Leuchtweis Isabel, Groeben Christer, Flegar Luka, Zacharis Aristeidis, Baunacke Martin, Thomas Christian, Schmidt Marcel, Schneider Andreas, Schultz-Lampel Daniela, Volkmer Björn, Eisenmenger Nicole, Salem Johannes, Huber Johannes
Klinik und Poliklinik für Urologie, TU Dresden, Dresden, Deutschland.
Klinik für Urologie, Philipps-Universität Marburg, Baldingerstr., 35033, Marburg, Deutschland.
Urologie. 2022 Nov;61(11):1229-1236. doi: 10.1007/s00120-022-01873-w. Epub 2022 Jun 29.
Although outpatient provision of services is economically desirable, many minor urological interventions in Germany are currently carried out on an inpatient basis. The aim of our study is to investigate whether the current health policy framework contributes to more outpatient treatment.
We used a sample of 4.9 million anonymous, insured persons representative according to age and region provided by the Institute for Applied Health Research (InGef GmbH). We report extrapolations for the number of outpatient and inpatient services throughout Germany between 2013 and 2018. In addition, we performed an economic analysis for two selected interventions.
During the study period, the total number of prostate biopsies declined from 184,573 to 174,558 cases. The share of outpatient biopsies declined continuously by 0.9% per year from 81% to 76% (p < 0.001). For botulinum toxin injection into the bladder, the total increased from 15,630 to 26,824 cases. The share of outpatient treatments increased by 2.7% per year from 3% to 19% (p = 0.01). For the other examined interventions (insertion of suprapubic urinary catheters, the insertion, removal, and changing of ureteral stents, cystoscopies and urethral dilatation), there were no significant changes in the share of outpatient procedures.
The significant increase of outpatient botulinum toxin injections shows the successful control effect through adapted remuneration options. A shift to the inpatient sector was observed for prostate biopsies. This may be due to higher hygienic standards and technical requirements for MRI fusion.
尽管门诊服务在经济上是可取的，但德国目前许多小型泌尿外科手术仍在住院基础上进行。我们研究的目的是调查当前的卫生政策框架是否有助于增加门诊治疗。
我们使用了应用健康研究所在年龄和地区方面具有代表性的490万匿名参保人员样本（InGef GmbH）。我们报告了2013年至2018年德国门诊和住院服务数量的推断情况。此外，我们对两项选定的手术进行了经济分析。
在研究期间，前列腺活检的总数从184,573例下降到174,558例。门诊活检的比例每年持续下降0.9%，从81%降至76%（p < 0.001）。对于膀胱注射肉毒杆菌毒素，总数从15,630例增加到26,824例。门诊治疗的比例每年增加2.7%，从3%增至19%（p = 0.01）。对于其他检查的手术（耻骨上导尿管插入、输尿管支架的插入、取出和更换、膀胱镜检查和尿道扩张），门诊手术的比例没有显著变化。
门诊肉毒杆菌毒素注射的显著增加表明通过调整薪酬选项取得了成功的控制效果。前列腺活检出现了向住院部门的转变。这可能是由于MRI融合的卫生标准和技术要求更高。
