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448. Surgical oncological elderly – Risk factors for ICU death
S170
ABSTRACTS
446. Ten reasons why surgical oncology is not a model of success in Germany: A personal view H. Becker1 1 Westpfalz-Klinikum, Kaiserslautern, Germany
may explain disparities between voivodeships in reference to therapy instituted. The cost of BC treatment in Poland has no effect on treatment outcomes, despite it belongs to the lowest in EU. No conflict of interest.
Introduction: Surgical Oncology is an evolving field and many societies exist throughout Europe. But it seems that this sub-speciality is not as successful in Germany as in other European countries. The following items aim at establishing a discussion and to improve this situation. Items: 1. Misunderstanding 2. Hierarchy 3. History 4. Bureaucracy 5. Minority 6. Financial interests 7. Ignorance 8. Technical fascination 9. Structure of healthcare system (G-DRG’s) 10. Quality vs Quantity Discussion: These items are illustrated with real examples and discussed. Steps towards improvement of this situation are presented. No conflict of interest.
http://dx.doi.org/10.1016/j.ejso.2014.08.435
http://dx.doi.org/10.1016/j.ejso.2014.08.434
447. Breast cancer therapy methods and treatment costs in Poland (2005e2007) K. Herman1, W.M. Wysocki1, J. Mitus2, A. Sliwczynski3 1 Centre of Oncology Maria Sklodowska e Curie Memorial Institute Krakow Branch Krakow Poland, Department of Surgical Oncology, Krakow, Poland 2 Department of Surgical Oncology Cancer Centre Maria SklodowskaCurie Institute of Oncology, Department of Anatomy Collegium Medicum Jagiellonian University Krakow Poland, Krakow, Poland 3 National Health Fund Warsaw Poland, Institute of Medical Biology Medical Collage L odz Poland, Krakow, Poland Background: Survival rates in breast cancer (BC) patients in Poland have significantly improved. However 5-year relative survival (5y RS) rates in Western European countries are still better. The aim of this study is to analyze the treatment methods and therapy costs with their correlation to 5y RS. Material and methods: In 2005e2007 in Poland 43 738 patients were diagnosed with breast cancer for the first time. The Polish National Health Fund Patients’ Therapy Registry was analyzed with special focus on the treatment methods, therapy costs and differences in these regards between particular voivodeships. Results: The 5y RS was 79.8% (range 75.3%e82.4% in voivodeships). Chemotherapy was given to 69.4% of patients (range 59.3%e87.6%). The rate of trastuzumab usage varied between voivodeships from 1.0% to 5.7%. Irradiation rate in different voivodeship ranged from 32.4% to 63.0%. Over 83% of patients was treated surgically (range 78.6% e 87.3%). The difference in the 5y RS was statistically significant between voivodeships. The 5y RS was significantly longer in voivodeships where breast conserving surgery was used more frequently. A higher rate of sentinel node (SN) procedure was significantly related to the longer 5y RS. There were no statistically significant differences referring to 5y RS and treatment costs between voivodeships. The average treatment costs were approx. 6423 V per patient. Significant differences were observed between voivodeships (range 4760e 9755 V), mainly attributed to chemotherapy costs. Systemic therapy constituted 25%e48% of all treatment costs. The average costs of chemotherapy were 3235 V, radiotherapy 1641 V and surgical treatment 737 V per patient. Conclusions: There was a steady improvement in 5y OS rate (approx. 1% annually) in Poland. Lack of efficient control of treatment standards
448. Surgical oncological elderly e Risk factors for ICU death C. Carneiro1, R. Rocha1, R. Marinho1, A. Gomes1, M. Sousa1, T. Brand~ao1, I. Braga1, V. Nunes1 1 Hospital Fernando Fonseca Lisbon, Surgery, Amadora, Portugal Background: Elderly oncological patients requiring Intensive Care Unit (ICU) after surgery is rising. ICU treatment is a costly and limited resource and everyday we must face the decision on who to admit. Our aim was to evaluate the risk factors for ICU death in our elderly patients (65 or older) submitted to surgery for an oncological disease and treated in ICU for organ dysfunction. Methods: We conducted a retrospective cohort study of surgical elderly patients treated in ICU for organ dysfunction from January 2008 to December 2013. We analyzed patients’ demographic and clinical parameters, number of ICU days, number of mechanical ventilation days, SAPS II, death in ICU, total hospitalization days and survival time since ICU. Parametric and non-parametric tests, uni and multivaried analysis were used. Results: During this period our surgical ICU treated 2139 patients. We excluded those treated for medical reasons, transferred to another hospital and non oncological. 908 oncological patients remained and of those we selected 795 with 65 or more years, excluded 450 admitted for post operative surveillance and studied the remaining 345 patients. 205 males (59%), mean age 75,9y (range 65e102y). SAPS II 42,5 (range 12e100). Mean days of mechanical ventilation of 3,8 days (range 0e82). Mean days of ICU stay 4 ,6 days (range 3e138). We conducted uni and multivariate analysis of risk factors for death in ICU. Conclusion: Elderly patients are a frail population, in which oncological disease is frequent, with multiple comorbidities, making their mortality an important issue mainly when treated for organ dysfunction. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.436
449. Impact of a proprietary database management system on quality assurance and patient safety in surgery T. Ja¨ger1, A. Dinnewitzer1, S. Sta¨ttner1, F. Primavesi1, D. Ofner1 1 Paracelsus Medical University, Surgery, Salzburg, Austria Background: Digital health data are an integral part of high level patient safety and quality assurance. To achieve steady flow of reliable information, intelligent and adapted database management systems (DBMS) are crucial. The objective of this analysis was to investigate the impact of a proprietary DBMS on quality and safety at the surgical department of a university hospital. The practical use and technical background of ChiBaseÓ together with the implementation of quality assurance and patient safety will be presented. Material and methods: ChiBaseÓ is a proprietary DBMS developed by surgeons in cooperation with computer scientists using FileMaker Pro 12Ó.The integration in hospital information system was realized by HL7Ó interface. To accomplish audit criteria several security standards were included. Results: The implementation of ChibaseÓ over a five year period has proved its worth in daily surgical routine in terms of enhancing patient safety and quality assurance. By continuous optimization of patient coordination and monitoring together with constant assessment of surgical
ABSTRACTS
446. Ten reasons why surgical oncology is not a model of success in Germany: A personal view H. Becker1 1 Westpfalz-Klinikum, Kaiserslautern, Germany
may explain disparities between voivodeships in reference to therapy instituted. The cost of BC treatment in Poland has no effect on treatment outcomes, despite it belongs to the lowest in EU. No conflict of interest.
Introduction: Surgical Oncology is an evolving field and many societies exist throughout Europe. But it seems that this sub-speciality is not as successful in Germany as in other European countries. The following items aim at establishing a discussion and to improve this situation. Items: 1. Misunderstanding 2. Hierarchy 3. History 4. Bureaucracy 5. Minority 6. Financial interests 7. Ignorance 8. Technical fascination 9. Structure of healthcare system (G-DRG’s) 10. Quality vs Quantity Discussion: These items are illustrated with real examples and discussed. Steps towards improvement of this situation are presented. No conflict of interest.
http://dx.doi.org/10.1016/j.ejso.2014.08.435
http://dx.doi.org/10.1016/j.ejso.2014.08.434
447. Breast cancer therapy methods and treatment costs in Poland (2005e2007) K. Herman1, W.M. Wysocki1, J. Mitus2, A. Sliwczynski3 1 Centre of Oncology Maria Sklodowska e Curie Memorial Institute Krakow Branch Krakow Poland, Department of Surgical Oncology, Krakow, Poland 2 Department of Surgical Oncology Cancer Centre Maria SklodowskaCurie Institute of Oncology, Department of Anatomy Collegium Medicum Jagiellonian University Krakow Poland, Krakow, Poland 3 National Health Fund Warsaw Poland, Institute of Medical Biology Medical Collage L odz Poland, Krakow, Poland Background: Survival rates in breast cancer (BC) patients in Poland have significantly improved. However 5-year relative survival (5y RS) rates in Western European countries are still better. The aim of this study is to analyze the treatment methods and therapy costs with their correlation to 5y RS. Material and methods: In 2005e2007 in Poland 43 738 patients were diagnosed with breast cancer for the first time. The Polish National Health Fund Patients’ Therapy Registry was analyzed with special focus on the treatment methods, therapy costs and differences in these regards between particular voivodeships. Results: The 5y RS was 79.8% (range 75.3%e82.4% in voivodeships). Chemotherapy was given to 69.4% of patients (range 59.3%e87.6%). The rate of trastuzumab usage varied between voivodeships from 1.0% to 5.7%. Irradiation rate in different voivodeship ranged from 32.4% to 63.0%. Over 83% of patients was treated surgically (range 78.6% e 87.3%). The difference in the 5y RS was statistically significant between voivodeships. The 5y RS was significantly longer in voivodeships where breast conserving surgery was used more frequently. A higher rate of sentinel node (SN) procedure was significantly related to the longer 5y RS. There were no statistically significant differences referring to 5y RS and treatment costs between voivodeships. The average treatment costs were approx. 6423 V per patient. Significant differences were observed between voivodeships (range 4760e 9755 V), mainly attributed to chemotherapy costs. Systemic therapy constituted 25%e48% of all treatment costs. The average costs of chemotherapy were 3235 V, radiotherapy 1641 V and surgical treatment 737 V per patient. Conclusions: There was a steady improvement in 5y OS rate (approx. 1% annually) in Poland. Lack of efficient control of treatment standards
448. Surgical oncological elderly e Risk factors for ICU death C. Carneiro1, R. Rocha1, R. Marinho1, A. Gomes1, M. Sousa1, T. Brand~ao1, I. Braga1, V. Nunes1 1 Hospital Fernando Fonseca Lisbon, Surgery, Amadora, Portugal Background: Elderly oncological patients requiring Intensive Care Unit (ICU) after surgery is rising. ICU treatment is a costly and limited resource and everyday we must face the decision on who to admit. Our aim was to evaluate the risk factors for ICU death in our elderly patients (65 or older) submitted to surgery for an oncological disease and treated in ICU for organ dysfunction. Methods: We conducted a retrospective cohort study of surgical elderly patients treated in ICU for organ dysfunction from January 2008 to December 2013. We analyzed patients’ demographic and clinical parameters, number of ICU days, number of mechanical ventilation days, SAPS II, death in ICU, total hospitalization days and survival time since ICU. Parametric and non-parametric tests, uni and multivaried analysis were used. Results: During this period our surgical ICU treated 2139 patients. We excluded those treated for medical reasons, transferred to another hospital and non oncological. 908 oncological patients remained and of those we selected 795 with 65 or more years, excluded 450 admitted for post operative surveillance and studied the remaining 345 patients. 205 males (59%), mean age 75,9y (range 65e102y). SAPS II 42,5 (range 12e100). Mean days of mechanical ventilation of 3,8 days (range 0e82). Mean days of ICU stay 4 ,6 days (range 3e138). We conducted uni and multivariate analysis of risk factors for death in ICU. Conclusion: Elderly patients are a frail population, in which oncological disease is frequent, with multiple comorbidities, making their mortality an important issue mainly when treated for organ dysfunction. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.436
449. Impact of a proprietary database management system on quality assurance and patient safety in surgery T. Ja¨ger1, A. Dinnewitzer1, S. Sta¨ttner1, F. Primavesi1, D. Ofner1 1 Paracelsus Medical University, Surgery, Salzburg, Austria Background: Digital health data are an integral part of high level patient safety and quality assurance. To achieve steady flow of reliable information, intelligent and adapted database management systems (DBMS) are crucial. The objective of this analysis was to investigate the impact of a proprietary DBMS on quality and safety at the surgical department of a university hospital. The practical use and technical background of ChiBaseÓ together with the implementation of quality assurance and patient safety will be presented. Material and methods: ChiBaseÓ is a proprietary DBMS developed by surgeons in cooperation with computer scientists using FileMaker Pro 12Ó.The integration in hospital information system was realized by HL7Ó interface. To accomplish audit criteria several security standards were included. Results: The implementation of ChibaseÓ over a five year period has proved its worth in daily surgical routine in terms of enhancing patient safety and quality assurance. By continuous optimization of patient coordination and monitoring together with constant assessment of surgical