Qualitätssicherung in der Brustrekonstruktion – Etablierung eines prospektiven nationalen Onlineregisters für mikrochirurgische Brustrekonstruktionen

Zusammenfassung

Hintergrund Der Verlust der weiblichen Brust ist für betroffene Frauen extrem traumatisierend. Obwohl sich freie Lappenplastiken zum Goldstandard in der rekonstruktiven Brustchirurgie entwickelt haben, war es bisher nicht gelungen, ihre Überlegenheit im Hinblick auf die alternativen konventionellen Techniken zweifelsfrei zu belegen. Bis heute existieren keine Daten zur Versorgungssituation in Deutschland. Durch den Aufbau eines prospektiven Onlineregisters zur Brustrekonstruktion sollte die Versorgungsstruktur und -qualität systematisch erfasst und transparent dargestellt werden, um Defizite zu verbessern und mittelfristig eine flächendeckende Versorgung auf hohem Niveau zu ermöglichen.

Methoden Hierfür hat die Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) eine internetbasierte Datenbank zur anonymisierten Erfassung der Behandlungsdaten aufgebaut. Im Rahmen einer Zertifizierung wurde die Strukturqualität, Erfüllung der Vorgaben und die Stringenz der eingegebenen Daten im Abgleich mit der krankenhausinternen Dokumentation überprüft. Bei positiver Bewertung wird das Qualitätssiegel der DGPRÄC vergeben.

Ergebnisse Seit ihrer Einführung im Jahr 2012 liefert die Datenbank validierte Informationen. Waren zu Anfang nur wenige Abteilungen zur transparenten Darstellung ihrer Resultate bereit, wuchs deren Zahl in den vergangenen Jahren stetig an. Die Qualitätsdarstellung konnte bundesweit eine Vorreiterfunktion übernehmen und wird von Patienten und Kollegen als seriöse und verlässliche Informationsquelle genutzt. Die Internetseite der DGPRÄC weist die Zentren nach ihrer jeweiligen Qualifikation aus. Inzwischen ist es gelungen, in akzeptabler Nähe zu jedem onkologischen Brustzentrum einen qualifizierten plastisch-chirurgischen Ansprechpartner auszuweisen. Auch zeigen die Daten, dass in Deutschland auf einem international vergleichbaren Spitzenniveau gearbeitet wird.

Schlussfolgerung Die Datenbank liefert einen Überblick über die verschiedenen Operationstechniken und damit die Möglichkeit einer seriösen Selbstkontrolle und wissenschaftliche Analyse. Dies hat dazu geführt, dass die Akzeptanz mikrochirurgischer Eingriffe und die Stellung der Plastischen Chirurgie in der rekonstruktiven Brustchirurgie erheblich gestiegen ist. Die notwendige finanzielle und personelle Ausstattung zur Etablierung der Datenbank wurde jedoch deutlich zu gering eingeschätzt.

Abstract

Background The loss of a breast, and thus of the female body shape, is often extremely traumatising for women affected. Although free flap grafts have become the gold standard in reconstructive breast surgery, it has not been possible to date to unequivocally document their superiority over conventional alternative techniques. To date, there are no data on the care situation in Germany. Neither the number of reconstructions nor the proportion of the individual techniques is known. A prospective online registry has been set up in order to systematically collect and transparently present the structure and quality of care. The long-term goals are to record the existing quality of care, improve deficits and to certify centres with the appropriate expertise to establish a high level of care nationwide.

Methods For this purpose, the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) has set up an internet-based database in which treatment data are recorded anonymously. As part of a certification process, auditors checked structure quality, compliance with specifications, and the stringency of the data entered in comparison with the hospital’s internal documentation. If the evaluation is positive, the DGPRÄC quality seal is awarded.

Results Since its introduction in 2012, the database has provided validated information. Initially, only a few departments were prepared to present their results transparently. However, the number has grown steadily in recent years. As a result, the quality recording assumed a pioneering function nationwide and can now be used as a reliable source of information by patients and doctors. The DGPRÄC website features a map of the centres, which are colour-coded according to their respective qualifications. It is thus possible to find a qualified plastic surgeon with comprehensive expertise in acceptable proximity to every oncological breast centre.

Conclusion The database provides an overview of the quality of the various surgical techniques and thus the possibility of serious self monitoring and scientific analysis. The systematic collection of data has contributed to strengthening the position of plastic surgery in the field of reconstructive breast surgery. However, the financial and personnel resources required to establish the database were clearly underestimated.

Schlüsselwörter

Brustrekonstruktion - Mikrochirurgie - Register - Qualitätssicherung

Key words

Registry - microsurgery - quality assurance - breast reconstruction

Publication History

Received: 28 May 2019

Accepted: 12 July 2019

Article published online:
20 December 2019

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