Volume Growth of Inpatient Treatments for Spinal Disease – Analysis of German Nationwide Hospital Discharge Data from 2005 to 2014

Hintergrund Seit der Einführung der Diagnosis related Groups (DRG) zur Vergütung akutstationärer Krankenhausleistungen wurden Anstiege der stationären Fallzahlen zur Behandlung von Erkrankungen der Wirbelsäule beobachtet. Ziel dieser Arbeit ist, diese Mengenentwicklung bevölkerungsbezogen und nach Behandlungsarten differenziert darzustellen. Material und Methode In den deutschlandweiten Krankenhausabrechnungsdaten (DRG-Statistik) wurden Behandlungsfälle mit operativer sowie nicht operativer Versorgung von Wirbelsäulenerkrankungen identifiziert. Unter Berücksichtigung der demografischen Entwicklung wurde analysiert, in welchem Umfang sich die Fallzahlen im Zeitraum von 2005 bis 2014 verändert haben und in welchen Altersgruppen und bei welchen Eingriffs- bzw. Behandlungsarten Anstiege zu verzeichnen sind. Ergebnisse Im Jahr 2014 (2005) wurden 289 000 (177 000) operativ versorgte und 463 000 (287 000) nicht operativ versorgte Behandlungsfälle identifiziert. Nach Bereinigung um demografische Faktoren wurden sowohl bei operativen als auch bei nicht operativen Behandlungen relative Fallzahlanstiege um jeweils ca. 50% beobachtet, die in höheren Altersgruppen und bei Frauen besonders ausgeprägt waren. Die Mengenentwicklung fiel je nach Art des Eingriffs bzw. der Behandlung sehr unterschiedlich aus. Bei den operativ versorgten Behandlungsfällen hat sich die Anzahl der Bandscheibenoperationen demografiebereinigt nur um + 5% erhöht während sich Wirbelkörperversteifungs- und -ersatzeingriffe, Kypho- und Vertebroplastien und alleinige Dekompressionen der Wirbelsäule mehr als verdoppelt haben. Bei den nicht operativ versorgten Behandlungsfällen wurde bei Behandlungen mit lokaler Schmerztherapie der Wirbelsäule ein demografiebereinigter Anstieg von + 142% beobachtet. Bei rein konservativen Behandlungen lag der demografiebereinigte Anstieg bei + 22%. Schlussfolgerung Welche Ursachen den nicht demografiebedingten Fallzahlanstiegen zugrunde liegen, kann diese Untersuchung nicht direkt klären. Die stratifizierte Betrachtung der Fallzahlen in den verschiedenen Untergruppen kann aber dazu beitragen, die Entwicklungen differenziert einzuordnen und damit die Diskussion um eine mögliche Über- oder Fehlversorgung zielgerichteter als bisher zu führen.Background Marked volume growth of inpatient treatments for spinal disease has been observed since diagnosis related groups (DRG) were introduced as payment for inpatient services in Germany. This study aims to analyse this increase by population and stratified by types of treatment. Material and Methods Using German nationwide hospital discharge data (DRG statistics), inpatient treatments for spinal disease with or without surgery were identified. Trends in case numbers were analysed from 2005 to 2014 with consideration of demographic changes, in order to explore which age groups and which types of treatment are affected by volume growth. Results In 2014 (2005), 289 000 (177 000) inpatient treatments with surgery and 463 000 (287 000) treatments without surgery were identified. After adjusting for demographic factors, treatments with and without surgery exhibited a relative volume growth of + 50%. This increase affected higher age groups and women, in particular. Depending on the type of treatment, very different degrees of volume growth were observed. For example, disc surgeries adjusted for demographic change increased by about + 5%, whereas spinal fusion and vertebral replacement surgeries, kypho-/vertebroplasties and decompression of the spine more than doubled. Within the non-surgically treated cases, local pain therapies of the spine increased after adjustment for demographic changes by about + 142%. The conservatively treated cases showed a demographically adjusted increase of + 22%. Conclusion Apart from demographic changes, this analysis cannot resolve the underlying causes of volume growth in treatments for spinal disease. However, the stratified analysis of various subgroups may help to classify these developments in a more differentiated manner. The results may support a more targeted debate about potential over- or misallocation of inpatient services in this area

Teledermatology: Comparison of Store-and-Forward Versus Live Interactive Video Conferencing

A decreasing number of dermatologists and an increasing number of patients in Western countries have led to a relative lack of clinicians providing expert dermatologic care. This, in turn, has prolonged wait times for patients to be examined, putting them at risk. Store-and-forward teledermatology improves patient access to dermatologists through asynchronous consultations, reducing wait times to obtain a consultation. However, live video conferencing as a synchronous service is also frequently used by practitioners because it allows immediate interaction between patient and physician. This raises the question of which of the two approaches is superior in terms of quality of care and convenience. There are pros and cons for each in terms of technical requirements and features. This viewpoint compares the two techniques based on a literature review and a clinical perspective to help dermatologists assess the value of teledermatology and determine which techniques would be valuable in their practice

Absorption and distribution of etoricoxib in plasma, CSF, and wound tissue in patients following hip surgery—a pilot study

The perioperative administration of selective cyclooxygenase-2 (COX-2)-inhibitors to avoid postoperative pain is an attractive option: they show favorable gastro-intestinal tolerability, lack inhibition of blood coagulation, and carry a low risk of asthmatic attacks. The purpose of this study was to determine the cerebrospinal fluid (CSF), plasma, and tissue pharmacokinetics of orally administered etoricoxib and to compare it with effect data, i.e., COX-2-inhibition in patients after hip surgery. The study was performed in a blinded, randomized, parallel group design. A total of 12 adult patients were included who received 120 mg etoricoxib (n = 8) or placebo (n = 4) on day 1 post-surgery. Samples from plasma, CSF, and tissue exudates were collected over a period of 24 h post-dosing and analyzed for etoricoxib and prostaglandin E2 (PGE2) using liquid chromatography-tandem mass spectrometry and immuno-assay techniques. CSF area under the curve (AUC) [AUCs(O–24h)] for etoricoxib amounted to about 5% of the total AUC in plasma (range: 2–7%). Individual CSF lag times with respect to (50%) peak plasma concentration were ≤2 h in all but one case (median: 1 h). PGE2 production in tissue was significantly blocked by the COX-2 inhibitor starting with the appearance of etoricoxib in tissue and lasting for the whole observation period of 24 h (P < 0.01). In conclusion, etoricoxib reaches the CSF and site of surgery at effective concentrations and reduces PGE2 production at the presumed site of action

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