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T Windhorst

Publications and source records attributed to T Windhorst.

5 recordsLinked to original sources
PubMed2001

[Fractures of the femoral neck--results of an external quality assurance in 32,000 patients].

Between Jan. 1st 1993 and Dec. 31st 1999 data was collected on 31.917 patients with fractures of the femoral neck in a statewide report card system in Westphalia-Lippe. Only 6.3% of patients were younger than 60 years. Ten percent of the population of Germany live in Westphalia-Lippe so that our data can be considered representative of Germany. A significant change was seen in the following indicators of quality: increase of operative treatment 1993 93.2%--1999 96.0% (p < 0.01 Chi Quadrat Test), decrease of mortality 1993 6.9%--1999 5.7% (p < 0.01 Chi Quadrat Test), decrease of cardiopulmonary complications 1993 11.2%--1999 8.4% (p < 0.01 Chi Quadrat Test), decrease of mean length of stay 1993 33.5 days--1999 22.2 days (p < 0.01 one-way-ANOVA), decrease of pre-operative length of stay 1993 2.57 days--1999 1.86 days (p < 0.01 one-way-ANOVA), increase of operative treatment on weekends (p < 0.01 Chi Quadrat Test). 25% of the patients had post-operative complications. Intra-operative complications were rare (1.4%). Only 48.6% of internal fixations were performed on the day of admission. The most frequent operation is hemiarthroplasty and its frequency is still increasing. Total hip replacement was done 34.1% of all cases. More patients are transferred from primary hospitals to rehabilitation facilities following operative procedures: 1993 8.3%; 1999 27.2%.

Adult↗
PubMed2000

[Does quantity mean quality? An analysis of 116,000 patients regarding the connection between the number of cases and the quality of results].

METHODS: Between 1993 and 1998 data of 27,000 patients with hip fractures and 89,000 patients undergoing cholecystectomy were collected by the department of external quality assurance at the chamber of physicians of Westphalia-Lippe. The data were analyzed for the relationship between volume and outcome, specified as mortality and morbidity. Logistic regression was used to adjust the results for demographic and clinical risk factors. RESULTS: The risk-adjusted probability of death from cholecystectomy was 89% higher in the group of small volume clinics (less than 30 procedures per year) than in the group of large volume clinics (more than 120 procedures per year) (odds ratio 1.89; 95% CI 1.19-3.00). Mortality from hip fractures was 33% higher (odds ratio 1.33, 95% CI 1.09-1.63) for the group of small volume clinics (less than 15 procedures per year) than the group of large volume clinics (more than 45 procedures per year). Among the group of small volume hospitals were some with excellent results, but they are more likely to be found in the group of large volume hospitals. On the other hand there were some departments with poorer results in the group of large hospitals. CONCLUSIONS: There is no threshold for good results. In general there is an inverse relationship between volume and outcome. High volume, though, is not a substitute for good results. It is not possible to infer good quality from high volume alone. Small-volume departments should document quality of care and results thoroughly.

Cholecystectomy↗
PubMed2000

[General practice-relevant conclusions based on 74,400 documented biliary surgery interventions].

A statewide report card system for cholecystectomy as a surgical tracer has been established in Westfalia-Lippe as part of a program of external quality assurance. 74,400 data between 1993 and 1997 were analyzed. Pathologic findings in preoperative diagnostics (sonography, elevated bilirubin) do not lead to therapeutic splitting in a sufficient number of cases. Removal of bile duct stones should happen at the latest during cholecytectomy. Preoperative gastroscopy is performed in just about 40%. Higher rates of morbidity and lethality in the aged favour an early elective operation of symptomatic stones.

Aged↗
PubMed1998

[Recurrent laryngeal nerve paralysis after thyroid gland operations. Etiology and consequences].

In the period of 1 January 1990 to 31 December 1996 the thyroidectomy cases we performed were immediately followed by vocal cord evaluation using a flexible bronchoscope while the patient was still on the operating table. If an obvious cord paralysis was discovered, an exploration of the recurrent laryngeal nerve, to the level of the larynx, was performed. If the nerve was found to be intact, no further measures were taken. A severed nerve underwent suture repair. If an otolaryngologist diagnosed a vocal cord paralysis 1-5 days after surgery, a reoperation was recommended except in the cases where postoperative bronchoscopy had shown an easily mobile cord or the recurrent nerve was completely dissected during the operation. Within this 7-year period, we performed 3492 thyroidectomy operations. The diagnosis of subsequent unilateral postoperative vocal cord paralysis occurred in 48 cases. In 33 of these cases the status of the nerve in the surgical field was known: 4 patients had an intact nerve proved by complete dissection during thyroidectomy, in two patients the lesions of the nerve were detected intraoperatively (1 transsection, 1 partial resection), and 27 cases were followed by reoperation. Of the 33 patients mentioned above, in 19 instances the recurrent laryngeal nerve was found to be intact; 3 displayed signs of local trauma, and 11 were found to be severed with total discontinuity. Those patients with an intact nerve, or local nerve trauma only, went on to develop normal function within 6 months in 20 (91%) of 22 cases. Of the 11 with a severed nerve, 8 showed "autoparalysis" with good voice within 4-8 months, after suture repair in 10 cases. The patient with partial resection had no repair of the nerve. If immediate postoperative evaluation showed mobility of the vocal cords but a paralysis was detected later by an otolaryngologist and repeat intervention was not done, vocal cord function was spontaneously restored in 9 of 11 patients. Four patients refused reoperation. From 1990 to 1991, the recurrent laryngeal nerve was not always dissected during our thyroidectomy operations. However, this was done routinely from 1991 to 1996. Routine intraoperative dissection of the vocal cord nerve reduced the rate of postoperative cord paralysis from 2.0% to 1.2%. It also reduced the frequency of intraoperative nerve injury with total discontinuity from 0.58% to 0.23%.

Follow-Up Studies↗