Chirurgie (Heidelberg, Germany)最新文献

Background: For people without health insurance coverage access to healthcare is severely restricted. In large cities such as Frankfurt am Main, parallel structures have emerged to ensure free basic medical care for those affected; however, when inpatient treatment is required the medical infrastructure for people without health insurance is inadequate. This article outlines the importance of access to surgical treatment for people without health insurance and the serious consequences when this access is denied.

Material and method: The Clearing Center 1.0 at the Public Health Authority of Frankfurt am Main and the Elisabeth Street Outpatient Department of the Caritas Association Frankfurt represent two low-threshold outpatient clinics that exist in the city of Frankfurt. The basic structure and function of each clinic are described along with a characterization of the patient populations, including a description of the sociodemographic characteristics. From the total patient collective, three case scenarios are selected as examples and are outlined with respect to (1) social history, (2) access barriers, (3) findings, (4) surgical indications and (5) treatment course.

Results: Patients face complex barriers due to legal restrictions, financial hardships and precarious living conditions. The lack of a funding provider results in necessary surgery not being performed. The consequences are pain, functional limitations and worsening of life-threatening diseases.

Conclusion: Timely surgical care for people without health insurance is essential to maintain health and avoid high follow-up costs. A treatment fund provides a solution. The combination of case management, secure accommodation and raising awareness among professionals helps close care gaps and develop solutions.

Screening of nutritional status of cancer patients plays a crucial role in the perioperative management and is mandatory for the certification of oncological centers by the German Cancer Society (DKG). The available screening tools do not differentiate between muscle and adipose tissue. Recent advances in computed tomography (CT) and magnetic resonance imaging (MRI) as well as the automatic picture archiving communication system (PACS) imaging analysis by high performance reconstruction systems have recently enabled a detailed analysis of adipose tissue and muscle quality. Rapidly growing evidence shows that body composition parameters, especially reduced muscle mass, are associated with adverse outcomes in cancer patients and have been reported to negatively affect overall survival (OS), disease-free survival (DFS), toxicity associated with chemotherapy and surgical complications. In this article, we summarize the recent literature and present the clinical influence of body composition in oncological visceral diseases.

Palliative surgery aims to improve the quality of life for patients with incurable diseases. This patient group is vulnerable due to the underlying illness, prior treatment and comorbidities, which increase the risk of complications that can negatively impact the course of the disease and quality of life. Palliative surgical interventions often provide effective long-term symptom control but are more invasive than conservative, interventional endoscopic or interventional radiological alternatives. This article exemplary discusses frequent palliative visceral surgical procedures and less invasive alternatives. In practice, a close interdisciplinary collaboration, open and realistic communication, optimized perioperative care and in particular the minimization of cumulative invasiveness are crucial to maximize the quality of life and safety for oncological patients.

Biliary atresia (BA) is a rare disease in neonates of unknown etiology. BA is defined by the extent of extra- and intrahepatic bile duct destruction, which results in liver deterioration and cirrhosis within the first years of life. Liver transplantation (LT) is the only curative treatment for BA, accompanied by LT-associated risks and complications; however, more than 60 years after it's first report, the Kasai hepatoportoenterostomy (KPE) is still an essential procedure in the sequential management of BA, as the primary surgical treatment option that can achieve long-term survival with a native liver. We highlight the key surgical steps of KPE and discuss relevant aspects.

Background: Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment concept for highly selected patients with peritoneal metastases and primary tumors (PMT). A challenge from the perspective of hospitals is the cost intensity of this promising multimodal treatment option.

Research question: Which factors influence the cost and revenue structure of CRS/HIPEC treatment in the current diagnosis-related group (DRG) system according to § 17b of the German Hospital Financing Act (KHG)?

Material and methods: The database for this analysis was constituted by all patients treated with combined CRS/HIPEC at a certified tumor center between 2017 and 2021. The statistical analysis performed was descriptive, using two-sample and multisample comparisons (ANOVA) as well as linear correlation and regression analyses.

Results: The total length of hospitalization for 173 patients was on average 16.1 days and the average length of stay in the intensive care unit was 2.2 days. Postoperative complications occurred in 110 (63.6%) patients. The average DRG revenue obtained was € 21,658.48. The total costs for the combined CRS/HIPC treatment amounted to an average of € 23,764.77 and were therefore on average € 2106.29 (8.86%) higher than the DRG revenue granted for the treatment. The length of stay in the intensive care unit and the total length of hospitalization correlated positively with the treatment costs and DRG revenue.

Discussion: This study presents key factors influencing the cost and revenue structure of CRS/HIPEC and illustrates that this promising surgical treatment approach is relevantly underfunded by the German DRG system. A reform of the current DRG system with special consideration of highly complex oncological treatment concepts is therefore recommended.

Background: The current Association of the Scientific Medical Societies in Germany (AWMF) S3 guidelines recommend among others a Limberg flap for the treatment of pilonidal sinus disease. This article reports the long-term results of the pilot study: "Results of a two-stage intervention with primary excision and Limberg flap in the interval for treatment of sacrococcygeal pilonidal sinus disease", published in 2015.

Method: From 2010 to 2013 a total of 50 patients with sacrococcygeal pilonidal sinus disease were treated. Following initial excision patients were offered plastic coverage in the presence of clean wound conditions according to the then relevant AWMF guidelines in primary cases and recommended in recurrent cases. Of the patients 22 opted for a Limberg flap. In 2022 recurrences were recorded via telephone interviews with patients. The groups with a Limberg flap were compared with the excision group.

Results: There were no recurrences in the Limberg flap group (0%) while there were six recurrences in the excision group (23%) p = 0.028. In the Limberg group one patient and in the excision group two patients were lost to follow-up.

Conclusion: With a two-stage technique a Limberg flap is obviously more effective under inflammation-free wound conditions. The Limberg flap is a simple plastic surgery procedure; however, one should remember that it is a transposition flap.