Universität zu Köln

Loosen, Sven H., Bock, Hans H., Hellmich, Martin, Knoefel, Wolfram T., Trautwein, Christian, Keitel, Verena ORCID: 0000-0003-1383-7662, Bode, Johannes G., Neumann, Ulf P. and Luedde, Tom (2021). Hospital Mortality and Current Trends in Liver Transplantation in Germany A Systematic Analysis of Standardized Hospital Discharge Data, 2008-2017. Dtsch. Arztebl. Int., 118 (29.3). S. 497 - 508. COLOGNE: DEUTSCHER AERZTE-VERLAG GMBH. ISSN 1866-0452

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Abstract

Background: Liver transplantation (LT) has undergone dynamic developments in recent decades. In Germany, the Federal Joint Committee (G-BA) recently tightened the guidelines regarding the minimum number of transplantations a center should perform annually. The aim of the study presented here, was to analyze recent trends in hospital mortality due to LT in Germany. Methods: Standardized hospital discharge data (2008-2017) from the Federal Statistical Office of Germany were used to establish hospital mortality after LT and case volume distribution among centers performing <20 LT annually (low volume centers, LVC), 20-49 LT (medium volume centers, MVC), and >_ 50 LT (high volume centers, HVC). Results: Data from 9254 LT procedures were evaluated. The annual frequency of LT fell from n = 984 (2008) to n = 747 (2017), and over the same period the hospital mortality for all LT procedures went down from 15.8% to 11.0%. Hospital mortality was associated with age (<16 years: 5.3% to 60-69 years: 17.4%); however, there was no further increase in patients >_ 70 years (16.5%). Univariate analysis revealed association of increased hospital mortality with liver disease etiology, the necessity for relaparotomy, and prolonged mechanical ventilation. The proportion of LT procedures performed in LVC and MVC increased and that in HVC decreased. LVC had higher hospital mortality than MVC/HVC, but this effect was dependent on patient age and disease etiology. Conclusion: Our study showed that differences in mortality rate after LT among centers (LVC vs. MVC/HVC) were dependent on patient age and disease etiology. This should be taken into account when discussing the overall organization of LT in Germany.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Loosen, Sven H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bock, Hans H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hellmich, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Knoefel, Wolfram T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Trautwein, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Keitel, Verena UNSPECIFIED orcid.org/0000-0003-1383-7662 UNSPECIFIED Bode, Johannes G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Neumann, Ulf P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Luedde, Tom UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-593358
DOI:	10.3238/arztebl.m2021.0210
Journal or Publication Title:	Dtsch. Arztebl. Int.
Volume:	118
Number:	29.3
Page Range:	S. 497 - 508
Date:	2021
Publisher:	DEUTSCHER AERZTE-VERLAG GMBH
Place of Publication:	COLOGNE
ISSN:	1866-0452
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MECHANICAL VENTILATION Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59335