Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Technical aspects of segment I resection of the liver].
Due to posterior location and the close relationship to vascular and biliary structures, resection of tumors within the caudate lobe of the liver may be a surgical challenge as well as an oncological hazard. Various approaches and techniques of isolated tumorectomy and combined liver resections are available and must be tailored to the individual situation. Prerequisite for a low operative risk is control of bleeding which can be achieved by sequential inflow and outflow occlusion of the liver.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Emergency care and treatment costs of polytrauma patients].
Treatment costs of emergency therapy, surgery and intensive care were analysed in 20 randomly chosen, representative patients with severe multiple trauma (mean ISS 32 p). For an average stay of about 22.5 days on ICU, the total costs were DM 106924.36 (about 70,000 US $). DM 39,635.88 (= 37%) were the costs for physicians and nurses; DM 67,289.08 (= 63%) were needed for materials, X-rays, laboratory investigations, drugs and blood components. ⋯ In Germany, a new way of compensation by a diagnosis-related group was introduced in 1996. These data suggest that treatment of severe multiple trauma is very expensive and trauma care could be economically harmful for smaller hospitals. We conclude that treatment of multiply injured patients (ISS > 16 p) should be compensated for by a special daily amount of about DM 5000 (about 3500 US $) for selected trauma centres.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Extent of radical surgery in cardia carcinoma--esophagectomy or gastrectomy?].
In patients with cardia cancer, showing a tumor center between 1 cm above to 2 cm below the anatomical cardia, the results of transhiatal esophagectomy with proximal gastrectomy versus total extended gastrectomy with distal esophageal resection were compared. For gastrectomy, postoperative mortality was significantly lower (2% vs. 8.6%), whereas the rates of R0 resection (81% vs. 68%) and 5-year survival rate (48 vs. 25%) were significantly higher than after esophagectomy. If in cardia cancer, according to the mentioned definition, R0 resection can be achieved by extended total gastrectomy and distal esophageal resection, this represents the procedure of choice for this strictly defined type of carcinoma of the cardia.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[General automated documentation and performance data on the surgical intensive care unit--the theoretical concept of the Regensburg Surgical University Clinic].
Documentation is becoming an ever more time-consuming task due to the need to document increasing ICU productivity, quality management and cost-assessment data. Automatic charting of on-line monitoring data, therapeutic-device data, clinical laboratory data, microbiological data, radiological data and other data reduces documentation time significantly. ⋯ Not only the physician, but also nurses and physiotherapists are able to benefit from these advantages. Our concept, SURGIC (Department of Surgery, University Regensburg, Germany, Intensive Care), stands for: widely automated documentation, work orientation, including physicians, nurses' and physiotherapists' tasks, minimal dataset for simple use and perfect overview, costs assessments, scientific dataset, SICU PDMS as a part of the clinical information system, and professional support by a software-house is necessary.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Economic considerations in critically ill intensive care patients].
Since 1992 the data for all patients referred to our ICU have been entered on computer and analyzed for parameters relevant to therapeutic effectiveness on the one hand and cost-containment on the other. The analysis of data for 5424 patients concerning APACHE II-score, age, number of ICU days, time of mechanical ventilation and/or hemodialysis, cardio-respiratory complications and insufficiency, ICU discharge date and hospital discharge date demonstrates a profile or our intensive care services using all resources efficiently. The data revealed no ethically acceptable parameter or necessity to include economic considerations in medical decisions which had to be taken for individual patients and situations.