Ambulantes Operieren in der HNO-Heilkunde in Deutschland

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

Publikationsverlauf

Eingereicht: 06. März 2021

Angenommen: 08. März 2021

Artikel online veröffentlicht:
01. April 2021

• Literatur

• 1 Verse T, Dreher A, Heiser C. et al Leitlinie: „HNO-spezifische Therapie der obstruktiven Schlafapnoe bei Erwachsenen“. AWMF-Leitlinie, Registernummer: 001-041 2015
• 2 Badelt G, Goeters C, Becke-Jakob K. et al [German S1 guideline: obstructive sleep apnea in the context of tonsil surgery with or without adenoidectomy in children-perioperative management]. HNO 2021; 69: 3-13 . doi:10.1007/s00106-020-00970-6
• 3 Hormann K. [Joint statement on the need for preoperative coagulation tests before adenotomy and tonsillectomy in children]. Laryngorhinootologie 2006; 85: 580-581 . doi:10.1055/s-2006-944590. doi:10.1055/s-2006-944590
• 4 Windfuhr JP. Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology. GMS Curr Top Otorhinolaryngol Head Neck Surg 2013; 12: Doc08 . doi:10.3205/cto000100
• 5 Windfuhr JP, Schloendorff G, Baburi D. et al Serious post-tonsillectomy hemorrhage with and without lethal outcome in children and adolescents. Int J Pediatr Otorhinolaryngol 2008; 72: 1029-1040 . doi:10.1016/j.ijporl.2008.03.009
• 6 Deitmer T, Neuwirth C. [105 cases of post-tonsillectomy hemorrhage revisited]. Laryngorhinootologie 2010; 89: 424-428 . doi:10.1055/s-0030-1253366
• 7 Subramanyam R, Chidambaran V, Ding L. et al Anesthesia- and opioids-related malpractice claims following tonsillectomy in USA: LexisNexis claims database 1984-2012. Paediatr Anaesth 2014; 24: 412-420 . doi:10.1111/pan.12342
• 8 Fischer M, Horn IS, Quante M. et al Respiratory complications after diode-laser-assisted tonsillotomy. Eur Arch Otorhinolaryngol 2014; 271: 2317-2324 . doi:10.1007/s00405-014-2956-z
• 9 Acevedo JL, Shah RK, Brietzke SE. Systematic review of complications of tonsillotomy versus tonsillectomy. Otolaryngol Head Neck Surg 2012; 146: 871-879 . doi:10.1177/0194599812439017
• 10 Lee DJ, Forner D, End C. et al Outpatient versus inpatient superficial parotidectomy: clinical and pathological characteristics. J Otolaryngol Head Neck Surg 2021; 50: 10 . doi:10.1186/s40463-020-00484-9
• 11 Forner D, Lee DJ, Walsh C. et al Outpatient versus Inpatient Parotidectomy: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 162: 818-825 . doi:10.1177/0194599820911725
• 12 Briner HR, Leunig A, Schlegel C. et al. Preoperative risk assessment for ambulatory sinonasal surgery. Eur Arch Otorhinolaryngol 2020;
• 13 Compton RA, Simmonds JC, Dhingra JK. Total Thyroidectomy as an Ambulatory Procedure in Community Practice. OTO Open 2020; 4: 2473974X20957324 . doi:10.1177/2473974X20957324
• 14 Tewfik MA, Frenkiel S, Gasparrini R. et al Factors affecting unanticipated hospital admission following otolaryngologic day surgery. J Otolaryngol 2006; 35: 235-241 . doi:10.2310/7070.2006.0018
• 15 Bailey CR, Ahuja M, Bartholomew K. et al Guidelines for day-case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia 2019; 74: 778-792 . doi:10.1111/anae.14639
• 16 Kerimian M, Bastier PL, Reville N. et al Feasibility study of bilateral radical ethmoidectomy in ambulatory surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135: 377-382 . doi:10.1016/j.anorl.2018.08.002
• 17 Bajaj Y, Sethi N, Carr S. et al Endoscopic sinus surgery as day-case procedure. J Laryngol Otol 2009; 123: 619-622 . doi:10.1017/S0022215108003332
• 18 Terris DJ, Snyder S, Carneiro-Pla D. et al American Thyroid Association statement on outpatient thyroidectomy. Thyroid 2013; 23: 1193-1202 . doi:10.1089/thy.2013.0049
• 19 De Oliveira Jr GS, Holl JL, Lindquist LA. et al Older Adults and Unanticipated Hospital Admission within 30 Days of Ambulatory Surgery: An Analysis of 53,667 Ambulatory Surgical Procedures. J Am Geriatr Soc 2015; 63: 1679-1685 . doi:10.1111/jgs.13537
• 20 Malard O, Michel G, Espitalier F. Outpatient management in plastic and reconstructive head and neck surgery in France. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136: 29-32 . doi:10.1016/j.anorl.2018.11.003
• 21 Mitchell RB, Archer SM, Ishman SL. et al Clinical Practice Guideline: Tonsillectomy in Children (Update)-Executive Summary. Otolaryngol Head Neck Surg 2019; 160: 187-205 . doi:10.1177/0194599818807917
• 22 Lerman J. Pediatric ambulatory anesthesia: an update. Curr Opin Anaesthesiol 2019; 32: 708-713 . doi:10.1097/ACO.0000000000000787
• 23 Coates ML, Carrie S. A local safety standard for invasive procedures for out-patient endonasal procedures performed under local anaesthetic: a template from Newcastle upon Tyne hospitals. J Laryngol Otol 2019; 133: 441-444 . doi:10.1017/S0022215119000781
• 24 de Gabory L, Sowerby LJ, DelGaudio JM. et al International survey and consensus (ICON) on ambulatory surgery in rhinology. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135: S49-S53 . doi:10.1016/j.anorl.2017.12.010
• 25 Jafari A, Shen SA, Bracken DJ. et al. Incidence and predictive factors for additional opioid prescription after endoscopic sinus surgery. Int Forum Allergy Rhinol 2018;
• 26 Prokopakis E, Vardouniotis A, Bachert C. et al Rhinology Future Debates 2018, a EUFOREA Report. Rhinology 2020; 58: 384-393 . doi:10.4193/Rhin19.455
• 27 Grubey JS, Raji Y, Duke WS. et al Outpatient thyroidectomy is safe in the elderly and super-elderly. Laryngoscope 2018; 128: 290-294 . doi:10.1002/lary.26707
• 28 Rodriguez LV. Anesthesia for Ambulatory and Office-Based Ear, Nose, and Throat Surgery. Otolaryngol Clin North Am 2019; 52: 1157-1167 . doi:10.1016/j.otc.2019.08.012
• 29 Anaesthesiologists ASo. Guidelines for Ambulatory Anesthesia and Surgery. 2018
• 30 Zalzal HG, Makary CA, Evans R. et al Using Clinical Indicators to Reduce Perianesthesia Recovery Time Following Outpatient Tonsillectomy. Ann Otol Rhinol Laryngol 2018; 127: 620-624 . doi:10.1177/0003489418783226
• 31 Becke-Jakob K. Obstruktive Schlafapnoe im Rahmen von Tonsillenchirurgie mit oder ohne Adenotomie bei Kindern – perioperatives Management. AWMF-Leitlinie, Registernummer: 001-041 2020
• 32 Surgery IAfA. Discharge Process and Criteria Following Day Surgery. 2020
• 33 Jakobsson JG. Recovery and discharge criteria after ambulatory anesthesia: can we improve them?. Curr Opin Anaesthesiol 2019; 32: 698-702 . doi:10.1097/ACO.0000000000000784
• 34 Aronson S, Murray S, Martin G. et al Roadmap for Transforming Preoperative Assessment to Preoperative Optimization. Anesth Analg 2020; 130: 811-819 . doi:10.1213/ANE.0000000000004571
• 35 Juul ML, Rasmussen ER, Rasmussen SHR. et al A nationwide registry-based cohort study of incidence of tonsillectomy in Denmark, 1991-2012. Clin Otolaryngol 2018; 43: 274-284 . doi:10.1111/coa.12959
• 36 Lawlor CM, Riley CA, Carter JM. et al Association Between Age and Weight as Risk Factors for Complication After Tonsillectomy in Healthy Children. JAMA Otolaryngol Head Neck Surg 2018; 144: 399-405 . doi:10.1001/jamaoto.2017.3431
• 37 Sedlmaier B, Bohlmann P, Jakob O. et al [Outpatient diode laser tonsillotomy in children with tonsillar hyperplasia. Clinical results]. HNO 2010; 58: 244-254 . doi:10.1007/s00106-009-2052-7
• 38 Bhattacharyya N. Unplanned revisits and readmissions after ambulatory sinonasal surgery. Laryngoscope 2014; 124: 1983-1987 . doi:10.1002/lary.24584
• 39 de Gabory L, Serrano E, Lecanu JB. et al French Otorhinolaryngology Society guidelines for day-case nasal surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132: 35-40 . doi:10.1016/j.anorl.2014.09.001
• 40 Eisenberg G, Perez C, Hernando M. et al. [Nasosinusal endoscopic surgery as major out-patient surgery]. Acta Otorrinolaringol Esp 2008; 59: 57-61
• 41 Gengler I, Carpentier L, Pasquesoone X. et al Predictors of unanticipated admission within 30 days of outpatient sinonasal surgery. Rhinology 2017; 55: 274-280 . doi:10.4193/Rhin16.251
• 42 Menezes AS, Guimaraes JR, Breda M. et al Septal and turbinate surgery: is overnight essential?. Eur Arch Otorhinolaryngol 2018; 275: 131-138 . doi:10.1007/s00405-017-4813-3
• 43 Oker N, Dupuch V, Herman P. et al Outcomes of endoscopic ethmoidectomy performed on a day-case basis: a prospective bi-centric study. Eur Arch Otorhinolaryngol 2017; 274: 305-310 . doi:10.1007/s00405-016-4263-3
• 44 Wong A, Kacker A. Incidence of unplanned admissions after sinonasal surgery: a 6-year review. Int Forum Allergy Rhinol 2014; 4: 143-146 . doi:10.1002/alr.21250
• 45 Lee JT, DelGaudio J, Orlandi RR. Practice Patterns in Office-Based Rhinology: Survey of the American Rhinologic Society. Am J Rhinol Allergy 2019; 33: 26-35 . doi:10.1177/1945892418804904
• 46 Anderson J, Bensoussan Y, Townsley R. et al In-Office Endoscopic Laryngeal Laser Procedures: A Patient Safety Initiative. Otolaryngol Head Neck Surg 2018; 159: 136-142 . doi:10.1177/0194599818774511
• 47 Bensoussan Y, Anderson J. In-office laryngeal procedures (IOLP) in Canada: current safety practices and procedural care. J Otolaryngol Head Neck Surg 2018; 47: 23 . doi:10.1186/s40463-018-0270-2
• 48 Chau SM, Kim CM, Vahabzadeh-Hagh A. et al Safety of outpatient unilateral medialization laryngoplasty across two academic institutions. Laryngoscope 2019; 129: 1647-1649 . doi:10.1002/lary.27688
• 49 Junlapan A, Sung CK, Damrose EJ. Type I thyroplasty: A safe outpatient procedure. Laryngoscope 2019; 129: 1640-1646 . doi:10.1002/lary.27686
• 50 Hu QL, Livhits MJ, Ko CY. et al Same-day discharge is not associated with increased readmissions or complications after thyroid operations. Surgery 2020; 167: 117-123 . doi:10.1016/j.surg.2019.06.054
• 51 Lee DJ, Chin CJ, Hong CJ. et al Outpatient versus inpatient thyroidectomy: A systematic review and meta-analysis. Head Neck 2018; 40: 192-202 . doi:10.1002/hed.24934
• 52 McLaughlin EJ, Brant JA, Bur AM. et al Safety of outpatient thyroidectomy: Review of the American College of Surgeons National Surgical Quality Improvement Program. Laryngoscope 2018; 128: 1249-1254 . doi:10.1002/lary.26934
• 53 Siddiqui SH, Singh R, Siddiqui E. et al Outpatient versus inpatient parotidectomy: Comparison of postoperative complication rates. Laryngoscope 2019; 129: 655-661 . doi:10.1002/lary.27358
• 54 Ziegler A, Lazzara G, Thorpe E. Safety and Efficacy of Outpatient Parotidectomy. J Oral Maxillofac Surg 2018; 76: 2433-2436 . doi:10.1016/j.joms.2018.04.032
• 55 Flach S, Hey SY, Lim A. et al Outpatient (same-day discharge) versus inpatient parotidectomy: A systematic review and meta-analysis. Clin Otolaryngol 2020; 45: 529-537 . doi:10.1111/coa.13519
• 56 Farquhar DR, Rawal RB, Masood MM. et al Outpatient management and surgeon specialty for thyroglossal duct cyst excision: A retrospective analysis of 377 patients and 30-day outcomes in the American College of Surgeons NSQIP-P Database. Clin Otolaryngol 2018; 43: 1402-1406 . doi:10.1111/coa.13170
• 57 Shoman N. Pilot Study Assessing the Feasibility and Clinical Outcomes of Office-Based Ossiculoplasty. Ann Otol Rhinol Laryngol 2019; 128: 50-55 . doi:10.1177/0003489418806922
• 58 Wu V, Hall SF. Rates and causes of 30-day readmission and emergency room utilization following head and neck surgery. J Otolaryngol Head Neck Surg 2018; 47: 36 . doi:10.1186/s40463-018-0283-x
• 59 Shah PD. Patient Safety and Quality for Office-Based Procedures in Otolaryngology. Otolaryngol Clin North Am 2019; 52: 89-102 . doi:10.1016/j.otc.2018.08.015
• 60 Bansal VK, Dobie KH, Brock EJ. Emergency Response in the Ambulatory Surgery Center. Anesthesiol Clin 2019; 37: 239-250 . doi:10.1016/j.anclin.2019.01.012
• 61 de Lima A, Osman BM, Shapiro FE. Safety in office-based anesthesia: an updated review of the literature from 2016 to 2019. Curr Opin Anaesthesiol 2019; 32: 749-755 . doi:10.1097/ACO.0000000000000794
• 62 Eibling DE. Building highly reliable office-based surgery [Editorial]. Ear Nose Throat J 2018; 97: 266-268 . doi:10.1177/014556131809700912
• 63 Scott AJ, Mason SE, Langdon AJ. et al Prospective Risk Factor Analysis for the Development of Post-operative Urinary Retention Following Ambulatory General Surgery. World J Surg 2018; 42: 3874-3879 . doi:10.1007/s00268-018-4697-4
• 64 Bundesverfassungsgericht: Huber K-W, König. Urteil in dem Verfahren über eine Verfassungsbeschwerde. Aktenzeichen 2 BvR 1615/16 2020
• 65 Hübner LWA. HNO-Arzt haftet nach Atemstillstand im Aufwachraum. Zur Verantwortlichkeit des Praxisinhabers bei Organisationsmängeln. HNO-Informationen 2020; 4: 134-136