Qualit?tssicherung in der Thoraxchirurgie anhand von Eingriffen beim Bronchialkarzinom

摘要

Lung Cancer still is the major cause of death in malignant diseases. For several years the German Society for Thoracic Surgery attempted to establish an external quality management for the surgical treatment of lung cancer. Despite positive expert opinions and several negotiations no governmental support could be achieved. Therefore a pilot trial was started with financial support from the German Society for Thoracic Surgery and from the Association for Quality Management of Pneumology and Thoracic Surgery. During 2001 data of patients operated for lung cancer were prospectively recorded. Six high volume centres were prepared to participate. Mortality and morbidity rate as well as rate of sleeve resections and mediastinoscopies were selected as quality criteria. For the evaluation percentage and appropriate confidence intervals were used. 1494 interventions in 1099 patients were recorded. The type of resection was lobectomy in 565 (38%) cases, pneumonectomy in 148 (10%) cases and other interventions in 781 (52%) cases. Complications occurred in 31% of lobectomies and pneumonectomies with variations between the hospitals between 20% and 44%. Hospital mortality was 2.8% (1.5-3.5%) for the whole group. For lobectomies the hospital mortality was 2.6%, for pneumonectomies 8.1% (4-33%). The rate of mediastinoscopies in the hospitals varied between 20% and 80%. On the basis of the selected indicator and the quality criteria it could be shown that a quality management is possible.