Zukunft der operativen Therapie degenerativer Wirbelsäulenerkrankungen: Kontra – Wandel hin zu weniger Operationen aufgrund fehlender Evidenz

Zusammenfassung

Der starke Anstieg von Wirbelsäulenoperationen ist Gegenstand der gesundheitspolitischen Diskussion in Deutschland und bietet Anlass zu einer kritischen Analyse. Teilweise ist die rezente Steigerung um 82 % innerhalb von 10 Jahren durch die demographische Entwicklung, das verbesserte perioperative Patientenmanagement und die technische Weiterentwicklung in der spinalen Chirurgie bedingt. Einen größeren Anteil scheinen jedoch systemimmanente Faktoren aufzuweisen. So sind der Einfluss von finanziellen Anreizen, Patientenerwartungen und Chirurgendichte nicht von der Hand zu weisen. Die Operationshäufigkeiten und die vorliegenden Versorgungsdaten aus Deutschland legen nahe, dass die evidenzbasierten Richtlinien nicht verlässlich bzw. nicht flächendeckend eingehalten werden. Bei oftmals fehlender Evidenz für chirurgische Maßnahmen oder für bestimmte Operationstechniken wird eine strengere Indikationsstellung nicht zu umgehen sein, sodass ein Wandel zu weniger Operationen die Folge sein wird. Ob dies durch bereits angestoßene Maßnahmen beispielsweise der Deutschen Wirbelsäulengesellschaft wie Ausbildungsverbesserung, Wirbelsäulenregister oder Zweitmeinungsportale ausreichend erfolgen wird oder durch politische Intervention aufoktroyiert werden muss, wird sich zeigen.

Abstract

The dramatic increase of spine surgery is vividly discussed in German health politics and necessitates a critical analysis. The recent rise by 82 % within 10 years is partly explained by demographic societal changes, improved perioperative patient management and technical advances in spine surgery. System-based factors like financial incentives, patient expectations and surgeon density, however, also play a major role. German health care data and rates of spine surgery indicate that evidence-based guidelines and recommendations are not reliably or not globally adhered to. As evidence for surgical procedures or particular surgical techniques is often lacking in spine surgery, interventions will be indicated more strictly in the future. Consequently, a change to reduced surgery rates may ensue. If this can be accomplished by measures recently taken by the German Spine Society like improved training, spine registries or portals for second opinions or if it will be imposed by governmental intervention remains to be seen.

Schlüsselwörter

Wirbelsäulenoperationen - Operationszahlen - Evidenz - nationale Trends - Versorgungsbedarf

Keywords

Spine surgery - rates of surgery - evidence - national trends - health care demand

• Literatur

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