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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
Thomas Deitmer
1   Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie, Bonn, Germany
,
Andreas Dietz
2   Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Universität Leipzig, Leipzig, Germany
,
K.-Wolfgang Delank
3   HNO-Klinik, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany
,
Stefan K. Plontke
4   Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
,
H.-J. Welkoborsky
5   Klinik für HNO-Heilkunde, regionale plastische Chirurgie, Kopf- und Halschirurgie, Klinikum Region Hannover GmbH, Hannover, Germany
,
Stefan Dazert
6   Klinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Germany
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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


Publication History

Received: 06 March 2021

Accepted: 08 March 2021

Article published online:
01 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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