Chirurgie (Heidelberg, Germany)最新文献

Waste management plays an important role in the healthcare system, as up to 6 million tons of waste are generated annually by the German healthcare sector, contributing to a global environmental burden. Surgical departments in particular produce approximately up to 70% of hospital waste, mostly arising in operating rooms. The waste produced during operations regularly requires disposal at high temperatures and is associated with significant greenhouse gas emissions, underlining the urgent need for action on the path towards a more sustainable healthcare system. Restructuring waste management in the operating room is of central importance in this context. Efficient waste separation and the implementation of recycling processes to reintegrate recyclable materials into the raw material cycle can effectively reduce waste volumes and associated greenhouse gas emissions. In addition, the use of reusable materials represents a promising approach to waste reduction and prevention.

Prehabilitation is gaining increasing importance as an integral component of modern, patient-centered perioperative care. The objective of this position paper is to outline the current national and international state of prehabilitation, to highlight existing barriers to its implementation and to provide practical recommendations for clinical application. Particularly in older, multimorbid and oncology patients, targeted preoperative interventions, such as exercise therapy, nutritional support, psychological counselling, and additional measures, can contribute to reducing postoperative complications, accelerating recovery and improving the quality of life. Despite the growing body of international evidence, implementation in Germany has so far been slow, often hindered by a lack of reimbursement structures and limited resources. This paper therefore advocates a stepwise introduction of prehabilitation measures, tailored to high-risk groups and aligned with local healthcare reality. It is emphasized that prehabilitation should not be regarded as an isolated intervention but as an integrative element within established concepts such as enhanced recovery after surgery (ERAS) and rehabilitation. Furthermore, the paper addresses the need for national networking, harmonized standards, digital solutions and structural as well as political support to ensure sustainable integration.

A close interdisciplinary collaboration between anesthesia and surgery is essential to ensure that our mutual patients receive the best possible care throughout the entire surgical process. Both specialties have different tasks and perspectives and only when these are balanced with rather than against each other can the operating room, along with all related preoperative and postoperative measures, become a place where excellent medicine, patient safety and efficient management go hand in hand. Despite potential areas of conflict interdisciplinary cooperation between surgeons and anesthesiologists can be highly effective when mutual respect, structured communication and shared decision-making are upheld and cultivated. This article aims to provide an overview of some key prerequisites for successful collaboration in this context.

The suture to incision time (turnover time, TOT) is a key indicator of the efficiency of perioperative care and reflects the quality of numerous preceding organizational and logistical processes. In the field of visceral surgery optimizing the turnover time poses particular challenges due to the highly variable duration of procedures, complex surgical workflows and substantial requirements for postoperative intensive monitoring capacities. This narrative review summarizes the factors described in the literature as having a relevant influence on turnover time. These include patient flow from the wards to the operating theater, operating room preparation including material and equipment availability, suitable staffing and infrastructural resources as well as the integration of unplanned interventions, such as emergencies, revision procedures and transplantations. Furthermore, organizational strategies are presented that in various studies were found to be associated with an improvement in perioperative workflows, including standardized turnover processes, lean-based approaches, parallel task execution and digital support systems. Finally, the review discusses the role of operating room management that can be centralized, decentralized or as hybrid model depending on the local structure, with a focus on coordination, prioritization and the establishment of reliable communication pathways.