Acceptable risks in surgery from the perspective of the evidence-based medicine and an evaluation of the quality of surgical care
Authors:
M. Duda 1,2; L. Adamčík 2; M. Škrovina 2
Authors place of work:
II. chirurgická klinika FN a LFUP Olomouc, přednosta: Prof. MUDr. Petr Bachleda, CSc
1; Chirurgické oddělení nemocnice a KOC Nový Jičín, primář: MUDr. M. Škrovina, Ph. D.
2
Published in the journal:
Rozhl. Chir., 2013, roč. 92, č. 9, s. 517-522.
Category:
Various Specialization
Práce je určena k postgraduálnímu vzdělávání lékařů.
Summary
A qualified assessment of the risks of surgical treatment and especially operations is based on the evaluation of morbidity, mortality and long-term results of surgeons’ work. These analyses should be conducted based on the principles of the evidence-based medicine (EBM) and, in recent years, an assessment of the risks that surgical treatment has been included into a broader complex of evaluating the quality of surgical care. Surgery, other surgical specializations, and the urgent medicine belong among medical fields which most often carry a risk of unsuccessful outcomes and complications. Taking into account the complexity of medicine, the diagnostic and therapeutic processes are burdened necessarily by a certain number of complications. It is never possible to completely eliminate human errors, but what is possible is to continuously decrease their numbers and repair them on time. EBM is defined as a method of treating for patients based on the best scientific evidence resulting from clinical and epidemiological scientific research publications. From an EBM perspective, surgery compared with pharmaceutical treatment is usually at a disadvantage because the studies with the highest level of evidence (the controlled randomized studies) are usually not possible to be performed in surgery. In various situations it is only possible to obtain certain kinds of evidence and in surgery the highest level of evidence is most often obtained from cohort studies and case control studies as a possible means of sorting our information. Currently, evaluating the quality of surgical care should be in the forefront of interest of every surgeon. Traditional criteria include the evaluation of operative and postoperative complications, mortality, the number of re-operations, the evaluation of the satisfaction of the patient with the procedure performed, the length of survival of oncological patients, the number of recurrences and a number of other criteria. The term „High Volume Hospital“ represents a newly developing concept of evaluating quality in surgery, which arises from the assumption that with the increasing number of procedures (operations) performed the quality of the results attained increases as well. The evaluation of quality in surgery is a topic which should be addressed more thoroughly among surgeons. The creation of indicators of quality of surgical care and their application into clinical practice has great significance for the development of surgery and it is not possible to leave it beyond the control of surgeons.
Key words:
surgical care – risk – assessment of quality of care
Zdroje
1. Leape LL. Error in medicine. JAMA 1994;272:1851–1857.
2. Duda M. Expertní činnost v chirurgii (Editorial). Rozhl Chir 2008;87:335–337.
3. Hájek M. O úspěšnosti operací (Editorial). Rozhl Chir 2012;91:587.
4. Škrla P. Především neublížit, Cesta k prevenci pochybení v léčebné a ošetřovatelské péči. 1.vyd. Brno, Národní centrum ošetřovatelství a nelékařských zdravotnických oborů 2005.
5. Vondráček L. Hájek M. Pooperační hnisavé komplikace z pohledu odpovědnosti a nároku na odškodnění. Rozhl Chir 1998;77: 187–188.
6. Wetter PA, Editor. Prevention and Managment of laparoscopic surgical complication. 1th. Ed. Miami, Florida,Societi of Laparoscopic Surgeons 2005.
7. De Voto E. Kramer BS. Evidence-Based Approach to Oncology. In: Oncology An Evidence-Based Approach. 1th. Ed. New York, Springer Science and Business Media Inc 2006:3–13.
8. Cochrane A. Effectiveness and efficiency. London, Nuffi eld Provintial Hospitals Trust 1972.
9. Sackett DL, Straus SE, RichardsonWS, Rosenberg W, Haynes BR. Evidence-based medicine. 2nd ed. Edinburgh, Churchil Livingstone 2000.
10. Grade Working Group. Grading quality of evidence and stregth of recommendations. Brit Med J 2004;328:1492.
11. North of England evidence based guidelines development project:methods of guidelines development. Brit Med J 1996;312: 760–762.
12. Líčeník R. Klinické doporučené postupy. Olomouc, Univerzita Palackého v Olomouci, Lékařská fakulta 2009.
13. Duda M. Evidence-based medicine a hodnocení kvality v chirurgii jícnu. In: Duda M, a kol. Jícen: pohled z mnoha úhlů v zrcadle zkušeností olomoucké jícnové školy. Olomouc, Universita Palackého Olomouc 2. vyd. 2012:353–358.
14. Duda M. Léčba založená na důkazech a hodnocení kvality v onkochirurgii. In: Duda M, Žaloudík J a kol. Onkochirurgie, I, II, III. 1. Vyd. Praha, IPVZ (Institut postgraduálního vzdělávání ve zdravotnictví) 1. díl, Praha 2013:80–85.
15. Janout V. Klinická epidemiologie – nedílná součást klinických rozhodovacích procesů. Praha, Grada 1998.
16. Greenhgalgh T. Jak pracovat s vědeckou publikací Základy medicíny založené na důkazech. Praha, Grada 2003.
17. Šejda J, Šmerhovský Z, Göpfertová D. Výkladový slovník epidemiologické terminologie. Praha, Grada 2005.
18. Šmerhovský Z, Göpfertová D, Feberová J. Medicína založená na důkazech z pohledu klinické epidemiologie. Praha, Univerzita Karlova Praha, Nakladatelství Karolinum 2007.
19. Mihál V, Potomková J. Pronační spánková poloha kojenců jako rizikový faktor SIDS s největší sílou důkazů. Pediatr pro Praxi 2009;10:127–131.
20. Tilson JK, Kaplan SL, Harris JL, Hutchinson A, Illis D, et al. Sicily statement on classification and development of evidence-based practice leasing assessment tools. BMC Medical Education 2011;11:78.
21. Bencko V, Hrach K, Malý M, Pikhart H, Reissigová J, et al. Stastistické metody v epidemiologii. In: Zvárová J, Malý M, editors. Biomedicínská statistika III. Praha, Karolinum 2003.
22. Duda M, Žaloudík J, Ryska M, Dušek L. Chirurgická léčba solidních nádorů v České republice. Rozhl Chir 2010; 89: 588–593.
23. Ryska M, Žaloudík J, Duda M, Dušek L. Impakt radikální resekce v komplexní léčbě nemocných se solidním maligním nádorem (editorial). Rozhl Chir 2012;91:647–648.
24. Dušek L. editor. Czech cancer care in numbers. 2008–2009. Praha, Grada 2009.
25. Duda M, Adamčík L, Dušek L, Škrovina M, Jinek T. Zhoubné nádory jícnu v České republice. Rozhl Chir 2012;91:132–140.
26. Bentrem DJ, Brennan MF. Outcomes in Oncologic Surgery: Does Volume Make a Diference? World J Surg 2005;29:1210–1216.
27. Zinner MJ, Rogers Jr SO. The Question of Quality. World J Surg 2005;29:1201–1203.
28. Hohenberg W, Meyer TH. Grundzüge der chirurgischen Onkologie (Teil 1, 2). Zentralbl Chir 2000;125:31–38,39–48.
29. Siewert JR, Siest MA. High Volume Hospital Über den Zusammenhang von Fallzahlen und Ergebnissqualiät in der Chirurgie. Chirurg 2003;74:278–281.
30. Národní onkologický registr (NOR) České Republiky, Systém pro vizualizaci Onkologických dat (SVOD). www.cba.muni.cz /svod.
31. Hermanek Jr P, Wiebelt H, Riedl S, Staimmer D, Hermanek P, und die Studiengruppe Kolorektales Karcinom. Lagzeitergebnisse der chirurgischen Therapie des Coloncarcinoms. Chirurg 1994;65:387–397.
32. Žaloudík J spol. Koncepce onkochirurgické péče v České republice. Připravované, dosud nepublikované sdělení.
33. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A. A quality-of-life instrument for international clinical trials in oncology. J. Natl Cancer Inst 1993;85:365–376.
34. Dindo D, Clavien PA. What is a surgical complication? World J Surg 2008;32:939–941.
35. Clavien PA, Barkun J, de OlivieraML, Michelle L, Vauthey JN, et all. The Clavien-Dindo classification of surical complications:five-year experience. Ann Surg 2009;250:187–196.
36. Khan A, Palit V, Myatt A, Cartledge JJ, Browning AJ, et al. Assessment of Clavien-Dindo classification in patients >75 years undergoing nephrectomy/nephroureterectomy. Urol Ann 2013:18–22.
37. Tokunaga M, Kondo J, Tanizawa Y, Bando E, Kawamura T, et al. Postoperative intra-abdominal complications assessed by the Clavien-Dindo classification following open and laparoscopy-assisted distal gastrectomy for early gastric cancer. J Gastrointest Surg 2012;16:1854–1859.
38. Šubrt Z, Ferko A, Čečka F, Jon B, Örhalmi J. Klasifikace chirurgických komplikací: analýza vlastní skupiny nemocných. Rozhl Chir 2012;91:666–669.
39. Dindo D, Clavien PA. Quality assessment in surgery: mission impossible? Patient Saf Surg. 2010;4:18.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
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