Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Eur J Vasc Endovasc Surg. 2021 Aug;62(2):167-176. doi: 10.1016/j.ejvs.2021.03.021. Epub 2021 May 7.
This is a description of the German healthcare landscape regarding carotid artery disease, assessment of hospital incidence time courses for carotid endarterectomy (CEA) and carotid artery stenting (CAS), and simulation of potential effects of minimum hospital caseload requirements for CEA and CAS.
The study is a secondary data analysis of diagnosis related group statistics data (2005-2016), provided by the German Federal Statistical Office. Cases encoded by German operation procedure codes for CEA or CAS and by International Classification of Diseases (ICD-10) codes for carotid artery disease were included. Hospitals were categorised into quartiles according to annual caseloads. Linear distances to the closest hospital fulfilling hypothetical caseload requirements were calculated.
A total of 132 411 and 33 709 patients treated with CEA and CAS from 2012 to 2016 were included. CEA patients had lower rates of myocardial infarction (1.4% vs. 1.8%) and death (1.2% vs. 4.0%), and CAS patients were more often treated after emergency admission (38.1% vs. 27.1%). Age standardised annual hospital incidences were 67.2 per 100 000 inhabitants for CEA and 16.3 per 100 000 inhabitants for CAS. The incidence for CEA declined from 2005 to 2016, with CAS rising again until 2016 after having declined from 2010 to 2013. Regarding distance from home to hospital, centres offering CEA are distributed more homogeneously across Germany, compared with those performing CAS. Hypothetical introduction of minimum annual caseloads (> 20 for CEA; > 10 for CAS) imply that 75% of the population would reach their hospital after travelling 45 km for CEA and 70 km for CAS.
Differences in spatial distribution mean that statutory minimum annual caseloads would have a greater impact on CAS accessibility than CEA in Germany. Presumably because of a decline in carotid artery disease and a transition towards individualised therapy for asymptomatic patients, hospital incidence for CEA has been declining.
本研究描述了德国颈动脉疾病的医疗保健状况，评估了颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）的医院发病时间进程，并模拟了 CEA 和 CAS 最低医院病例量要求的潜在影响。
本研究是对德国联邦统计局提供的诊断相关组统计数据（2005-2016 年）的二次数据分析。包括编码为 CEA 或 CAS 的德国手术程序代码和国际疾病分类（ICD-10）颈动脉疾病代码的病例。根据年度病例量将医院分为四组。计算到满足假设病例量要求的最近医院的线性距离。
2012 年至 2016 年期间，共纳入 132411 例 CEA 和 33709 例 CAS 患者。CEA 患者心肌梗死（1.4% vs. 1.8%）和死亡（1.2% vs. 4.0%）发生率较低，而 CAS 患者更常接受紧急入院治疗（38.1% vs. 27.1%）。CEA 的年龄标准化年发病率为每 10 万人 67.2 例，CAS 为每 10 万人 16.3 例。CEA 的发病率从 2005 年下降到 2016 年，而 CAS 在 2010 年至 2013 年下降后，又在 2016 年再次上升。关于到医院的距离，与 CAS 相比，提供 CEA 的中心在德国的分布更加均匀。假设引入最低年度病例量要求（CEA > 20；CAS > 10），则 75%的人口在前往 CEA 时将行驶 45 公里，前往 CAS 时将行驶 70 公里。
空间分布的差异意味着，在德国，法定最低年度病例量对 CAS 可及性的影响将大于 CEA。由于颈动脉疾病的减少和对无症状患者个体化治疗的转变，CEA 的医院发病率一直在下降。
