[Surgery in the hospital and the practice : Chances, challenges and perspectives in otorhinolaryngology].

Operative ear, nose and throat (ENT) medicine in Germany is facing a profound structural change, which is significantly influenced by the ongoing hospital reform, the expansion of outpatient surgery services and technical innovations. University and peripheral hospitals, practices, medical care centres and private clinics differ significantly in terms of resources, specialisation, remuneration systems and training opportunities. The reform is leading to a greater concentration of complex ENT services in high-performance centres, while standardised procedures are increasingly being performed on an outpatient basis. Hybrid forms of diagnosis-related groups (DRGs) and the Ambulantes Operieren im Krankenhaus (AOP; outpatient surgery) catalogue extensions are intended to promote sector-specific remuneration but are creating new economic tensions, especially for clinics with high standby costs. At the same time, outpatient surgery centres and practices are gaining in importance, but some face structural disadvantages. Digitalisation, artificial intelligence-based planning, robotic assistance and intraoperative imaging are fundamentally changing surgical work and opening up new possibilities in precision, documentation and training. This creates new requirements for surgical training: while highly complex procedures remain centre based, basic procedures must increasingly be learned in the outpatient sector. This requires cross-sectoral rotation models, consolidated curricula, digital simulation and reliable funding for outpatient training positions. Overall, the future of surgical ENT care lies in coordinated interaction between hospitals and practices, structural cooperation, modern remuneration systems, and technical and ecological innovation.