Availability of Transcatheter Vessel Occlusion Performed by Interventional Radiologists to Treat Bleeding in Germany in the Years 2016 and 2017 – An Analysis of the DeGIR Registry Data

Abstract

<jats:p> Purpose Acute bleeding is a life-threatening condition that can be effectively treated minimally invasively by interventional radiologists using transcatheter vessel occlusion (TCVO). The purpose of this study was to evaluate the availability of TCVO performed by interventional radiologists in Germany based on the DeGIR registry.</jats:p><jats:p> Materials and Methods TCVO interventions from the years 2016 and 2017 were included (DeGIR module B). The number of interventions was assessed by state and region.</jats:p><jats:p> Results TCVO interventions were reported by 242 clinics in Germany. 16 763 module B interventions were reported in 2016 and 16 399 in 2017. DeGIR requirements for certification as a training center were fulfilled by 160 facilities in 2016 and by 162 facilities in 2017. Normalized to one million citizens, an average of 211 TCVO interventions were performed in 2016 and 200 in 2017 (standard deviation was 101 and 109); the median was 202 and 222, respectively. In all regions TCVO interventions were reported. Only a minimal number of small regions showed a lower number of clinics offering TCVO interventions.</jats:p><jats:p> Conclusion The results from the DeGIR registry indicate comprehensive nationwide availability of TCVO performed by interventional radiologists with the necessary experience in Germany on the state level for the treatment of acute bleeding. Furthermore, the distribution of facilities fulfilling the requirements of training centers allows for good educational possibilities for young interventional radiologists in Germany. Only the distribution of clinics offering TCVO in a few small regions might lead to increased transfer times in the case of acute bleeding.</jats:p><jats:p> Key Points: </jats:p><jats:p> Citation Format </jats:p>

Availability of Interventional Oncology in Germany in the Years 2018 and 2019 – Results from a Nationwide Database (DeGIR Registry Data)

“…Here, too, Brandenburg (85), Bremen (25) and Saxony-Anhalt (49) deviated by more than one standard deviation (184) from the mean value of 291. Similar regional variations could already be found in the study on vaso-occlusive measures, which was also based on the DeGIR quality registry data 21 . An acceptable correlation that the increased incidence of certified oncology centers leads to an increase in oncological interventions could not be demonstrated.…”

“…For example, it is conceivable that clinics with low intervention numbers and no prospect of certification may decline to enter their interventions in the quality registry because of the lack of incentive and increased time required. In particular, the similar distribution of regional differences with respect to the provision of interventional procedures in the current study and the DeGIR study on vaso-occlusive procedures suggests a systemic error 21 . With regard to the similar distribution of regional differences in the two studies, it would also be conceivable that individual high-volume centers do not participate in data collection and that this leads to significant distortions of the collected data in structurally poor regions with low hospital density.…”

“…Due to the anonymity of the data collected, this could unfortunately not be investigated in greater detail. However, this distribution phenomenon could also be explained by general regional differences in terms of hospital density, geographic location, and different care structures 21 . However, the fact that the data collected provide a reliable overview of the current supply situation with oncological interventions shows that the difference between the ablations recorded in the DeGIR registry and the ablations performed according to the German hospital registry – 5.8 % – is rather small.…”

“…Dies gilt umso mehr, da die onkologischen Therapieformen zunehmend ambulant durchgeführt werden, was optimalerweise eine wohnortnahe Versorgung erfordert. [21]. Ein annehmbarer Zusammenhang, dass das erhöhte Vorkommen von zertifizierten onkologischen Zentren zu einem Anstieg der onkologischen Interventionen führt, konnte nicht nachgewiesen werden.…”

“…Beispielsweise ist es denkbar, dass Kliniken mit geringen Interventionszahlen ohne Aussicht auf eine Zertifizierung aufgrund des fehlenden Anreizes und des erhöhten Zeitaufwands es ablehnen, ihre Interventionen in das Qualitätsregister einzutragen. Insbesondere die ähnliche Verteilung der regionalen Unterschiede hinsichtlich der Versorgung mit interventionellen Verfahren in der aktuellen Studie sowie der DeGIR-Studie zu gefäßverschließenden Maßnahmen lässt auf einen systemischen Fehler schließen [21]. Im Hinblick auf die ähnliche Verteilung der regionalen Unterschiede in den beiden Studien wäre es auch denkbar, dass sich einzelne "High Volume"-Zentren nicht an der Datenerfassung beteiligen und dies in strukturarmen Regionen mit niedriger Krankenhausdichte zu deutlichen Verzerrungen der erhobenen Daten führt.…”