Evidenzbasierte Medizin

[Are the measures to ensure patient safety in surgery evidence-based?]

Errors occurring in surgical procedures often have serious consequences for the patients. For this reason various measures have been designed over the past few years to ensure a greater level of patient safety in surgery. One such measure is the implementation of the WHO safety checklist in German hospitals. The benefits of this checklist on postoperative complications have been substantiated by evidence from EbM level II studies and meta-analyses. The application of further tools such as the systematic rating of hospitals in terms of defined operative procedures would appear theoretically rational, but has not been demonstrated by studies with a higher level of evidence.

[Patient-oriented multicentre research in surgery: the Surgical Trial Network (CHIR-Net)]

BACKGROUND

Patient-oriented clinical research in surgery requires prospective randomised multicentre trials (mRCTs) to generate valid evidence. In order to conduct high quality mRCTs, a network of surgical clinical trial centres is necessary.

METHODS

The Surgical Trial Network (CHIR-Net), which is funded by the German Federal Ministry of Education and Research (BMBF), was established as a structure of surgical regional centres. Currently, the CHIR-Net comprises 12 regional surgical centres with their associated clinical partner hospitals. The major aim of this network is to generate patient-relevant surgical questions of high clinical impact and to answer these questions in high-quality prospective randomised multicentre trials with well-trained study personnel.

RESULTS

Since 2006 32 mRCTs have been initiated in the CHIR-Net. Twelve surgical regional centres - in cooperation with 333 German and European hospitals - have recruited more than 7,500 patients. More than 80 surgeons have successfully completed the CHIR-Net educational curriculum for young surgeons.

CONCLUSIONS

The CHIR-Net has successfully established a national clinical trial network to investigate surgical questions in randomised multicentre clinical trials. A nationwide research infrastructure, including university and non-university hospitals as well as the associated clinical coordination centres (KKS), was created to ensure patient-oriented surgical clinical research in a network at the highest methodological level thus implementing evidence-based medicine in daily surgical practice.

[Valid liability law in surgery. Principles of legal requirements and clinical benchmarks exemplified by visceral surgery]

The spectacular increase in liability processes in the field of surgery and in particular in visceral surgery, necessitates an objectification of the conflict between surgical medical professionals and medico-legal institutions, firms of solicitors and courts. Out of court settlements assisted by expert opinion commissions of the Medical Council can avoid many legal conflicts. For improvement of the legal standpoint of a defendant medical professional an unambiguous, extensive and detailed documentation of medical examination findings, the indications for the planned operative intervention, extensive and detailed documentation on disclosure and informed consent of the patient for the planned operative intervention, an extensive, detailed careful and responsibly guided report of the operation as well as a systematic, orderly well-planned postoperative complication management are necessary to counter the accusation of an organizational failure of medical professionals and the accused hospital. The mutual building of confidence between surgical medical professionals and legal institutions is safeguarded by a comprehensive documentation and an unambiguous description and formulation of the medical discharge report on termination of inpatient treatment.

Evidence-based medicine—from best research evidence to a better surgical practice and health care

BACKGROUND

The use of the terms evidence-based medicine (EBM) and healthcare (EBHC) has become commonplace in the medical as well as in the surgical literature. Using the best available evidence, however, is not yet a working routine among surgeons because of the large amount and complexity of published research and the lack of user-friendly tools and necessary skills for the use of research results.

DISCUSSION

This article encourages to formulate surgically relevant questions and to answer them on the basis of high-quality research, preferably by using systematic reviews which are based on the quality criteria of the Cochrane Collaboration.

CONCLUSIONS

As currently only 77 Cochrane reviews address surgical procedures; much work remains to be done to enlarge the number of high-quality and relevant reviews. Similarly, the number and quality of randomized controlled trials need to be increased in all surgical specialties.