Spatial Analysis of Hospital Incidence and in Hospital Mortality of Abdominal Aortic Aneurysms in Germany: Secondary Data Analysis of Nationwide Hospital Episode (DRG) Data

Kuehnl, Andreas; Salvermoser, Michael; Erk, Alexander; Trenner, Matthias; Schmid, Volker; Eckstein, Hans‐Henning

doi:10.1016/j.ejvs.2018.02.024

Cited by 15 publications

(16 citation statements)

References 27 publications

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“…By means of controlled remote data processing (CRDP), the microdata of the diagnosis-related groups (DRG) statistics of the StBA from 2012 to 2014 were evaluated. The basic methods for CRDP of DRG statistics have been used and described in detail in previous studies [6,9,[15][16][17][18].…”

Section: Methodsmentioning

confidence: 99%

“…Although a certain regional variation can be expected on a statistical basis and conclusions should be drawn with caution [8], regional differences in the frequency of operations can be used to generate hypotheses in order to identify determinants of suboptimal care processes (e.g., access to the health care system, supplier-induced increase in demand, etc.) [9][10][11][12]. Recent studies from the US [13] and Spain [14] showed significant regional differences in the application of EVAR for treatment of iAAA (US, Spain) and rAAA (US).…”

Section: Introductionmentioning

confidence: 99%

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Regional variation in endovascular treatment rate and in-hospital mortality of abdominal aortic aneurysms in Germany

Trenner

Salvermoser

Reutersberg

et al. 2020

Vasa

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Summary: Background: Abdominal aortic aneurysms (AAA) can be treated by either open surgery (OAR) or endovascular aortic repair (EVAR). The aim of this study was to analyze regional variations in application of (EVAR) and in-hospital mortality after intact AAA (iAAA) repair. Methods: Using data provided by the German Federal Statistical Office, a nationwide analysis for 2012 to 2014 was conducted. Patients with a diagnosis of iAAA (I71.4) and corresponding procedure codes for OAR (5-384.5/7) or EVAR (5-38a.1) were included. Odds ratios (ORs) for use of EVAR (proportion of EVAR among total EVAR + OAR cases) and mortality were calculated for all regions in Germany. ORs for EVAR use were adjusted for age, sex, and risk (Elixhauser score). ORs for mortality were additionally adjusted for type of procedure (OAR/EVAR). Results: Finally, 31,757 procedures for iAAA were included. Median age of all patients was 73 years (interquartile range 67–78 years) and 87.1 % were male. The mean proportion of EVAR procedures was 72.6 %; however, the application of EVAR for repair of iAAA varied widely depending on region. The lowest unadjusted regional rate of EVAR use was 48.8 %, while the highest was 92.5 %. After adjustment, the lowest regional OR for EVAR use (compared to the nationwide mean) was 0.23 (95 % confidence interval [0.15–0.36]), the highest 5.93 [1.79–19.65]. Overall in-hospital mortality was 2.9 % (OAR 6.2 %; EVAR 1.7 %). The adjusted regional OR for mortality ranged from 0.31 [0.07–1.42] to 4.98 [2.08–11.93]. Conclusions: This study reveals variations in use of EVAR and in-hospital mortality for iAAA treatment in Germany. This may imply that selection of treatment might not only be influenced by patient characteristics, but also by regional location. These results need to be taken into account when discussing centralization of AAA treatment in Germany.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Regional variation in endovascular treatment rate and in-hospital mortality of abdominal aortic aneurysms in Germany

Trenner

Salvermoser

Reutersberg

et al. 2020

Vasa

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“…The highest regional incidences were found in the northwestern parts of Germany, whereas southern and eastern regions showed below average incidences. Mortality rates did not significantly differ [13].…”

Section: Regional Variations In Aaamentioning

confidence: 82%

Secondary analysis of statutorily collected routine data

et al. 2019

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“…im Verlauf beschrieben werden. Auch kleinräumige Analysen von Versorgungsmerkmalen sind möglich (z.B Kuehnl et al 2018…”

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Datenzugang für die Qualitätsmessung in der akutstationären Krankenhausversorgung

Nimptsch¹,

Schömann²,

Mansky³

2019

Qualitätsmonitor 2019

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Mit der Einführung des DRG-Systems, das Krankenhausleistungen auf der Grundlage von dokumentierten Patienten-und Behandlungsinformationen pauschal vergütet, sind in den administrativen Datenbeständen der Krankenhäuser umfassende Informationen in standardisierter elektronischer Form verfügbar geworden. Da diese Abrechnungsdaten (sog. DRG-Daten) in allen Krankenhäusern, die dem Krankenhausentgeltgesetz (KHEntgG) unterliegen, erhoben werden und auf der Grundlage des § 21 KHEntgG an zentraler Stelle zusammengeführt werden, ist in Deutschland ein Datenbestand verfügbar, der das akutstationäre Versorgungsgeschehen nahezu vollständig abbildet. Unter der derzeitigen Ausgestaltung des § 21 KHEntgG sind die Möglichkeiten zur Nutzung dieser Daten auf bestimmte Nutzungsberechtigte und bestimmte Nutzungszwecke beschränkt. Eine weitergehende Nutzung der deutschlandweiten DRG-Daten könnte jedoch zusätzliche Möglichkeiten zur Qualitätsmessung in der akutstationären Krankenhausversorgung eröffnen und damit zur Qualitätstransparenz und zur Weiterentwicklung der Versorgungsstrukturen beitragen. Der vorliegende Beitrag beschreibt die Entstehung und die Eigenschaften der DRG-Daten und zeigt die derzeitigen Nutzungsmöglichkeiten des Datenbestandes gemäß § 21 KHEntgG. Es wird erläutert, welches Potenzial die deutschlandweiten DRG-Daten über die derzeitigen Nutzungsmöglichkeiten hinaus bieten könnten und welche gesetzlichen Änderungen für eine erweiterte Nutzung erforderlich wären.

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Spatial Analysis of Hospital Incidence and in Hospital Mortality of Abdominal Aortic Aneurysms in Germany: Secondary Data Analysis of Nationwide Hospital Episode (DRG) Data

Abstract: There was significant regional variation and clustering of the hospital incidence of AAA in Germany, with higher rates in the northwest and lower rates in the southeast. There was no significant variation in standardised (age/sex/risk) mortality between counties.

Cited by 15 publications

References 27 publications

Regional variation in endovascular treatment rate and in-hospital mortality of abdominal aortic aneurysms in Germany

Regional variation in endovascular treatment rate and in-hospital mortality of abdominal aortic aneurysms in Germany

Secondary analysis of statutorily collected routine data

Datenzugang für die Qualitätsmessung in der akutstationären Krankenhausversorgung

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