[Are IT-based clinical pathways superior to hard-copy form?]. / Sind IT-gestützte klinische Behandlungspfade der Papierform überlegen?

BACKGROUND: Today clinical pathways are established as a basis for the operational and organisational structure of surgical, interventional and conservative treatments in many hospitals. QUESTION: In our study we have evaluated the establishment and systematic applicability of IT-based clinical pathways in the department of general surgery in comparison with existing clinical pathways. Does the systematic application of IT-based clinical pathways improve the quality of medical treatment? METHODS: In our department of general surgery we evaluated and compared the treatment by laparoscopic surgery before and after establishment of IT-based clinical pathways. The preoperative duration of stay, the duration of treatment and the patients' pain perception were compared. Since July 2009 we used in our department of general surgery an IT-based clinical pathway for laparoscopic cholecystectomy and hernia repair. From January 2006 until October 2009 we compared the treatment by these procedures with and without the use of IT-based clinical pathways. RESULTS: From January 2006 until October 2009 743 patients underwent surgery and treatment following the conventional clinical pathway and 51 patients following the new, IT-based clinical pathway. In the group of patients who received a laparoscopic hernia repair we found a reduction of the preoperative duration of stay. CONCLUSION: IT-based clinical pathways are applicable for routine use in general surgery departments. For certain surgical procedures they are an eligible management device. IT-based clinical pathways lead to an improved operational structure of medical treatment and moreover to a complete and continuous documentation through the electronic file. Especially for departments which are using the electronic file, the use of IT-based clinical pathways can be recommended.

[Superinfected epidermal inclusion cyst of the thigh with development of squamous cell carcinoma--case report of a rare complication]. / Superinfektion einer epidermalen Inklusionszyste des Oberschenkels mit Ausbildung eines Plattenepithelkarzinoms--Fallbericht einer seltenen Komplikation.

Epidermal cysts (atheroma) are the most common benign tumours of the skin with ubiquitous localisation all over the body. However, rupture of the atheroma and formation of an inclusion cyst with additional superinfections are frequently seen. Malignant transformations have rarely been reported. Presented here is the unusual case of a 65-year-old woman with multiple atheromas and a distinctive tumour of the upper limb. Imaging diagnostics showed malignant deformation. Contrary to the imaging findings the histological/microbiological examination showed an enormous superinfected and ruptured epidermoid cyst with multiple abscess formation in the ventral upper limb. Radical surgical restoration with salvage of the limb was frustrated because of honey-combed anterior soft tissue and the changing bacterial spectrum. After resection of the complete ventral compartment, remission was realised approximately. In the follow-up there was a recurring infection with spontaneous fistula formation that histologically impressed as a squamous cell carcinoma. After proximal ablation of the upper limb, total rehabilitation of the infection as well as the malignoma could be achieved.

[Diagnostic laparoscopy and laparoscopic appendectomy in the diagnosis and therapy concept of abdominal pain of unknown origin]. / Diagnostische Laparoskopie und laparoskopische Appendektomie im Diagnostik- und Therapiekonzept des unklaren Unterbauchschmerzes.

The unclear lower abdominal pain can be problematic for the surgeon although modern diagnostics and technical equipment are applied. We present the experiences in a retrospective study carried out in our hospital since beginning of laparoscopy in unclear lower abdominal pain. The laparoscopic diagnostic provides valuable additional informations for the further treatment. We can get important informations about differential diagnosis of appendicitis, especially of young women and old patients. The laparoscopy as a minimal invasive diagnostics goes together with a high benefit for the patients and a low rate of complications.

[Appendectomy with respect to flat fee and special rate charges. Cost analysis of open and laparoscopic operation]. / Die Appendektomie unter den Bedingungen von Fallpauschale und Sonderentgelt. Kostenanalyse bei offener und laparoskopischer Operation.

The introduction of flat charges per case and special fees, first put into effect on Jan. 1, 1996, has lead medical and administrative personnel to rethink how fixed daily hospital rates, costs individually determined by each hospital, and prime costs for hospital and nursing charges will be reimbursed. The amount paid for flat charge cases and special fees (in German Marks) are currently the same nationwide. This applicable system of billing consists of a combination of diagnosis (ICD 9) and the type of therapy administered after each specific operation (ICPM). Between Jan. 1, 1996 and Dec. 31, 1996 we had 78 cases, where detailed personnel and relevant costs were recorded with the aid of three sheets of medical records and two reports for each patient. When comparing expenditures and compensation, there were deficits in 75 cases and surpluses in 3. This existing pressure to cut costs should not be allowed to lead to uncritical medical judgement. The major costs of an operation are for disposable materials, especially for the use of the endo-cutter. Laparoscopic appendectomies, on selected patients in our clinic, has created a deficit when covering costs for open appendectomies. The knowledge we have gained from this now enables us to balance out the deficit.