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Objective: We aimed to determine the effect of hospital volume on inhospital mortality, and failure to rescue following major pancreatic resections using hospital discharge data of every inpatient case in Germany. Summary Background Data: Several studies have found strong volume– outcome relationships in pancreatic surgery, with high mortality in low-volume facilities. However, their datasets were only based on portions of national populations. In addition, these studies did not assess the effect of hospital volume according to other crucial variables such as medical indications, postoperative complications, and failure to rescue. Methods: We studied all inpatient cases of major pancreatic surgery (n = 60,858) in Germany from 2009 to 2014, using national hospital discharge data. We evaluated the association between hospital volume and in-hospital mortality following major pancreatic resections by using multivariate regression methods. In addition, we analyzed rates of major complications and failure to rescue across hospital volume quintiles. Results: Risk-adjusted in-hospital mortality varied widely across hospital volume quintiles, from 6.5% (95% CI 6.0–7.0) in very high volume hospitals to 11.5% (95% CI 10.9–12.1) in very low volume hospitals (OR 0.47, 95% CI 0.41–0.54). Rates of postoperative interventions necessary for complications and failure to rescue were lower in higher volume hospitals [eg, mortality following septic complications in very high volume hospitals: 24.2% (95% CI 22.4–26.1) vs. very low volume hospitals: 36.8% (34.9–38.7)]. Moreover, we estimated that centralization of surgical care to the minimum volume and mortality risk of the medium volume quintile could prevent at least 94 deaths per year. Conclusions: In Germany, patients who are undergoing major pancreatic resections have improved outcomes if they are admitted to higher volume hospitals. As current health policies failed to centralize pancreatic surgery procedures in Germany, new strategies to initiate a sufficient centralization process in the field of pancreatic surgery are needed. [ABSTRACT FROM AUTHOR]

Background In Germany, the financing of stroke unit care was implemented into the hospital reimbursement system in 2006. Since then, many acute care hospitals newly implemented stroke units. Simultaneous, in-hospital mortality for stroke declined. Aims The study aims to analyze the association of mortality trends for stroke with the increasing provision of stroke unit care in German hospitals. Methods Hospitalizations for acute stroke from 2005 to 2010 are identified in the nationwide German Diagnosis Related Groups statistics. Trends of risk-adjusted in-hospital mortality are studied stratified by existence of a stroke unit in the admitting hospital, as well as stratified by cohorts of hospitals defined by the respective period of stroke unit implementation. Results Overall, mortality in patients admitted to stroke unit hospitals is lower (crude 9·2%; adjusted 9·8%) compared to patients admitted to nonstroke unit hospitals (12·7%; 11·6%). The longitudinal analysis revealed a general secular trend of declining mortality in all cohorts of hospitals. However, while all stroke unit-providing hospital cohorts converge to a quite similar level of mortality in 2010, mortality in hospitals without stroke unit remains significantly higher. Reduction of mortality in hospitals with early provision of stroke unit care seems to be attributable to the secular trend. A reduction of mortality exceeding the secular trend was observed in hospitals with late stroke unit implementation. Conclusions The earlier stroke unit implementations might represent rather 'formal' inceptions in experienced hospitals with preexisting appropriate stroke care, whereas late implementations seem to have caused extra improvements. Overall, stroke patients are more likely to survive when admitted to an stroke unit-providing hospital. A more stringent assignment of acute stroke patients to stroke unit-providing hospitals could possibly further reduce stroke mortality in Germany. [ABSTRACT FROM AUTHOR]

This nationwide routine data analysis evaluates if oral anticoagulant (OAC) use in patients with heart failure (HF) and atrial fibrillation (AF) leads to a lower mortality and reduced readmission rate. Superiority of new oral anticoagulants (NOACs), compared to vitamin K antagonists (VKA), was analyzed for these endpoints. Anonymous data of patients with a health insurance at the Allgemeine Ortskrankenkasse and a claims record for hospitalization with the main diagnosis of HF and secondary diagnosis of AF (2017–2019) were included. A hospital stay in the previous year was an exclusion criterion. Mortality and readmission for all-cause and stroke/intracranial bleeding (ICB) were analyzed 91–365 days after the index hospitalization. Kaplan-Meier survival curves and multivariable Cox regression models were used to evaluate the impact of medication on outcome. 180,316 cases were included [81 years (IQR 76–86), 55.6% female, CHA 2 DS 2 -VASc score ≥ 2 (96.81%)]. In 80.6%, OACs were prescribed (VKA: 21.7%; direct factor Xa inhibitors (FXaI): 60.0%; direct thrombin inhibitors (DTI): 3.4%; with multiple prescriptions per patient included). Mortality rate was 19.1%, readmission rate was 29.9% and stroke/ICB occurred in 1.9%. Risk of death was lower with any OAC (HR 0.77, 95% CI [0.75–0.79]) but without significant differences in OAC type (VKA: HR 0.73, [0.71–0.76]; FXaI: HR 0.77, [0.75–0.78]; DTI: HR 0.71, [0.66–0.77]). The total readmission rate (HR 0.97, [0.94 to 0.99]) and readmission for stroke/ICB (HR 0.71, [0.65–0.77]) was lower with OAC. Nationwide data confirm a reduction in mortality and readmission rate in HF-AF patients taking OACs, without NOAC superiority. Routine data analysis showing a favorable effect of OAC use in patients with heart failure and atrial fibrillation 91–365 days after the index hospital stay; *: including patients with more than one OAC prescription. Abbreviations: dx. Diagnosis; ICD international classification of disease version; VKA vitamin K antagonist; FXaI direct factor Xa inhibitor; DTI direct thrombin inhibitor; HR hazard ratio; CI confidence interval; ICB intracranial bleeding [Display omitted] • Effects of oral anticoagulants (OAC) in patients with heart failure (HF) and atrial fibrillation (AF) were analyzed. • With use of any OAC, a reduced mortality and readmission rate was visible 91–365 days after index hospitalization for HF-AF with use of any OAC. • No superiority of non-vitamin K oral anticoagulants (NOAC), compared to vitamin K antagonists, was visible for the endpoints. [ABSTRACT FROM AUTHOR]