[Prospective hospital documentation as an instrument of surgical quality assurance]

In this study expenditure and benefits of a differentiated internal hospital documentation were analyzed. We particularly wanted to find out whether an independent prospective documentation of all postoperative complications has a reducing effect on the frequency of these events and therefore can be used as a means of control.

In the time between May 1989 and September 1992 the data of 8682 patients of our hospital were documented. Scientific assistants who regularly visited every ward registered every course of treatment. All data were coded and simultaneously checked.

We found the risk of postoperative pneumonia (3.6%) especially high in units for vascular surgery and in the intensive care unit. Wound infections (5.2%) were mostly seen after transplantations and vascular surgery. Specific complications after operations showed an accumulation in certain wards. If we look at the progress since 1979 we can perceive a significant regression in the rate of wound infections and pneumonia and a constant rate of clinical lethality. In elective bowel-resections a significant reduction of wound infections and leakages could be recorded. Concerning the patient's characteristics we saw apart from a general increase in the number of operations a clear increase of endoscopic performances.

Hospital documentation can uncover internal correlations and thus takes part in clinical quality assurance. Helpful are evaluations of each specific ward and the specific operations. Basis for this is the selection of suitable data and their independent evaluation. Measures of external quality assurance have not yet solved these problems convincingly.