Dear members of the DGOU,
It is an exceptional honour for me to represent the German Society for Orthopaedics and Trauma Surgery as its President in 2020. I wish to thank you for your trust and your support in allowing me to take up this position.
What are the questions and tasks we need to address in 2020 and the subsequent years? I feel that there are four main aspects:
- Which structures in clinic and practice do we need in Orthopaedics and Trauma Surgery under the given health policy framework conditions to ensure good care quality for our patients?
- How do we make our subject attractive to the next generation and how can we ensure excellent ad-vanced training?
- What structures do orthopaedics and trauma surgery need in research to be able to answer the many questions that remain open in a translational manner?
- What can the professional society do and what should it do to implement these aspects?
To answer the first question, let me briefly summarise the framework conditions that are currently in place. In both clinic and practice, we work in an environment determined by economics that is character-ised by ever-increasing regulation (keyword: Working Hours Act), a delay in structural investment (key-word: digitisation) and an innovative capacity that is no longer there (keyword: medical device regulation). On the other hand, the justified patient desire for greater quality of life and quality of care is also increas-ing in an ageing society. Personalised and individualised treatment methods with a high degree of differ-entiation and specialisation are what society is demanding.
In an international comparison of orthopaedics and trauma surgery, we are still in a good position: almost every one of us would prefer to be treated at home than in another healthcare system. However, we cannot ignore the fact that the analysis of the current data from the German Endoprosthesis Register (see 2019 EPRD annual report), for example, show that we have significantly higher complication and revision rates for certain procedures compared to other countries. Among other reasons, this is because we offer care that is close to the patient’s home for many surgical procedures in our specialism, particularly planned operations. The extensive hospital landscape ensures good basic care across a wide range of specialisms, which is right and important for emergency traumatological care in particular. On the other hand, not every planned operation needs to be carried out in every hospital and by every surgeon with a specialist qualifi-cation, whether it’s an endoprosthesis or trauma surgery.
I am therefore of the opinion that our specialism needs more of a central point, with a clear definition of which clinical pictures and which injury patterns need to be treated in which clinic. Ultimately, the profes-sional associations have set out where which patients need to be treated and by whom in the case of inju-ries covered by professional association insurance. I am convinced that even larger clinics (orthopaedics and trauma surgery centres) should in an ideal world no longer be divided into orthopaedics and trauma surgery but rather need internal clinic structures focused on topography and anatomy (e.g. a department of shoulder/elbow surgery, a department of spinal surgery, a department of pelvic/hip surgery etc.). Only those who always work on the spine or on the pelvis and hips will be able to achieve excellent quality in their results. Case numbers, experience and knowledge of complication management all pay off when it comes to care quality. This applies to treating fractures caused by accidents and to planned orthopaedic surgery.
Of course structures of this type are human resource and cost-intensive, but this is the only way for com-plex surgery (including replacement of endoprostheses, septic surgery and pelvic/spinal fractures) well in an interdisciplinary setup. In order to achieve this, a clearly defined centre supplement is needed in the mean-oriented DRG system. Even the clinics that offer 24/7 emergency surgery can only maintain well-trained teams and the corresponding infrastructure if they are given the corresponding financial resources to do this.
As a professional society, we need to use dialogue with politicians setting out clear data and facts to en-sure that the existing broad spectrum emergency care in Germany is further expanded and is not de-stroyed by the closure of hospitals. On the other hand, we also have to make the case for the formation of “in-depth”, specialised centres providing complex care being established and paid for separately. In order to achieve these objectives, we need reliable figures from our registers (including the trauma register and EPRD) and from research into care that has not yet been sufficiently intensive.
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