Dinc Nazife, von Sass Christiane, Calero-Martinez Sergio, Won Sae-Yeon, Dubinski Daniel, Bergmann Joachim, Fink Larissa, Adelstein Jil, Ebner Florian, Steiger Hans-Jakob, Senft Christian A, Kamp Marcel A
Department of Neurosurgery, Jena University Hospital, Jena, Germany.
Department of Neurosurgery, Friedrich-Schiller-University Hospital, Jena, German, Germany.
Neurosurg Rev. 2025 Aug 19;48(1):610. doi: 10.1007/s10143-025-03759-9.
This observational cross-sectional study aims to investigate the accessibility of German hospitals in the event of an aneurysmal subarachnoid hemorrhage (SAH). Specifically, it analyzes the average travel time to hospitals of varying care levels (level 2 = advanced, level 3 = comprehensive), defined as facilities equipped with neurosurgical and/or neurointerventional treatment capacities essential for SAH management, and examines the role of university hospitals in SAH management. Furthermore, the association between accessibility and socioeconomic deprivation will be evaluated. Data from all German hospital cases in 2022 were analyzed, based on Section 136b of the Social Code Book V as outlined by the G-BA. Hospital infrastructure and accessibility metrics were sourced from the trinovis VISION platform (trinovis GmbH, Hannover, Germany) using the tools "hospitals" and "accessibility". A total of 7,855 SAH cases were treated in 794 hospitals across Germany. Among these, 27.3% of hospitals provided extended emergency care (treating 1,249 cases), and 19.6% offered comprehensive care (treating 4,279 cases). In total, 78,576 cerebral angiographies and 4,929 selective embolizations were performed. The average travel time to an SAH-capable hospital was 13.6 minutes, with 97% of the population within a 60-minute reach. A significant correlation was found between geographic accessibility and socioeconomic deprivation, with more deprived areas experiencing longer travel times. This cross-sectional study highlights disparities in access to aneurysmal SAH care across Germany. The findings demonstrate that while most of the population lives within a 60-minute travel time to appropriate hospitals, individuals in socioeconomically deprived areas face longer travel times and potentially reduced access to timely, specialized care. Given the high prehospital mortality associated with SAH, these accessibility gaps may contribute to worse outcomes in disadvantaged regions. To improve equity in emergency neurosurgical care, targeted political and structural interventions are required - especially for underserved populations in geographically and socioeconomically isolated areas.
这项观察性横断面研究旨在调查德国医院在动脉瘤性蛛网膜下腔出血（SAH）情况下的可及性。具体而言，它分析了前往不同护理水平医院（2级=高级，3级=综合）的平均出行时间，这些医院被定义为配备有SAH管理所需神经外科和/或神经介入治疗能力的机构，并研究大学医院在SAH管理中的作用。此外，还将评估可及性与社会经济剥夺之间的关联。根据德国医疗卫生质量与效率研究所（G-BA）概述的《社会法典》第五编第136b节，对2022年德国所有医院病例的数据进行了分析。医院基础设施和可及性指标来自trinovis VISION平台（德国汉诺威的trinovis有限公司），使用“医院”和“可及性”工具。德国794家医院共治疗了7855例SAH病例。其中，27.3%的医院提供延长急诊护理（治疗1249例），19.6%的医院提供综合护理（治疗4279例）。总共进行了78576次脑血管造影和4929次选择性栓塞。前往具备SAH治疗能力医院的平均出行时间为13.6分钟，97%的人口在60分钟可达范围内。地理可及性与社会经济剥夺之间存在显著相关性，贫困地区的出行时间更长。这项横断面研究凸显了德国各地在获得动脉瘤性SAH护理方面的差异。研究结果表明，虽然大多数人口居住在距离合适医院60分钟出行时间内，但社会经济贫困地区的个人面临更长的出行时间，可能难以获得及时、专业的护理。鉴于SAH院前死亡率较高，这些可及性差距可能导致贫困地区的治疗结果更差。为了提高急诊神经外科护理公平性，需要有针对性的政治和结构性干预措施——特别是针对地理和社会经济孤立地区服务不足的人群。
