A lack of routine causes numerous unnecessary deaths during cancer surgery
Cancer treatments are usually risky and thorough risk-benefit assessment is required. This applies in particular to operations that are required. According to a recent study by the AOK Scientific Institute (WIdO), a risk that is often underestimated in cancer surgery appears to be the risk of a lack of experience in the treating clinics. This often has fatal consequences for those affected.
"Many patients in Germany die prematurely because they are operated on in clinics that have too little experience with complicated cancer surgeries," according to the current WIdO announcement. According to the experts, the setting of a minimum number of interventions for the clinics could be remedy this. The institute reports that the number of deaths from lung cancer surgery alone could drop by a fifth (from 361 to 287 per year) by introducing a purely arithmetically determined minimum amount
Hospital billing data evaluated
For the "Quality Monitor 2018", the WIdO, the association Gesundheitsstadt Berlin and the Initiative Qualitätsmedizin (IQM) evaluated, among other things, the hospital billing data from 2009 to 2014. It was found that the clinics with the lowest number of cases in cancer operations tended to have a significantly higher death rate after the surgery than clinics in which such operations were carried out particularly frequently. This applied not only to operations for lung cancer, but also for other cancer indications such as esophageal cancer, pancreatic cancer, bladder and colon cancer.
Lack of experience in cancer surgery is a common problem
Professor Thomas Mansky, head of the department for structural development and quality management in health care at the Technical University (TU) Berlin and one of the authors of the quality monitor, emphasizes in view of the current results that there are still far too many clinics in Germany, “which only occasionally perform a complicated cancer operation again. ”For example, the partial lung removal operations that are required in many cases for lung cancer patients involve treating a fifth of the patients in a total of 260 clinics, which only average five of these operations per year.
Surgical routine and necessary specialization not available
Due to the low number of treatments, according to Prof. Mansky it is "very likely" that the 260 hospitals mentioned "do not have the necessary operating routine and the specialization necessary for adequate overall care". The chairman of the AOK federal association Martin Litsch adds that this “occasional surgery” is not acceptable. The problem can only be dealt with by the introduction and consistent implementation of minimum OR quantities. The enforcement of such minimum quantities and the associated centralization of services, however, will not be easy for the hospitals and a "painful process", which, however, given the clear data situation, is "absolutely logical", says Professor Ralf Kuhlen, Chairman of the Scientific Advisory Board of IQM.
280 colon cancer deaths per year can be avoided by using a minimum amount of surgery
According to the study authors, colorectal cancer also shows that there are still far too many clinics in Germany that only carry out one of these complicated operations every now and then. A fifth of the patients were treated in a total of 492 clinics, which only carry out an average of 23 of these procedures per year. Here too, the necessary surgical routine and the specialization required for adequate overall care are often not available. The risk of dying from colorectal cancer surgery is 59 percent higher in the 492 clinics that operate the least cases of colorectal cancer per year than in the 71 clinics with the most operations. 280 deaths per year would be avoidable if a minimum of 82 operations were introduced for the treating clinics, reports the WIdO.
Based on the new data situation, the AOK demands the introduction of minimum quantities for complicated operations in lung cancer and breast cancer and an increase in the existing minimum quantities for esophageal and pancreatic cancer. The health insurance company will also increase the pressure on the clinics to consistently implement the existing minimum quantities. "Hospitals that do not meet the requirements and for which there is no exception, will no longer receive compensation from the AOK for these interventions in the interests of patient safety," said Litsch. (fp)