How many surgeons are there in a hospital?
Surgery: How to Find Good Surgeons
Will everything go well? Does the procedure bring the desired result? What if there are complications? Am I in good hands in this hospital, with this surgeon? Can he do that? Doctors performed around 17 million operations in German clinics in 2016. Many patients must have asked themselves anxious questions beforehand. Answering this is not that easy. How do you judge the quality of a hospital - especially as a medical layperson?
Countless studies have dealt with this topic and prove that the risk of dying in a clinic does not only depend on the illness for which one was admitted. But also from the surgeon's experience with the operation in question. How often he does this. About the right response to complications. In addition, there is the equipment and personnel equipment of the house. For example, is the intensive care unit organized smoothly and staffed by specialists around the clock?
Specialized centers instead of comprehensive care
Politicians and doctors have also recognized that such quality criteria are more important than the shortest possible distance to the nearest hospital. Specialized centers and clinics for basic care, such as appendix operations or the care of patients with cardiac insufficiency - this is what the future of the German hospital landscape looks like for numerous experts. Many interventions should no longer be offered across the board, but only where high case numbers and high quality are possible.
"The time of the surgical jack-of-all-trades who mastered all interventions equally well is over," emphasizes Professor Albrecht Stier, President of the German Society for General and Visceral Surgery (DGAV). "And that's just as well." The DGAV and the German Cancer Society now award certificates for individual operating areas to clinics that meet certain criteria. At the moment, this is almost the only way for patients to find out more about a house - apart from the quality reports that every facility has to produce, but which are usually incomprehensible to laypeople.
Help with finding suitable clinics online
The Society for General and Visceral Surgery awards seals for ten areas. Including operations on the liver, thyroid and esophagus.
Behind this offer are centers certified by the German Cancer Society for various cancer operations.
The Weisse Liste (Bertelsmann Foundation) search engine is based on the data that each clinic publishes in its quality report. In addition to the number of cases, there are equipment, staff, patient safety and hygiene. The display can be limited to clinics that meet a minimum level of quality. Many health insurance companies use the service on their websites. Also the pharmacy magazine is a cooperation partner of the White List.
DGAV certification: number of cases, staff and equipment count
The surgeons use a register as the basis for certification, in which they have collected data on the treatment of 110,000 patients. Not only compliance with the number of cases is necessary for a seal, but also the appropriate staff and equipment. "The 24/7 rule applies to complex interventions on the organs," explains Stier. "Around the clock, every day of the week, we need a team that is trained and knows how to react to complications after the operation."
More than 300 clinics currently have a DGAV certificate. The necessary inspection for the seal with which they can advertise their services cost them at least 5,000 euros. About every tenth house failed. Mandatory specifications would be better. At present there are only seven procedures such as those for kidney transplants, complex operations on the pancreas and the installation of artificial knee joints. More are to follow. In addition, one is thinking about - strictly regulated - exceptions for smaller facilities that do not perform the interventions often, but still meet the quality criteria.
Required number of cases could lead to unnecessary operations
There is a catch in the regulation: hospitals that do not adhere to the number of cases have not faced any consequences so far. There are no penalties, and surgery costs have usually also been reimbursed. The latter could change now. The AOK will no longer pay for interventions in clinics that fall below the minimum quantities, announced the chairman of their federal association. Maybe other funds will follow suit. Due to financial incentives, however, minimum quantities could also have the opposite effect: Instead of generally no longer offering operations that are seldom performed, clinics could try to meet the required number of cases at all costs - and urge their patients to undergo unnecessary surgical interventions.
Anyone who has to undergo an operation should therefore not only ask themselves the question of where best to have it carried out. But also: is an operation really necessary in my case? The decision should be preceded by detailed consultations with a general practitioner or specialist as well as in the clinic. It may also make sense to get a second opinion. When choosing the clinic, the pure statistics clearly show that, especially when it comes to complicated interventions and / or life-threatening diseases, the success rates increase with the number of cases.
Five questions to ask your surgeon
- Would you undergo such an operation in my situation and with my diagnosis?
- How many times have you performed such an operation? How much experience does your establishment have with patients like me? Should I go to another house?
- Will there be a high probability that I will be permanently better after this procedure?
- Are there alternatives to the operation? Are there treatment options that you should at least try out beforehand? Can the operation be postponed?
- What would happen if I didn't have an operation at all?
Nevertheless, in Germany there is often a wide gap between claims and reality. This is illustrated, for example, by AOK accounting data. Take breast cancer, for example: In 2015, fewer than eight patients were operated on in a quarter of hospitals. The cancer society demands a minimum of 100 interventions. Not even half of the more than 800 clinics that perform these interventions achieved this ideal. Example of colon cancer: over 1000 German clinics operated on those affected. But about half of the houses performed the procedure fewer than 23 times. At least 50 operations are required for good quality, says the cancer society.
Surgery experience affects the patient's survival
This has consequences, as a study by the Technical University of Berlin shows. Professor Thomas Mansky, Head of Structural Development and Quality Management in Health Care, found that in 20 out of 25 common interventions, the number of operations directly depends on how many patients die in the clinic. If the clinics had adhered to a minimum amount, in purely mathematical terms, 280 fewer colon cancer patients would have died in hospital across Germany, 124 fewer from pancreatic cancer and 74 fewer from lung cancer. Most of the time, the patients would not have left the clinic in good health, but still lived for weeks, months or years.
"There is simply too much occasional surgery in Germany," says Christian Günster from the AOK Scientific Institute. He also calls for operations to be carried out only in clinics with a sufficient number of cases. Studies show that this would not jeopardize the nationwide supply. For colorectal cancer patients, for example, the average travel distance would increase from eight to 16 kilometers. Only a good two percent of patients would have to be treated further than 50 kilometers from their place of residence.
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