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We thank our correspondent for discussing the data we published (1), but our conclusions are different. The data set extracted from the registries of the Germany Society for General and Visceral Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV) was processed according to the current scientific knowledge; the risk adjustment is explained in the electronic addendum to the methods section. The study was a quality analysis of elective visceral cancer surgery, as in Germany the discussion about a possible effect of the day of the week on the result of surgical interventions keeps recurring. Overall, the results of the study for hospitals participating in the registry is very positive; postoperative fatality rates are notable lower than in the national comparison, even on Mondays and Tuesdays (2, 3). Similar calculation models exist in aeronautics and spaceflight. It was shown that only subsequent and more extensive structural analyses explain the causes underlying the described differences, provide a possible (clinical) relevance, and show measures for improvement. Comparable quality analyses with diverging results were conducted and published in the USA, Australia, England, and the Netherlands (4). We are not aware of any action brought for medical error, in which these studies resulted in a shift in the burden of proof.

Participation in the DGAV registries enables hospitals to undertake a risk adjusted comparison of their treatment results to the average/mean of the other participating hospitals. This helps with the identification of their own potential for improvement. By creating the StuDoQ registries the DGAV succeeded in creating a nationwide platform for analyzing surgical treatments and thus optimize surgical therapy for the benefit of the patients.

DOI: 10.3238/arztebl.m2021.0056

On behalf of the authors
Dr. med. Friedrich Anger
PD Dr. med. Armin Wiegering
Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-,
Gefäß- und Kinderchirurgie
Universitätsklinikum Würzburg
wiegering_a@ukw.de

Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists.

1.
Anger F, Wellner U, Klinger C, et al.: The effect of day of the week on morbidity and mortality from colorectal and pancreatic surgery—an analysis from the German StuDoQ register. Dtsch Arztebl Int 2020; 117: 521–7 VOLLTEXT
2.
Baum P, Diers J, Lichthardt S, et al.: Mortality and complications following visceral surgery—a nationwide analysis based on the diagnostic categories used in German hospital invoicing data. Dtsch Arztebl Int 2019; 116: 739–46 VOLLTEXT
3.
Nimptsch U, Krautz C, Weber GF, Mansky T, Grützmann R: Nationwide in-hospital mortality following pancreatic surgery in Germany is higher than anticipated. Ann Surg 2016; 264: 1082–90 CrossRef MEDLINE
4.
Ruiz M, Bottle A, Aylin PP: The global comparators project: international comparison of 30-day in-hospital mortality by day of the week. BMJ Qual Saf 2015; 24: 492–504 CrossRef MEDLINE PubMed Central
1.Anger F, Wellner U, Klinger C, et al.: The effect of day of the week on morbidity and mortality from colorectal and pancreatic surgery—an analysis from the German StuDoQ register. Dtsch Arztebl Int 2020; 117: 521–7 VOLLTEXT
2.Baum P, Diers J, Lichthardt S, et al.: Mortality and complications following visceral surgery—a nationwide analysis based on the diagnostic categories used in German hospital invoicing data. Dtsch Arztebl Int 2019; 116: 739–46 VOLLTEXT
3.Nimptsch U, Krautz C, Weber GF, Mansky T, Grützmann R: Nationwide in-hospital mortality following pancreatic surgery in Germany is higher than anticipated. Ann Surg 2016; 264: 1082–90 CrossRef MEDLINE
4.Ruiz M, Bottle A, Aylin PP: The global comparators project: international comparison of 30-day in-hospital mortality by day of the week. BMJ Qual Saf 2015; 24: 492–504 CrossRef MEDLINE PubMed Central

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