org/10.1097/SLA.0000000000001048
Nimptsch U, Krautz C, Weber GF et al (2016) Nationwide in-hospital mortality following pancreatic surgery in Germany is higher than anticipated. Ann Surg 264:1082–1090. https://doi.org/10.1097/SLA.0000000000001693
Nimptsch U, Peschke D, Mansky T (2016) Minimum caseload requirements and in-hospital mortality: observational study using nationwide hospital discharge data from 2006 to 2013. Gesundheitswesen. https://doi.org/10.1055/s-0042-100731
Roulin D, Cerantola Y, Demartines N, Schäfer M (2011) Systematic review of delayed postoperative hemorrhage after pancreatic resection. J Gastrointest Surg 15:1055–1062. https://doi.org/10.1007/s11605-011-1427-8
Sahni NR, Dalton M, Cutler DM et al (2016) Surgeon specialization and operative mortality in United States: retrospective analysis. BMJ. https://doi.org/10.1136/bmj.i3571
Schneider EB, Calkins KL, Weiss MJ et al (2014) Race-based differences in length of stay among patients undergoing pancreatoduodenectomy. Surgery 156:528–537. https://doi.org/10.1016/j.surg.2014.04.004
Seufferlein T, Porzner M, Becker T et al (2013) S3-guideline exocrine pancreatic cancer. Z Gastroenterol 51:1395–1440. https://doi.org/10.1055/s-0033-1356220
Sutton JM, Wilson GC, Wima K et al (2015) Readmission after pancreaticoduodenectomy: the influence of the volume effect beyond mortality. Ann Surg Oncol 22:3785–3792. https://doi.org/10.1245/s10434-015-4451-1
Tol JAMG, Busch ORC, van Delden OM et al (2014) Shifting role of operative and nonoperative interventions in managing complications after pancreatoduodenectomy: what is the preferred intervention? Surgery 156:622–631. https://doi.org/10.1016/j.surg.2014.04.026
Tol JAMG, Gouma DJ, Bassi C et al (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 156:591–600. https://doi.org/10.1016/j.surg.2014.06.016
Topal B, Fieuws S, Aerts R et al (2013) Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol 14:655–662. https://doi.org/10.1016/S1470-2045(13)70126-8
Van Buren G 2nd, Bloomston M, Hughes SJ et al (2014) A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg 259:605–612. https://doi.org/10.1097/SLA.0000000000000460
Verbeke CS (2013) Resection margins in pancreatic cancer. Surg Clin North Am 34(Suppl 2):647–662. https://doi.org/10.1016/j.suc.2013.02.008
Wellner UF, Klinger C, Lehmann K et al (2017) The pancreatic surgery registry (StuDoQ|Pancreas) of the German Society for General and Visceral Surgery (DGAV) – presentation and systematic quality evaluation. Trials 18:163. https://doi.org/10.1186/s13063-017-1911-x
Wellner UF, Kulemann B, Lapshyn H et al (2014) Postpancreatectomy hemorrhage – incidence, treatment, and risk factors in over 1,000 pancreatic resections. J Gastrointest Surg 18:464–475. https://doi.org/10.1007/s11605-013-2437-5
Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25. https://doi.org/10.1016/j.surg.2007.02.001
Wiegering A, Wellner U, Seyfried F et al (2017) MTL30 as surrogate parameter for quality of surgically treated diseases : establishment based on the StuDoQ register of the German Society for General and Visceral Surgery. Chirurg. https://doi.org/10.1007/s00104-017-0479-z
de Wilde RF, Besselink MGH, van der Tweel I et al (2012) Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg 99:404–410. https://doi.org/10.1002/bjs.8664
Witzigmann H, Diener MK, Kienkötter S et al (2016) No need for routine drainage after pancreatic head resection: the dual-center, randomized, controlled PANDRA trial (ISRCTN04937707). Ann Surg 264:528–537. https://doi.org/10.1097/SLA.0000000000001859
Yoshioka R, Yasunaga H, Hasegawa K et al (2014) Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy. Br J Surg 101:523–529. https://doi.org/10.1002/bjs.9420
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Interessenkonflikt
U.F. Wellner, R. Grützmann, T. Keck, N. Nüssler, H.E. Witzigmann und H.-J. Buhr geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
Rights and permissions
About this article
Cite this article
Wellner, U.F., Grützmann, R., Keck, T. et al. Qualitätsindikatoren für die Pankreaschirurgie. Chirurg 89, 32–39 (2018). https://doi.org/10.1007/s00104-017-0564-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00104-017-0564-3
Schlüsselwörter
- Krankenhausmortalität
- MTL30 (Mortalität-Transfer-Liegedauer)
- Majorkomplikationen
- Ergebnisqualität
- Strukturqualität