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Chirurg. 1997 Dec;68(12):1225-34.

[Quality control in surgery of inguinal hernias].

[Article in German]

Author information

II. Lehrstuhl für Chirurgie, Chirurgische Klinik Köln-Merheim, Universität zu Köln.


Quality assurance is a concept intended to ensure the quality of a surgical therapy on a defined level. But what is "quality" in surgical therapy? Quality can be described in a lot of different ways. Quality has something to do with taste, especially with individual preferences. The testing of the quality of wine is a good example. Even though this is quite difficult, it can still be done and has been done for hundreds of years. In surgery we are still at the beginning. Discussions regarding the definition of quality, the best method of quality assurance and, not least, who is responsibility for its measurement are well-known obstacles on the path to improvement. Quality has basically little to do with research. It is not a matter of finding the right technique, but of ensuring that the right technique, when found, is correctly used. Defined quality standards will allow this. Quality standards in inguinal hernia surgery are: outstanding comfort directly before and after the therapy, few or no side effects troubling the patient, most of all no disastrous side effects, disaster, low rate of relapse and, in our times, decent economy. The question: "Is the target to be oriented on the average or must the standard be brought nearer the best performance?" has to be answered. Surgery and average performance do not match; surgical performance cannot be oriented on the average. The next question is: "Which methods are suitable for this?". The "tracer method" is one method, one aspect within quality assurance methods in general. It is designed for obtaining information on the quality of a clinic/department. The obtained data on complication rates, for example (10%), and their striking points should above all give insight into the complete department, i.e., on complication rates of a surgical department in general. The same counts for infection rates or striking points. The essential question remains: "Who should carry it out?" Bureaucrats lacking expertise will buy it. The principle of autonomy, "expertise connected to competence" has to be kept when answering the question of who should do it and how. The tracer method, using hernia surgery as a tracer, is not necessarily suitable as a measure of the quality of inguinal hernia surgery. Even though it supplies--as a side effect--information about inguinal hernia surgery, like complication rates (10%) and relapse operations (10%), as well as the varying anaesthetic procedures, or the use for changes in therapeutic procedures, the tracer method is not suitable to sufficiently inform about the quality of inguinal hernia surgery in particular. A further essential aspect when analysing quality assurance--showing up clearly at the moment--is the fact, that "another" control will develop if this inactivity remains. In this case the "controllers" will certainly not be the surgeons. The nightmare vision of bureaucrats (insurance companies or other parties) as controllers is in sight. This would be the same situation as if Michael Schumacher's Ferrari were checked by clerks and not by engineers.

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