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Vascular bypass surgery in children differs significantly from adults. It is a rarely performed procedure in the setting of trauma and tumor surgery. Besides technical challenges to reconstruct the small and spastic vessels, another concern in bypass grafting is the adequate limb length growth over time. The primary aim of this study was to assess long-term outcome after pediatric bypass grafting, in a single academic center, focusing on potential effects on limb development. In this retrospective cohort analyses we included all pediatric patients undergoing vascular bypass grafting at our department between 2002 and 2017. All patients ≤ 18 years suffered a traumatic injury or underwent a tumor resection of the lower or upper limb. The youngest female patient was 0.4 years, the youngest male patient was 3.5 years. During the observation period, 33 pediatric patients underwent vascular repair, whereby 15 patients underwent bypass grafting. Median overall follow-up was 4.7 years (IQR ± 9). 8 patients (53%) had a traumatic injury (traumatic surgery group) and 7 patients had a planned orthopedic tumor resection (orthopedic surgery group). In 13/15 (87%) a great saphenous vein (GSV) graft and in 2/15 (13%) a Gore-Tex graft was used for bypassing. Both Gore-Tex grafts showed complete occlusion 12 and 16 years after implantation. No patient died in the early postoperative phase (

Von den jahrlich insgesamt rund 220.000 akutstationaren Aufenthalten von Kindern und Jugendlichen unter 18 Jahren werden rund 10,6 % (rund 23.500) uber Abteilungen fur Kinder- und Jugendchirurgie (KJC) abgedeckt. Im Jahr 2018 waren etwas mehr als 1000 dieser Aufenthalte den relativ seltenen Krankheiten mit KJC-Indikation vorwiegend im thorakalen und gastrointestinalen Bereich zuzuordnen. Das bedeutet, dass bei insgesamt 7 derzeit aktiven KJC-Abteilungen fur viele der hier relevanten medizinischen Einzelleistungen die – bei Erwachsenen haufig gewahlte – jahrliche Mindestfallzahl (n ≥ 10) nicht erreicht werden kann. Daraus ergibt sich die Frage, ob durch strukturplanerische Festlegungen (Standorte, Kapazitaten) und/oder durch die Festlegung von jahrlichen Mindestmengen an KJC-Eingriffen bei relativ seltenen Krankheiten eine regionale Bundelung angestrebt werden soll. Nachdem derartige Masnahmen in der Regel dann Akzeptanz finden, wenn ausreichende wissenschaftliche Evidenz fur die qualitative Verbesserung des medizinischen Outcomes an Krankenhausstandorten mit hoheren Fallzahlen vorhanden ist, musste eine derartige Evidenz entweder uber die Literatur oder aber durch entsprechende empirische Nachweise hergestellt werden. Auswertungen aus den in Osterreich verfugbaren Routinedaten (Daten aus der leistungsorientierten Krankenanstaltenfinanzierung) konnten den Aufbau eines KJC-Registers fur seltene Erkrankungen unterstutzen, das in der Folge derartige Nachweise sicherstellen konnte. Die Umsetzung einer regionalen Schwerpunktsetzung konnte entweder uber eine freiwillige Abstimmung zwischen den Experten und Expertinnen der einzelnen KJC-Abteilungen erfolgen oder aber auch durch die Anwendung der Instrumente des Osterreichischen Strukturplans Gesundheit: uberregionale Versorgungsplanung bzw. Leistungsmatrix-stationar. Die beste Voraussetzung fur eine derartige Weiterentwicklung ware, dass moglichst alle Beteiligten von deren Sinnhaftigkeit bzw. Notwendigkeit uberzeugt werden konnen.

Neonatal “surgical” malformations are associated with higher costs than major “non-surgical” birth defects. We aimed to analyze the financial burden on the Austrian health system of five congenital malformations requiring timely postnatal surgery. The database of the Austrian National Public Health Institute for the period from 2002 to 2014 was reviewed. Diagnosis-related group (DRG) points assigned to hospital admissions containing five congenital malformations coded as principal diagnosis (esophageal atresia, duodenal atresia, congenital diaphragmatic hernia, gastroschisis, and omphalocele) were collected and compared to all hospitalizations for other reasons. Out of 3,518,625 total hospitalizations, there were 1664 admissions of patients with the selected malformations. The annual mean number was 128 (SD 17, range 110–175). The mean cost of the congenital malformations per hospital admission expressed in DRG points was 26,588 (range 0–465,772, SD 40,702) and was significantly higher compared to the other hospitalizations (n = 3,516,961, mean DRG 2194, range 0–834,997, SD 6161, p &lt, 0.05). Surgical conditions requiring timely postnatal surgery place a significant financial burden on the healthcare system. The creation of a dedicated national register could allow for better planning of resource allocation, for improving the outcome of affected children, and for optimizing costs.

Background The recent Austrian Primary Care Act established new primary health care units (PHCUs) and obliged them to draw up a “care strategy” specifying their focal care tasks and objectives and emphasizing the health care needs of the population in their catchment area with its specific local health and epidemiological profile. The main purpose of these care strategies is thus to ensure that care-providers meet the local needs, but they also provide a rationale for evaluation and organizational development. To assist new PHCUs in establishing care strategies it was necessary to develop a method for automatically generating comprehensive local case studies for any freely definable location in Austria. Results We designed an interactive report generator capable of producing location-specific regional health care profiles for a PHCU located in any of Austria’s 2122 municipalities and of calculating the radius of its catchment area (defined by different levels of maximum car-travelling times). The reports so generated, called “regional health care profiles for primary health care” (RHCPs/PHC), are in comprehensive PDF report format. The core of each report is a set of 35 indicators, classified under five health and health service domains. The reports include an introductory text, definitions, a map, a graphic and tabular presentation of all indicator values, including information on local, supra-regional and national value distribution, a ranking, and numbers of service providers (e.g. pharmacies, surgeries, nursing homes) located within the catchment area. Conclusions The RHCPs/PHC support primary health care planning, efforts to improve care-effectiveness, and strategic organizational development by providing comprehensive information on the health of the population, the utilization of health services and the health care structures within the catchment area. In addition to revealing the scope and nature of the health care needed, they also provide information on what public health approaches are necessary. RHCPs/PHC for different locations have already been distributed to numerous stakeholders and primary health care providers in Austria.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are the major reason for COPD hospitalization and increased risk for readmissions. The organizational structure of Austrian hospitals provides the opportunity to investigate the impact of specialized respiratory care compared to general care on adherence to guidelines and readmission in AECOPD.The data from the European COPD audit, a prospective observational non-interventional cohort trial were analyzed. In total, 823 patients admitted due to AECOPD in 26 hospitals (specialized respiratory care vs. general care) within Austria were included. Patients characteristics and outcomes (length of stay, readmission rate, and mortality) were analyzed in relation to hospital resources (personnel and equipment) and adherence to international guidelines.Patients admitted to general care had more comorbidities (Charlson comorbidity index: 2.6 ± 1.7 vs. 2.0 ± 1.4; p 0.05) and a shorter length of stay (10.7 ± 7.8 days vs. 12.0 ± 10.2 days; p 0.05). Patients admitted to specialized respiratory care more often underwent blood gas analysis and non-invasive ventilation (98.4% vs. 81.5% and 68.6% vs. 26.7%, p 0.01; respectively). In multivariate analysis, the risk for AECOPD readmission was lower (odds ratio, OR 0.72 [0.51;0.91]; p 0.05) in patients admitted to specialized respiratory care.A greater adherence to COPD guidelines with respect to blood gas analysis and non-invasive ventilation and decreased AECOPD readmission risk was observed for patients admitted to specialized respiratory care. Adherence to guidelines may have the potential to decrease COPD readmission rates.

In previous international comparisons of regional differences in the utilisation of selected therapies, individual countries have mostly been described in isolation. In the present study, an attempt is made for the first time to systematically compare the utilisation of selected surgical interventions in Germany and Austria at the small-scale level. Comparative analyses were carried out for three surgical procedures: artificial hip and knee replacements and cardiopulmonary bypass surgery (CPB) using a heart-lung machine. Data were drawn from the German and Austrian diagnosis related groups (DRG) statistics. The regional variation in hospital admission rates was age-standardised and linked to the patients’ domicile before being analysed statistically and cartographically, both as a regional cross-section and as a longitudinal survey. At the county level, the quotients between the highest and the lowest rates in Germany were 2.1 and 3.1 for hip and knee joint replacements respectively, and 2.8 for both in Austria; for CPB interventions the regional variation is somewhat greater, namely 3.7 in Germany and 3.2 in Austria. In recent years, the interquartile distance for the hospital admission rates in individual regions has fluctuated in both countries, so there is no clear indication of a reduction in the regional differences in age-standardised hospital utilisation. The regional variation in selected surgical procedures can be analysed not only within each country separately, but also for Germany and Austria as a single unit, ignoring the border between them. In both countries, the regional cross-sectional analysis at the county level highlights regional distribution patterns whose causes merit further investigation.

Zusammenfassung Die Patientenorientierung wird in der Bedarfsplanung/Gesundheitsplanung in Osterreich unter Nutzung der laufend verbesserten Datengrundlagen bereits in vielfaltiger Weise berucksichtigt, allerdings primar in Richtung einer indirekten Beeinflussung bzw. Verbesserung der individuellen Patienten-Versorger-Interaktion. Die im „Osterreichischen Gesundheitsinformationssystem (OGIS)“ bei der Gesundheit Osterreich GmbH (GOG) verfugbaren Datengrundlagen werden seit Jahren auch zur Intensivierung der Patientenorientierung im Rahmen der Bedarfsplanung (angelegt als die Wechselwirkungen zwischen den Sektoren berucksichtigende „integrative regionale Versorgungsplanung“) und auch zur Festlegung bzw. zum Monitoring der zehn „Gesundheitsziele Osterreich“ genutzt. Fur die nachsten Jahre ist eine weitere Verbesserung bzw. Vervollstandigung der Datengrundlagen zur Unterstutzung der Bedarfsplanung/Gesundheitsplanung zum bedarfsgerechten Aus-/Umbau der regionalen Gesundheitssysteme, zur Intensivierung der Versorgungsforschung und in der Folge auch zu einer verbesserten Patientenorientierung in Osterreich zu erwarten. Generell gibt es in Osterreich Bemuhungen, die Patientenperspektive in der Gesundheitsplanung/Bedarfsplanung besser zu integrieren (z.B. durch Einbeziehung von Patientenanwaltschaft bzw. Selbsthilfegruppen). Allerdings sind diese Bemuhungen noch nicht bis ins Stadium einer vollen Umsetzung gediehen (u.a. auch deswegen, weil die von den Patienten selbst wahrgenommenen organisatorischen Verbesserungspotenziale bzw. die Ergebnisqualitat aus Patientensicht noch nicht ausreichend berucksichtigt werden konnten), sodass es in den kommenden Jahren noch weitere Bemuhungen in diese Richtung braucht.

Objectives: To assess the epidemiology of ALS in Austria and to evaluate the long-term effect of riluzole treatment on survival. Methods: Hospital discharge and riluzole prescription databases were used to identify ALS cases from January 2008 to June 2012. Using the capture-recapture method we evaluated the incidence and prevalence of ALS and patients' survival in dependence of age, gender and riluzole treatment. Results: The corrected incidence and prevalence of ALS were 3.13/100,000 person-years (95% CI, 2.77 to 3.50) and 9.14/100,000 persons (95% CI, 8.53 to 9.79), respectively. Median survival from diagnosis was 676 days (95% CI, 591 to 761). A younger age at diagnosis was associated with a longer survival. Gender did not appear to affect survival time. Riluzole therapy was associated with a survival advantage only for the initial treatment period. The adjusted hazard ratio of mortality for using riluzole increased continually over time resulting in an apparent reversal of its beneficial effect after 6 months of therapy. Conclusions: We report incidence and prevalence estimates that are on the upper end of the wide range discussed in literature. Riluzole seems to exert a beneficial effect only in the first 6 months of therapy.

Patient orientation has already been taken into account in healthcare planning approaches in Austria by using constantly improved routine health data, though primarily falling in the category of an indirect influence on or improvement of the individual patient-provider interaction. Data bases available in "Österreichische Gesundheitsinformationssystem (ÖGIS)" at Gesundheit Österreich GmbH (GÖG) have been used for years to both intensify the patient orientation within the needs-based planning framework (designed as "integrated regional healthcare planning", bearing the interactions between the sectors in mind) and to define and monitor the ten "Health Goals Austria". For the next few years, we can expect a further advancement and completion of the database in favour of healthcare planning to support the necessary adaptation and reorganization of the regional healthcare systems, the intensification of healthcare research and subsequently an improved patient orientation in Austria. In general, efforts are being made in Austria to improve the integration of the patient's perspective in the area of health care planning (e.g. by involving patients 'attorneys' or self-help groups). However, these efforts have not yet reached the stage of full implementation (inter alia also because the organizational potential for improvement or the quality of results from the patient's perception could not yet be adequately taken into account). Accordingly, further efforts to this end will be necessary in the upcoming years.

Introduction Rates and routes of hysterectomy have implications for quality, costs and training. This study analyzed rates of benign hysterectomy and surgical approaches for benign hysterectomy in Austria from 2002 to 2014. Material and Methods This was a population-based retrospective observational study of coding data from all acute care hospitals (public and private) in Austria. Main outcome measures were numbers of women undergoing hysterectomy for benign indications in Austria per year and the route of hysterectomy for benign indications. Results The number of benign hysterectomies performed per year declined from 10 675 in 2002 to 7747 in 2014, a decline of 27%. The use of vaginal hysterectomy was stable (53% and 47%, respectively). Use of laparoscopic techniques increased (5% in 2002, 32% in 2014) whereas use of abdominal hysterectomy decreased (41% and 20%, respectively). Conclusions Numbers of benign hysterectomies performed per year in Austria declined substantially between 2002 and 2014. Use of vaginal hysterectomy was stable at about 50%, whereas increased use of laparoscopic techniques was associated with lower rates of open hysterectomy.

For a needs-planning system to be able to guarantee to provide the population with universal, locally available ambulatory medical care, it requires information concerning how patients choose their doctors, the size of the catchment areas of medical practices and the resulting distance-sensitivity of the population in relation to each medical speciality. In this contribution a model of opportunity’s preference for the health sector is developed. The key parameter of the distance sensitivity of the patients on the basis of real data is calibrated. Furthermore, this contribution empirically examines whether people in their choice of the established surgeons minimize the ways time (expense minimization) or if they are not aware of the nearest doctor, but the doctor of their confidence (act of preferential expression).

When it came into force on 1 January 1993, the Health Structure Act brought about far-reaching changes in the German health system by completely reorganising needs-related planning for office-based medical care. The experience to date suggests that needs-related planning is having an effect. Since the law came into effect, the increase in the number of doctors has clearly levelled off, and in certain fields the trend can even be said to have been reversed. Indeed, needs-related planning will in future have to address a completely new issue, one that only a few years ago was considered inconceivable: a looming lack of doctors. It is precisely in this context that needs-related planning, an arrangement conceived when the number of doctors was rising, can be seen to have strategic flaws. It has now become clear that the data (population, number of doctors) and information on structures (geographical planning units) drawn on in needs-related planning to indicate the degree of provision are unsuitable for ascertaining the need for, and controlling the supply of, office-based medical care. Indeed, the current needs-related planning hardly justifies its name. There is a need for genuinely strategic planning that, rather than measuring the status quo in isolation, takes due heed of likely future trends in such factors as population and the number of doctors. The reversal of the trend from over- to undersupply of medical care has brought about an increasing scarcity of points of access. If the Associations of Statutory Health Insurance Physicians are to meet their legal commitment to provide universal medical coverage, it is essential that an analysis of the relationships within the care supply network be carried out. A potential solution to this problem is offered by “regional studies interaction models”, which model the physical accessibility and convenience for patients of supplier locations (here: office-based physicians) and the response of the demand side (here: the patients) to the existing geographical constellations.

Aim To identify effects of ‘needs planning’ for doctors under contract with statutory health insurance in Austria and in Germany on the evenness of doctors’ geographical distribution.

AIM OF THE STUDY: The notified incidence of meningococcal disease in European countries varies from

Background. Results of trial E2100 led to the accelerated approval of bevacizumab as first-line therapy for patients with metastatic breast cancer (MBC) in the U.S. in February 2008. Based on results from subsequent trials, the U.S. Food and Drug Administration Oncologic Drugs Advisory Committee (ODAC) issued a statement proposing to withdraw the license for bevacizumab in July 2010, whereas bevacizumab approval for MBC was not withdrawn in Europe. In this nationwide survey, we investigated the influence of the discrepancy between the ODAC and European Medicines Agency (EMA) positions on the prescription practice of bevacizumab for MBC in Austria during the period January 2006 to June 2011. Methods. The absolute number of bevacizumab administrations for MBC patients per month in all Austrian hospitals within the mentioned time frame was retrieved from a comprehensive national database. Bevacizumab prescription numbers for other malignancies were retrieved in order to rule out that a change in bevacizumab prescribing practice might reflect general changes in Austrian health care policy. Results. A steady increase in bevacizumab use was seen from January 2006 to June 2010 (42 versus 1,357 administrations per month) for MBC. Thereafter, a significant decline in bevacizumab prescriptions for MBC became evident, with numbers dropping to 842 in March 2011 and 662 in June 2011. Bevacizumab prescriptions showed only minor variations in control cohorts. Conclusions. The Austrian bevacizumab prescribing practice in MBC patients was significantly influenced by the ODAC statement issued in July 2010, whereas the EMA position was accepted to a lesser degree.

The purpose of this study was to investigate recent epidemiological trends of myasthenia gravis (MG) in Austria. We used the national hospital discharge register, which records the discharge diagnoses of all inpatient stays in Austria to calculate the yearly inpatient prevalence of MG from 1992 to 2009 (main or secondary diagnosis of MG). The population prevalence was indirectly estimated. The temporal and geographical variability of the inpatient prevalence was correlated with the number of practicing neurologists. The inpatient prevalence of 2009 was calculated as 8.0 and the population prevalence as 15.69 (95 % CI 13.16–19.42) per 100,000. We observed a 2.2 fold increase in the inpatient prevalence between 1992 and 2009, which was mainly due to a rise in the number of older patients (³ 50 years). Partly this could be accounted for by an ageing of the population as a whole and a rise in the age of hospitalised patients. However, after adjusting for demographic factors an unexplained average yearly rise of 3.7–3.9 % remained. We found a significant spatial and temporal correlation of MG inpatient prevalence rates with the number of practicing neurologists, which increased over the same period. The results from this study support the notion that the prevalence rate of MG in Austria is rising and near the higher end of the wide range discussed in the literature. Our data argue for the importance of specialist neurological care for the diagnosis of this disease.

To evaluate orchidopexy patterns in Austria.All boys with cryptorchidism who underwent orchidopexy (n = 19.998) in Austria between 1993 and 2009 were analyzed using the database Austrian Health Information System at the Austrian Federal Research and Planning Institute for Health Care. Regression models were constructed to examine associations between the probability of orchidopexy before 24 months of life and the following parameters: year of birth, federal state of residence, character of area of living (rural/urban) and hospital type.Average age at operation dropped from 6 to 4.3 years (mean 5.2 years, SD 3.8 years). Total incidence of orchidopexy was continuously rising throughout the study period (p0.0001), with an OR of 1.007 (95% C.I.: 1.004; 1.0100) per year. The rate of operations between 0 and 2 years (p0.001) and 3-7 years (p0.001) increased, while the rate in boys older than 7 years decreased (p0.001). Year of birth (p0.0001) and place of residence (p0.0001 and p0.024) are significant predictors for having early orchidopexy.In Austria the total incidence of orchidopexy is significantly rising. Moreover, the incidence of orchidopexies performed before 24 months of life is constantly rising with significant geographic differences.

Im vorliegenden Beitrag zur Gedenkschrift fur Egon Matzner wird dargestellt, in welcher Weise die theoretischen und methodischen Ansatze, die dem Verfasser wahrend seines Studiums der Raumplanung und Raumordnung an der TU Wien an den Instituten fur Infrastruktur- und Finanzplanung (IFIP) bzw. fur Stadt- und Regionalforschung (SRF) vermittelt wurden, zu einer Synthese verbunden werden konnten, die in der Gesundheitsplanung in Osterreich und auch im Ausland mittlerweile Akzeptanz gefunden hat und die in weiten Teilen bereits erfolgreich angewandt und umgesetzt wurde.