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Risikomanagement in der orthopädischen Chirurgie

Stratifizierung und Adjustierung patientenindividueller Risikofaktoren

Risk management in orthopedic surgery

Stratification and adjustment of patient-individual risk factors

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Zusammenfassung

Die präoperative Identifikation von Risikopatienten ermöglicht dem orthopädischen Chirurgen eine auf die individuelle Risikokonstellation angepasste Indikationsstellung, Operationsplanung und Aufklärung der Patienten. Zur individuellen Risikobeurteilung steht neben demographischen und eingriffsspezifischen Faktoren eine Vielzahl an Instrumenten zur Verfügung. Die Erfassung von Frailty (engl. Gebrechlichkeitssyndrom) scheint dabei ein vielversprechender Ansatz zur Identifikation von Risikopatienten zu sein. Modifizierbare Risikofaktoren wie Malnutrition, Anämie, Adipositas, Nikotinabusus und ein insuffizient eingestellter Diabetes mellitus sind bei elektiv orthopädischen Patienten verbreitet, können aber durch Screeningverfahren präoperativ erkannt, optimiert und das individuelle Komplikationsrisiko dadurch minimiert werden. Empfehlungen zur Risikostratifizierung und -adjustierung vor elektivem Hüftgelenksersatz haben mittlerweile auch Einzug in die nationalen Leitlinien gefunden.

Abstract

Preoperative identification of patients at risk of postoperative complications enables better patient education and surgical planning for the orthopedic surgeon. In addition to demographic and intervention-specific factors, a variety of instruments are available for individual risk assessment. The concept of frailty seems to be promising to identify patients at risk. Modifiable risk factors such as malnutrition, anemia, obesity, smoking, and insufficiently controlled diabetes mellitus are common in elective orthopedic patients. With the use of screening protocols, modifiable risk factors can be identified and optimized preoperatively in order to reduce the individual risk of complications. Recommendations regarding preoperative risk stratification and modification prior to elective hip replacement have meanwhile been incorporated in national guidelines.

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Abbreviations

ASA:

American Society of Anesthesiologists

BMI:

Body-Mass-Index

BZgA:

Bundeszentrale für gesundheitliche Aufklärung

CCI:

Charlson Comorbidity Index

COPD:

„Chronic obstructive pulmonary disease“

ECM:

Elixshauser Comorbidity Method

G‑BA:

Gemeinsamer Bundesausschuss

HFRS:

Hospital Frailty Risk Score

ICD:

International Statistical Classification of Diseases and Related Health Problems

ISAR:

Identification of Seniors at Risk Score

KHK:

Koronare Herzkrankheit

pAVK:

Periphere arterielle Verschlusskrankheit

rHuEPO:

Rekombinantes humanes Erythropoietin

RiFLS:

Risk Factor Liaison Service

SOG:

Spezielle Orthopädische Geriatrie

TUG:

„Timed up and go test“

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Authors and Affiliations

  1. Orthopädische Klinik für die Universität Regensburg, Regensburg, Deutschland

    Matthias Meyer

  2. Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland

    Matthias Meyer, Tobias Kappenschneider & Joachim Grifka

  3. Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland

    Markus Weber

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Correspondence to Matthias Meyer.

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Interessenkonflikt

M. Meyer, T. Kappenschneider, J. Grifka und M. Weber geben an, dass kein Interessenkonflikt besteht.

Diesem Beitrag liegt eine prospektive Datenerhebung bei Patienten der Klinik und Poliklinik für Orthopädie am Asklepios Klinikum Bad Abbach zu Grunde. Ein positives Votum der Ethikkommission an der Universität Regensburg liegt vor (Nr. 20-1837-101).

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Meyer, M., Kappenschneider, T., Grifka, J. et al. Risikomanagement in der orthopädischen Chirurgie. Orthopäde 51, 81–90 (2022). https://doi.org/10.1007/s00132-021-04206-5

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