DÄ internationalArchive5/2022Numbers Are Slightly Confusing
LNSLNS

We congratulate the authors on their work, which is very important and valid in the current political situation (1). Analyses of billing data have shown a clear correlation between annual case numbers and hospital mortality for a multitude of entities (2, 3, 4). This has always been the case for the univariate analysis as well as the multivariate analysis, which is adjusted by patient data. The current article does, however, leave several questions unanswered:

  • Is it possible in the multivariate analysis to clearly document the effect of the annual case numbers on hospital mortality? The authors’ chosen wording, “not independent of the patients’ age and disease etiology (OR: 0.863, 95% CI: 0.701–1.063, p = 0.166)” is somewhat confusing.
  • The fatality rate in a “high volume” center is higher than in the “medium volume” center—does this reach statistical significance in the univariate and multivariate analyses?
  • As the authors themselves reported and discussed, the fatality rate correlates primarily with the degree of liver disease, as reflected in the MELD [Model for End-stage Liver Disease] score. This elementary factor in particular was not included in the evaluable DRG data.
  • Many studies have explained that it is not the occurrence of a complication that is the deciding quality parameter, but the possibility/option of treating such a complication (3).

Medical monitoring of treatment quality is a crucial task. It is possible to carry this out by using billing data in the setting of multiple procedures—for example, oncological procedures—but this type of control does not seem entirely appropriate in the setting of liver transplantation. The low numbers of liver transplantations, the complex disease situation, which can be reflected only incompletely in the DRG system, and owing to the high ethical demands involved in a transplantation, individual control and, linked to this, approval/maintenance as a center for transplantations is preferable.

DOI: 10.3238/arztebl.m2022.0039

Prof. Dr. med. Armin Wiegering,
D
r. med. Johanna Wagner, Dr. med. Philip Baum,
Dr. med. Johannes Diers, Prof. Dr. med. Christoph-Thomas Germer, Prof. Dr. med. Ingo Klein

Klinik für Allgemein-, Viszeral-, Transplantations-,
Gefäß- und Kinderchirurgie; Universitätsklinikum Würzburg,
Wiegering_A@ukw.de

Conflict of interest statement

The authors declare that no conflict of interest exists.

1.
Loosen SH, Bock HH, Hellmich M, Knoefel WT, Trautwein C, Keitel V, Bode JG, Neumann UP, Luedde T: Hospital mortality and current trends in liver transplantation in Germany—a systematic analysis of standardized hospital discharge data, 2008–2017. Dtsch Arztebl Int 2021; 118: 497–502 VOLLTEXT
2.
Hendricks A, Diers J, Baum P, et al.: Systematic review and meta-analysis on volume-outcome relationship of abdominal surgical procedures in Germany. Int J Surg 2021; 86: 24–31 CrossRef MEDLINE
3.
Baum, P., Diers J, Lichthardt S, et al.: Mortality and complications following visceral surgery: a nationwide analysis based on the diagnostic categories used in German hospital invoicing data. Dtsch Arztebl Int 2019; 116: 739–46 VOLLTEXT
4.
Diers J, Baum P, Matthes H, Germer CT, Wiegering A.: Mortality and complication management after surgery for colorectal cancer depending on the DKG minimum amounts for hospital volume. Eur J Surg Oncol 2021; 47: 850–7 CrossRef MEDLINE
1.Loosen SH, Bock HH, Hellmich M, Knoefel WT, Trautwein C, Keitel V, Bode JG, Neumann UP, Luedde T: Hospital mortality and current trends in liver transplantation in Germany—a systematic analysis of standardized hospital discharge data, 2008–2017. Dtsch Arztebl Int 2021; 118: 497–502 VOLLTEXT
2.Hendricks A, Diers J, Baum P, et al.: Systematic review and meta-analysis on volume-outcome relationship of abdominal surgical procedures in Germany. Int J Surg 2021; 86: 24–31 CrossRef MEDLINE
3.Baum, P., Diers J, Lichthardt S, et al.: Mortality and complications following visceral surgery: a nationwide analysis based on the diagnostic categories used in German hospital invoicing data. Dtsch Arztebl Int 2019; 116: 739–46 VOLLTEXT
4.Diers J, Baum P, Matthes H, Germer CT, Wiegering A.: Mortality and complication management after surgery for colorectal cancer depending on the DKG minimum amounts for hospital volume. Eur J Surg Oncol 2021; 47: 850–7 CrossRef MEDLINE

Info

Specialities