Ambulantes Operieren in der HNO-Heilkunde in Deutschland

Thomas Deitmer; Andreas Dietz; K.-Wolfgang Delank; Stefan K. Plontke; H.-J. Welkoborsky; Stefan Dazert

doi:10.1055/a-1418-9745

Laryngo-Rhino-Otologie, Table of Contents

Laryngorhinootologie 2022; 101(06): 464-483
DOI: 10.1055/a-1418-9745

Übersicht

Ambulantes Operieren in der HNO-Heilkunde in Deutschland

Outpatient Surgery in German ENT

Authors

Thomas Deitmer

¹Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie, Bonn, Germany
Andreas Dietz

²Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Universität Leipzig, Leipzig, Germany
K.-Wolfgang Delank

³HNO-Klinik, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany
Stefan K. Plontke

⁴Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
H.-J. Welkoborsky

⁵Klinik für HNO-Heilkunde, regionale plastische Chirurgie, Kopf- und Halschirurgie, Klinikum Region Hannover GmbH, Hannover, Germany
Stefan Dazert

⁶Klinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Germany

Abstract

Zusammenfassung

Es ist gesundheitspolitischer Wille, die ambulante Chirurgie in der HNO-Heilkunde in Deutschland auszuweiten und in einem Umfang auszuüben, wie es im internationalen Bereich wahrgenommen wird.

Um die Voraussetzungen für eine sinnvolle Umsetzung dieses Ansatzes zu bestimmen und für Patienten und Ärzte einen akzeptablen und sicheren Rahmen bei gleichbleibender Qualität im Vergleich zu stationären Verfahren erreichen zu können, wird ein Review der internationalen Literatur zu Organisation, Ergebnissen und Durchführung solcher ambulanten Eingriffe in der HNO-Heilkunde durchgeführt.

Ambulantes Operieren findet international in verschiedenen Strukturen und Organisationsformen statt. So erfolgen z. B. kleinere Operationen ohne Vollnarkose in Praxen (office based surgery), größere Operationen in ambulanten Operationszentren, die solitär oder an Kliniken angelehnt sein können und in denen Verweildauern von wenigen Stunden (day case surgery) bis hin zu 23 Stunden (23 h case surgery) praktiziert werden. Eine sorgfältige Selektion der Patienten für die ambulante Chirurgie wird mit Blick auf Komorbiditäten, Medikationen, soziale und häusliche Betreuungsmöglichkeiten sowie Wegestrecken und -zeiten betrieben. Ein striktes Qualitätsmanagement der gesamten Abläufe wird unter Einbezug aller Berufsgruppen gefordert.

Abstract

Currently there is an intense discussion ongoing to enhance and expand outpatient surgery in the ENT in Germany, which is the intention by several politicians. The goal is to achieve a frequency of outpatient surgery comparable to an international level.

To achieve this goal, acceptance of outpatient interventions by both, surgeons and patients is required, particularly in regard of equal quality standards and patient safety requirements.

In the following review the organization, outcome, quality management and strategies for different ENT outpatient surgery worldwide is analyzed. Basically, outpatient surgery is organized in different ways: office-based-procedures in local anesthesia, procedures in ambulatory surgery center settings as standalone facilities or in connection with and adjacent to a hospital with possible inpatient treatment. Contact and resident times of the patients in the outpatient surgery centers differ between some hours through 23 hours. A deliberated and careful selection of patients which are suitable for outpatient procedures is required and should address comorbidities, medications, social circumstances, health literacy of the patient and its relatives, and distance from home to the hospital. A careful and strict quality management is mandatory which comprises the entire process from patient selection through patient entry, surgery, discharge and postoperative care in a multidisciplinary setting.

Zur besseren Lesbarkeit des Textes wird bei geschlechterbezogenen Bezeichnungen die männliche Form benutzt. Es sind jedoch in gleicher Rangfolge auch das jeweilige weibliche Geschlecht oder andere Geschlechtsausprägungen gemeint.

Schlüsselwörter

HNO-Operation - ambulantes Operieren - Tageschirurgie - ambulante Operation - Kopf-Hals-Chirurgie

Key words

ENT-Surgery - ORL-HNS - outpatient surgery - day-case-surgery - office-based-surgery

Full Text

References

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