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  • 1
    Online Resource
    Online Resource
    Effects of the new injury type catalogue of the German statutory accident insurance on a center for severe injury type procedures
    Springer Science and Business Media LLC ; 2020
    In:  Der Unfallchirurg Vol. 123, No. 5 ( 2020-05), p. 360-367
    Details
    In: Der Unfallchirurg, Springer Science and Business Media LLC, Vol. 123, No. 5 ( 2020-05), p. 360-367
    Type of Medium: Online Resource
    ISSN: 0177-5537 , 1433-044X
    URL: Article
    DOI: 10.1007/s00113-019-00714-4
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 3120926-9
    detail.hit.zdb_id: 1461952-0
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  • 2
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    Severe injury type procedures—Influence of the cipher 11 “complications” and the COVID-19 pandemic on a center for maximum care of severe injuries
    Springer Science and Business Media LLC ; 2023
    In:  Die Unfallchirurgie Vol. 126, No. 6 ( 2023-06), p. 477-484
    Details
    In: Die Unfallchirurgie, Springer Science and Business Media LLC, Vol. 126, No. 6 ( 2023-06), p. 477-484
    Abstract: Ensuring the best treatment options for injured patients (healing process, Heilverfahren , HV) is the main goal and responsibility of the German statutory accident insurance (DGUV). The injury type catalogue is the tool to guide the HV. The development of the number of cases treated in a center for severe injury type procedures, the effects of the cipher 11 “complications” of the catalogue and the effects of the COVID-19 pandemic are presented. Methods A retrospective study of all patients treated in the context of the DGUV from January 2019 to December 2021 was carried out. The number of cases before and during the legal lockdown actions were compared. The case mix index, the mean number of operations, the mean time in the operating room and the hospital stay were analyzed. Additionally, the cases under the cipher 11 were classified according to the specific anatomical regions. Results Out of 2007 cases 67% were classified as severe injury type procedures (SAV). Of these cases 51% were categorized to the cipher 11 of the injury type catalogue. Complications were observed particularly in the anatomical regions of the shoulder girdle, elbow, hand, knee, ankle joint and foot. These complex cases are economically not sufficiently represented. During the governmental COVID-19 lockdown actions, the number of patients treated in the context of the DGUV significantly decreased. Conclusion The injury type catalogue is used effectively in the catchment area of the present trauma center. Most of the cases treated in the present trauma center are severe injury type procedures; however, more than half of these cases are classified as complications. This development might show the need for a structural change or an adjustment of the HV. The current comments on the injury type catalogue offer important definitions and specifications; however, the conciseness of the entire catalogue should be maintained.
    Type of Medium: Online Resource
    ISSN: 2731-7021 , 2731-703X
    URL: Article
    DOI: 10.1007/s00113-023-01294-0
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 3120926-9
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  • 3
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    Male Sex Is Associated with Higher Mortality and Increased Risk for Complications after Surgical Treatment of Proximal Humeral Fractures
    MDPI AG ; 2021
    In:  Journal of Clinical Medicine Vol. 10, No. 11 ( 2021-06-05), p. 2500-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 10, No. 11 ( 2021-06-05), p. 2500-
    Abstract: Aims: The best surgical treatment of multi-fragmentary proximal humeral fractures in the elderly is a highly controversial topic. The aim of this study is to assess for sex-related differences regarding mortality and complications after reverse total shoulder arthroplasty (RTSA) and locking plate fixation (LPF). Patients and Methods: All patients from the largest German healthcare insurance (26.5 million policy holders) above the age of 65 years that were treated with LPF or RTSA after a multi-fragmentary proximal humerus fracture between January 2010 and September 2018 were included. Multivariable Cox regression models were used to assess the association of sex with overall survival, major adverse events and surgical complications. Results: A total of 8264 (15%) men and 45,707 (85%) women were followed up for a median time of 52 months. After 8 years, male patients showed significantly higher rates for death (65.8%; 95% CI 63.9–67.5% vs. 51.1%; 95% CI 50.3–51.9%; p 〈 0.001) and major adverse events (75.5%; 95% CI 73.8–77.1% vs. 61.7%; 95% CI 60.9–62.5%; p 〈 0.001). With regard to surgical complications, after adjustment of patient risk profiles, there were no differences between females and males after LPF (p 〉 0.05), whereas men showed a significantly increased risk after RTSA (HR 1.86; 95% CI 1.56–2.22; p 〈 0.001) with more revision surgeries performed (HR 1.76, 95% CI 1.46–2.12; p 〈 0.001) compared to women. Conclusion: The male sex is an independent risk factor for death and major adverse events after both LPF and RTSA. An increased risk for surgical complications after RTSA suggests that male patients benefit more from LPF. Sex should be considered before making treatment decisions.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm10112500
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2662592-1
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  • 4
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    Treatment Reality of Proximal Humeral Fractures in the Elderly—Trending Variants of Locking Plate Fixation in Germany
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 4 ( 2023-02-10), p. 1440-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 4 ( 2023-02-10), p. 1440-
    Abstract: Background: The surgical treatment of proximal humeral fractures (PHFs) with locking plate fixation (LPF) in the elderly is associated with high complication rates, especially in osteoporotic bone. Variants of LPF such as additional cerclages, double plating, bone grafting and cement augmentation can be applied. The objective of the study was to describe the extent of their actual use and how this changed over time. Methods: Retrospective analysis of health claims data of the Federal Association of the Local Health Insurance Funds was performed, covering all patients aged 65 years and older, who had a coded diagnosis of PHF and were treated with LPF between 2010 and 2018. Differences between treatment variants were analyzed (explorative) via chi-squared or Kruskal–Wallis tests. Results: Of the 41,216 treated patients, 32,952 (80%) were treated with LPF only, 5572 (14%) received additional screws or plates, 1983 (5%) received additional augmentations and 709 (2%) received a combination of both. During the study period, relative changes were observed as follows: −35% for LPF only, +58% for LPF with additional fracture fixation and +25% for LPF with additional augmentation. Overall, the intra-hospital complication rate was 15% with differences between the treatment variants (LPF only 15%, LPF with additional fracture fixation 14%, LPF with additional augmentation 19%; p 〈 0.001), and a 30-day mortality of 2%. Conclusions: Within an overall decrease of LPF by approximately one-third, there is both an absolute and relative increase of treatment variants. Collectively, they account for 20% of all coded LPFs, which might indicate more personalized treatment pathways. The leading variant was additional fracture fixation using cerclages.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12041440
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662592-1
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  • 5
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    Proximale Femurfrakturen bei liegender Hüftgelenkstotalendoprothese
    Georg Thieme Verlag KG ; 2015
    In:  OP-JOURNAL Vol. 31, No. 01 ( 2015-8-5), p. 22-27
    Details
    In: OP-JOURNAL, Georg Thieme Verlag KG, Vol. 31, No. 01 ( 2015-8-5), p. 22-27
    Type of Medium: Online Resource
    ISSN: 0178-1715 , 1439-2496
    URL: Issue
    URL: Journal
    URL: Article
    DOI: 10.1055/s-005-29896
    DOI: 10.1055/s-00000046
    DOI: 10.1055/s-0035-1545872
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2015
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  • 6
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    Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center
    Springer Science and Business Media LLC ; 2021
    In:  European Journal of Trauma and Emergency Surgery Vol. 47, No. 3 ( 2021-06), p. 665-675
    Details
    In: European Journal of Trauma and Emergency Surgery, Springer Science and Business Media LLC, Vol. 47, No. 3 ( 2021-06), p. 665-675
    Abstract: In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. Methods All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. Results During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. Conclusion This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.
    Type of Medium: Online Resource
    ISSN: 1863-9933 , 1863-9941
    URL: Article
    DOI: 10.1007/s00068-021-01654-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2276432-X
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  • 7
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    COVID-19 rapid molecular point-of-care testing is effective and cost-beneficial for the acute care of trauma patients
    Springer Science and Business Media LLC ; 2023
    In:  European Journal of Trauma and Emergency Surgery Vol. 49, No. 1 ( 2023-02), p. 487-493
    Details
    In: European Journal of Trauma and Emergency Surgery, Springer Science and Business Media LLC, Vol. 49, No. 1 ( 2023-02), p. 487-493
    Abstract: To evaluate the accuracy and cost benefit of a rapid molecular point-of-care testing (POCT) device detecting COVID-19 within a traumatological emergency department. Background Despite continuous withdrawal of COVID-19 restrictions, hospitals will remain particularly vulnerable to local outbreaks which is reflected by a higher institution-specific basic reproduction rate. Patients admitted to the emergency department with unknown COVID-19 infection status due to a- or oligosymptomatic COVID-19 infection put other patients and health care workers at risk, while fast diagnosis and treatment is necessary. Delayed testing results in additional costs to the health care system. Methods From the 8th of April 2021 until 31st of December 2021, all patients admitted to the emergency department were tested with routine RT-PCR and rapid molecular POCT device (Abbott ID NOW™ COVID-19). COVID-19-related additional costs for patients admitted via shock room or emergency department were calculated based on internal cost allocations. Results 1133 rapid molecular tests resulted in a sensitivity of 83.3% (95% CI 35.9–99.6%), specificity of 99.8% (95% CI 99.4–100%), a positive predictive value of 71.4% (95% CI 29–96.3%) and a negative predictive value of 99.9% (95% CI 99.5–100%) as compared to RT-PCR. Without rapid COVID-19 testing, each emergency department and shock room admission with subsequent surgery showed additional direct costs of 2631.25€, without surgery of 729.01€. Conclusion Although rapid molecular COVID-19 testing can initially be more expensive than RT-PCR, subsequent cost savings, improved workflows and workforce protection outweigh this effect by far. The data of this study support the use of a rapid molecular POCT device in a traumatological emergency department.
    Type of Medium: Online Resource
    ISSN: 1863-9933 , 1863-9941
    URL: Article
    DOI: 10.1007/s00068-022-02091-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2276432-X
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  • 8
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    The rise of quality indicators in neurosurgery: 30-day unplanned reoperation rate evaluated in 3760 patients—a single-center experience
    Springer Science and Business Media LLC ; 2020
    In:  Acta Neurochirurgica Vol. 162, No. 1 ( 2020-01), p. 147-156
    Details
    In: Acta Neurochirurgica, Springer Science and Business Media LLC, Vol. 162, No. 1 ( 2020-01), p. 147-156
    Type of Medium: Online Resource
    ISSN: 0001-6268 , 0942-0940
    URL: Article
    DOI: 10.1007/s00701-019-04146-2
    RVK:
    XA 10000
    RVK:
    XA 12300
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 1464215-3
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  • 9
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    Effects of anti-osteoporosis therapy on the risk of secondary fractures and surgical complications following surgical fixation of proximal humerus fracture in older people
    Oxford University Press (OUP) ; 2023
    In:  Age and Ageing Vol. 52, No. 6 ( 2023-06-01)
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 52, No. 6 ( 2023-06-01)
    Abstract: age-related fragility fractures cause significant burden of disease. Within an ageing society, fracture and complication prevention will be essential to balance health expenditure growth. Objective to assess the effect of anti-osteoporotic therapy on surgical complications and secondary fractures after treatment of fragility fractures. Patients and methods retrospective health insurance data from January 2008 to December 2019 of patients ≥65 years with proximal humeral fracture (PHF) treated using locked plate fixation (LPF) or reverse total shoulder arthroplasty were analysed. Cumulative incidences were calculated by Aalen–Johansen estimates. The influence of osteoporosis and pharmaceutical therapy on secondary fractures and surgical complications were analysed using multivariable Fine and Gray Cox regression models. Results a total of 43,310 patients (median age 79 years, 84.4% female) with a median follow-up of 40.9 months were included. Five years after PHF, 33.4% of the patients were newly diagnosed with osteoporosis and only 19.8% received anti-osteoporotic therapy. A total of 20.6% (20.1–21.1%) of the patients had at least one secondary fracture with a significant reduction of secondary fracture risk by anti-osteoporotic therapy (P  & lt; 0.001). An increased risk for surgical complications (hazard ratio: 1.35, 95% confidence interval: 1.25–1.47, P  & lt; 0.001) after LPF could be reversed by anti-osteoporotic therapy. While anti-osteoporotic therapy was more often used in female patients (35.3 vs 19.1%), male patients showed significantly stronger effects reducing the secondary fracture and surgical complication risk. Conclusions a significant number of secondary fractures and surgical complications could be prevented by consequent osteoporosis diagnosis and treatment particularly in male patients. Health-politics and legislation must enforce guideline-based anti-osteoporotic therapy to mitigate burden of disease.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afad097
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2065766-3
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  • 10
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    Decay and subluminality of modes of all wave numbers in the relativistic dynamics of viscous and heat conductive fluids
    AIP Publishing ; 2021
    In:  Journal of Mathematical Physics Vol. 62, No. 5 ( 2021-05-01)
    Details
    In: Journal of Mathematical Physics, AIP Publishing, Vol. 62, No. 5 ( 2021-05-01)
    Abstract: To further confirm the causality and stability of a second-order hyperbolic system of partial differential equations that models the relativistic dynamics of barotropic fluids with viscosity and heat conduction [H. Freistühler and B. Temple, J. Math. Phys. 59, 063101 (2018)], this paper studies the Fourier–Laplace modes of this system and shows that all such modes, relative to arbitrary Lorentz frames, (a) decay with increasing time and (b) travel at subluminal speeds. Stability is also shown for the related model of non-barotropic fluids [H. Freistühler and B. Temple, Proc. R. Soc. A 470, 20140055 (2014) and H. Freistühler and B. Temple, Proc. R. Soc. A 473, 20160729 (2017)] . Even though these properties had been known for a while in the sense of numerical evidence, the fully analytical proofs for the subluminality of modes of arbitrary wave numbers in arbitrary frames given here appear to be the first regarding any four-field formulation of dissipative relativistic fluid dynamics.
    Type of Medium: Online Resource
    ISSN: 0022-2488 , 1089-7658
    URL: Article
    DOI: 10.1063/5.0039351
    RVK:
    UA 4660
    Language: English
    Publisher: AIP Publishing
    Publication Date: 2021
    detail.hit.zdb_id: 1472481-9
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