[Challenges in outpatient surgical treatment in Germany].

Abstract

Background: In Germany the proportion of outpatient and day clinic surgery within the surgical service provision is still increasing. Recently, the catalogue of operations which can be carried out in outpatient surgery was revised and an intersectoral remuneration was introduced; however, the prerequisites in the surgical departments for an increased provision of outpatient services are very heterogeneous.

Objective: The aim of this study was to analyze the current situation and challenges of outpatient care in general and visceral surgery in Germany.

Material and methods: A questionnaire with 26 questions on the current situation of the treatment structure for outpatient surgery was constructed and the possibility for surgical training under outpatient conditions was surveyed. The questionnaire was digitally sent via the mailing list of the German Society for General and Visceral Surgery and the Convention of Senior Hospital Surgeons (Konvent der leitenden Krankenhauschirurginnen und -chirurgen) and the completed questionnaires were analyzed.

Results: A total of 204 head physicians took part in the survey. In 54.4% the surgeons were in charge of basic care hospitals followed by specialized and maximum care hospitals. An outpatient structure was present in 95.5% of the hospitals with a high proportion of medical care centers. The majority of the surgeons planned to extend outpatient services despite the lack of comprehensive structures. Even if a structured education curriculum for junior doctors does not exist up to 70% of outpatient operations are performed by junior doctors. The current status of outpatient surgery care in Germany was evaluate as weak by 70% of the participants. An improvement due to the implementation of a new intersectoral remuneration is not expected.

Discussion: Within the hospital landscape the structures for outpatient surgery show clear differences.

Conclusion: Of the participants two thirds felt that despite the existing infrastructure their hospital was not well-prepared for the increased provision of outpatient services and assessed the associated remuneration as insufficient.