Ideological or pragmatic value-added capture? An inter-cantonal study on the influence of political legitimacy on the configuration of value-added capture in Switzerland

Als eines der wenigen Beispiele weltweit sieht das Schwei-zer Planungsrecht ein Instrument zum Ausgleich planungs-bedingter Bodenwertsteigerungen vor. Die Bestimmung aufder Bundesebene ist jedoch nicht direkt anwendbar, son-dern lediglich ein verbindlicher Rechtsetzungsauftrag an dieKantone. Jenseits der bundesrechtlichen Minimalvorgabenkommen den Kantonen dabei in den Gesetzgebungsverfah-ren weitreichende Gestaltungsspielräume zu. Der vorliegendeBeitrag nutzt diese Konstellation, um zu untersuchen, wiesich die politische Legitimation des Instruments auf die kon-krete rechtliche Ausgestaltung auswirkt. Basierend auf derplanungswissenschaftlichen Literatur ist zu erwarten, dasspragmatische Argumente zu gravierenden kantonalen Rege-lungen führen müssten, beispielsweise durch die expliziteBerücksichtigung von Um- und Aufzonung als weitere Ab-gabetatbestände neben dem bundesrechtlich gefordertenTatbestand der Einzonung. Ideologische Argumente dürftenhingegen zu lediglich minimalen Umsetzungen führen, bei-spielsweise zu einem Abgabesatz, der die bundesrechtlich minimal vorgeschriebenen 20 Prozent nicht überschreitet.Die vergleichende Untersuchung anhand der Kantone Basel-Stadt, Basel-Landschaft und Bern zeigt jedoch eher auf einenumgekehrten Zusammenhang hin. Im Kontrast zu den inter-nationalen Erfahrungen führen in der Schweiz ideologischeArgumente zu einer entscheidenderen planungsrechtlichenAusgestaltung des Mehrwertausgleichs.As one of the few examples worldwide, Swiss law serves for an instrument to compensate for planning-related increases in land value. The provision at the federal level however is not directly applicable, but merely a binding legislative mandate to the cantons. Beyond the minimum requirements under federal law, the cantons are given far-reaching discretion in the legislative process. This paper exploits this constellation in order to examine how the political legitimacy of the instrument affects the concrete legal configuration. Based on the planning literature, two schools of thought hold precedence. First, that pragmatic arguments would lead to farreaching cantonal regulations, e.g., through the explicit consideration of rezoning and upzoning as further taxable events in addition to the federal law requirement of zoning. Second, that ideological arguments are likely to only lead to minimal implementations, e.g., to a levy rate that does not exceed the minimum 20 percent prescribed by federal law. However, this comparative study based on the cantons of Basel-Stadt, Basel-Landschaft, and Bern instead points to a reverse correlation. In contrast to international experience, ideological arguments in Switzerland lead to amore far-reaching design of value added capture under planning law

The duration of postoperative ileus after elective colectomy is correlated to surgical specialization

Aim: Postoperative ileus is an important factor of complications following gastrointestinal procedures. Its pathophysiology and the parameters, which may impact on its duration, remain unclear. The aim of this study was to measure the role of various clinical determinants on restoration of intestinal function after elective colorectal surgery. Methods: From July 2002 to September 2003, all patients who underwent laparotomy for colectomy (laparoscopic resections excluded) with either an ileotransverse, colocolic, or high colorectal anastomosis were entered in this prospective study. The intervals in hours between the end of the surgical procedure and passing of flatus (PG) and passing of stool (PS) were recorded by an independent investigator. PG and PS were eventually correlated with the following parameters: type of colectomy, early removal of nasogastric tube (NGT), mechanical bowel preparation (MBP), type of underlying disease, systemic administration of opiates, and surgical training (colorectal fellowship or other). Results: One hundred twenty-four patients were entered in this study. Four patients (3.2%) developed septic complications (3 anastomotic leaks and 1 intraabdominal abscess) and were excluded from the analysis. Median age in this population was 68 (range 30-95) years. Mean duration of postoperative ileus was 70±28h (PG) and 99±34h (PS). The type of colectomy, underlying disease, MBP, and early NGT removal failed, in univariate analysis, to correlate with the duration of postoperative ileus. By contrast, time intervals PG and PS were statistically shorter in the group of patients treated by a colorectal surgeon [56±23 vs 74±28h (PG); 82±26 vs 103±35h (PS), p=0.004], as well as in patients who received systemic opiates for less than 2days [64±27 vs 75±28h (PG), p=0.04; 88±32 vs 108±33h (PS), p=001]. Conclusion: Restoration of normal intestinal function after elective open colectomy takes 3 (PG) to 4 (PS) days. In our series, specialized training in colorectal surgery has a positive impact on the duration of postoperative ileus. Surgical specialization should be considered an important parameter in future clinical trials aiming to minimize postoperative ileu

Gastric perforation after duodenopancreatectomy

Fungal and bacterial infections are often which may cause sepsis. Mucormycosis is an unfrequent, but often life-threatening disease. A timely diagnosis and treatment is the cornerstone of success. An increase in incidence can be expected, given an aging population and increasing incidence of obesity, diabetes and cancer.We present a rare case where early diagnosis has helped to treat the patient mainly with antifungal therapy as surgical therapy has had high risk of complications. Keywords: Mucormycosis, Duodenopancreatectomy, Whipple operation, Gastric, Perforatio

Mesh fixation to fascia during incisional hernia repair results in increased prevalence of pain at long-term follow up: a multicenter propensity score matched prospective observational study

Background: Patient-reported outcomes such as postoperative pain are critical for the evaluation of outcomes after incisional hernia repair. The aim of this study is to determine the long-term impact of mesh fixation on postoperative pain in patients operated by open and laparoscopic technique. Methods: A multicenter prospective observational cohort study was conducted from September 2011 until March 2016 in nine hospitals across Switzerland. Patients undergoing elective incisional hernia repair were included in this study and stratified by either laparoscopic or open surgical technique. Propensity score matching was applied to balance the differences in baseline characteristics between the treatment groups. Clinical follow-up was conducted 3, 12 and 36 months postoperatively to detect hernia recurrence, postoperative pain and complications. Results: Three-hundred-sixty-one patients were included into the study. No significant differences in hernia recurrence and pain at 3, 12 and 36 months postoperatively were observed when comparing the laparoscopic with the open treatment group. Mesh fixation by sutures to fascia versus other mesh fixation led to significantly more pain at 36 months postoperatively (32.8% vs 15.7%, p = 0.025). Conclusions: At long-term follow-up, no difference in pain was identified between open and laparoscopic incisional hernia repair. Mesh fixation by sutures to fascia was identified to be associated with increased pain 36 months after surgery. Omitting mesh fixation by sutures to the fascia may reduce long-term postoperative pain after hernia repair

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease