Chirurgie (Heidelberg, Germany) · 2026
[Management of complications of the upper gastrointestinal tract following external primary procedures : Case series on complex clinical courses and continuation of treatment at a high-volume center].
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Rudek Loreen Sophie, Wirsik Naita M, Schlößer Hans A, Bruns Christiane J
Аннотация
BACKGROUND: The centralization of hospital services and the introduction of minimum volume requirements represent key pillars of modern health policy, affecting both the quality of care and the handling of clinical complications.
OBJECTIVE: This case study investigates the resources required at a tertiary or high-volume care center for the further treatment of patients with externally complicated primary procedures.
MATERIAL AND METHODS: The prospective single-center study included patients who underwent externally complicated surgery, intervention, or diagnostic procedure in the upper gastrointestinal tract between 1 January 2023 and 31 December 2024, and were subsequently treated at the Department of General, Visceral, Thoracic, and Transplantation Surgery of the University Hospital Cologne.
RESULTS: A total of 39 patients (male: 38.5%, female: 61.5%; average age: 68.1 years) were treated at our center after complicated primary procedures at external hospitals. The most common complications were perforation, suture insufficiency, and incomplete resection/reconstruction. Following occurrence of a complication 15 patients were transferred directly to the high-volume center. Interventional and/or surgical revisions were performed on 24 patients at external hospitals. At the time of transfer 71.8% of patients were in need of intensive care. A cumulative total of 115 surgical and 243 endoscopic procedures with 171 endoscopic vacuum (EndoVAC) changes were performed after transfer to the high-volume center. Over time, 25.6% of patients were readmitted to a local facility and 61.5% were discharged home. The mortality rate was 12.8 %.
CONCLUSION: The treatment of patients with externally complicated primary procedures requires considerable personnel, logistical, and medical resources, especially for extensive diagnostics, complex surgical care, and intensive medical care.
OBJECTIVE: This case study investigates the resources required at a tertiary or high-volume care center for the further treatment of patients with externally complicated primary procedures.
MATERIAL AND METHODS: The prospective single-center study included patients who underwent externally complicated surgery, intervention, or diagnostic procedure in the upper gastrointestinal tract between 1 January 2023 and 31 December 2024, and were subsequently treated at the Department of General, Visceral, Thoracic, and Transplantation Surgery of the University Hospital Cologne.
RESULTS: A total of 39 patients (male: 38.5%, female: 61.5%; average age: 68.1 years) were treated at our center after complicated primary procedures at external hospitals. The most common complications were perforation, suture insufficiency, and incomplete resection/reconstruction. Following occurrence of a complication 15 patients were transferred directly to the high-volume center. Interventional and/or surgical revisions were performed on 24 patients at external hospitals. At the time of transfer 71.8% of patients were in need of intensive care. A cumulative total of 115 surgical and 243 endoscopic procedures with 171 endoscopic vacuum (EndoVAC) changes were performed after transfer to the high-volume center. Over time, 25.6% of patients were readmitted to a local facility and 61.5% were discharged home. The mortality rate was 12.8 %.
CONCLUSION: The treatment of patients with externally complicated primary procedures requires considerable personnel, logistical, and medical resources, especially for extensive diagnostics, complex surgical care, and intensive medical care.