Zusammenfassung: Hintergrund: Nach wie vor stellen Krebsleiden die zweithäufigste Todesursache in Deutschland dar. Leistungssteuerung und Spezialisierungskonzepte in der Medizin bergen Potenziale, die Versorgung und die Überlebenschancen von Patientinnen und Patienten positiv zu beeinflussen. Ziel der Arbeit: Aus der Gesetzesinitiative im Rahmen des KHVVG resultiert aus der Perspektive des UKF eine ganze Reihe medizinstrategischer Implikationen. Diese Arbeit erläutert und diskutiert die Hintergründe, Ziele und Inhalte des Reformvorhabens „Gelegenheits-Onkochirurgie“ und gibt Perspektiven auf strategische Handlungsfelder. Material und Methoden: Analyse und Interpretation des Entwurfs eines Gesetzes zur Verbesserung der Versorgungsqualität im Krankenhaus und zur Reform der Vergütungsstrukturen (Gesetzentwurf der Bundesregierung). Ergebnisse: Aus Sicht des UKF sollten Krankenhäuser frühestmöglich und proaktiv Kooperationsgespräche mit benachbarten Krankenhäusern zur Gestaltung der regionalen Gesundheitsversorgung führen mit den Zielen, die lokale Allokation onkologischer Patientinnen und Patienten im Sinne einer bestmöglichen Behandlung abzubilden, den Verlust von Patienten an den betroffenen Standorten abzufedern sowie den Patientenaufwuchs bei den Einrichtungen, die weiterhin onkochirurgisch versorgen werden, vorzubereiten. Diskussion: Das noch laufende Gesetzgebungsverfahren sowie der Umstand, dass eine belastbare Analyse der relevanten Leistungsbereiche erst im ersten Halbjahr 2025 für Krankenhäuser möglich sein wird, stellt die Einrichtungen vor besondere Herausforderungen in der strategischen Planung ihrer Aktivitäten. Die im Rahmen dieser Arbeit dargestellten Lücken im Gesetzesvorhaben sollten dringend geschlossen werden, um die Ziele des Vorhabens nicht zu konterkarieren und die im System verbleibenden Leistungserbringer bei ihren Vorbereitungen zu unterstützen.

Background/Objectives: To estimate, against the background of the upcoming German healthcare reform, current access to neurosurgery for patients in Germany, and to derive improvement strategies from geographic information mapping. Methods: We defined access to neurosurgery on a geographical basis as the sum of all points from which one can reach a neurosurgical department within 40 min by car (A2N40). We identified 182 departments of neurosurgery, and we retrieved population numbers and geodetic information from open sources. We processed data and conducted statistical analyses in R. Results: Population density and A2N40 per square kilometer were significantly positively correlated (Spearman’s rho = 0.82, p = 0.0001). Population density is significantly lower (Wilcoxon rank sum test, p = 0.009) and A2N40 per square kilometer is significantly worse (Wilcoxon rank sum test, p = 0.005) in the new federal states (without Berlin) as compared to the rest of the country. Geographic information mapping yielded 3 distinct improvement strategies. Conclusions: In Germany, population density and A2N40 per square kilometer are significantly positively correlated, with significantly less A2N40 per square kilometer in the new federal states. Geographic mapping may inform tailored regional improvement policies.

Objective: There is a demand to make hospital management information beyond basic key performance indicators (KPIs) accessible for clinicians. Methods: We developed an interactive application (IAPP) in R Shiny to visualize such information. We provided the IAPP source code online. As a use case, we recorded basic KPIs (numbers of patients (NPs), reimbursed valuation ratios (RVRs), mean length of stay (LOS)), main diagnoses (MDGNs), main procedures (MPRCs), and catchment area (CA) by district from April 2022 to March 2024 at the index department in central Germany, where a neurotrauma and spinal surgery service was resumed on 1 April 2022. Case mix indexes (CMIs) were calculated. We retrieved information about online-reported patient satisfaction (ORPS) from an online physician rating platform between January 2022 and March 2024. Information on longitudes and latitudes of the index department and neighbouring hospitals was collected. We calculated car travelling isochrones (CTIs) of the hospitals as a proxy variable for accessibility. Chi-square and Fisher’s exact served as statistical tests. Results: During the observation period, the monthly NPs increased from 26 to 43, the RVR showed a 3.96-fold increase, the CMI showed a 2.41-fold increase, and the LOS reached a steady state in the 2nd year after service resumption. CA (p = 0.03), MDGNs, and MPRCs diversified. ORPS trended towards better overall evaluation after service resumption (p = 0.09). CTI mapping identified a unique market position of the index department. Conclusions: The IAPP makes extended hospital management data accessible to clinicians, can inform other stakeholders in healthcare, and can be tailored to local conditions.

Background/Objectives: The aim of this study was to simulate the impact of different minimum case volume thresholds, introduced under Germany’s Hospital Care Improvement Act, on the geographic accessibility of inpatient neurosurgical care. The Act introduces minimum case volume thresholds per service group, potentially leading to closures of low-volume neurosurgical units and reduced accessibility within 40 min of driving time (A2N40, Accessibility to a Neurosurgical Facility within 40 min). Methods: Inpatient case volumes of neurosurgical facilities were extracted from the Structured Quality Reports for reporting years 2023 and 2024, published by the Federal Joint Committee. Facilities were geocoded, 40-min driving time isochrones were generated, and the population within each isochrone was calculated. Results: At baseline in 2024, 66.6% of Germany’s area and 84.7% of the population were within the A2N40. Each one-percentile-point increase in the case volume threshold reduced A2N40 area coverage by an average of 0.70 percentage points, corresponding to approximately 305,000 additional people losing access, with the largest reductions observed in rural, less densely populated regions of the eastern federal states. Conclusions: Minimum case volume thresholds may substantially reduce the geographic accessibility of neurosurgical facilities, revealing a measurable trade-off between quality assurance through centralisation and geographic access to care, particularly in rural regions. The presented simulation approach can support evidence-based, geographically informed planning of future minimum case volume regulations.

Introduction: Dumping syndrome (DS) and recurrent weight gain are among the most relevant long-term challenges following Roux-en-Y gastric bypass (RYGB). Several treatment strategies have been proposed, including pouch resizing with ring augmentation (PRRA). This study presents long-term outcomes of PRRA, with a focus on weight trajectory and the management of DS symptoms. Methods: A retrospective analysis of all PRRA procedures performed at a tertiary referral center between January 2008 and September 2023. Clinical data were obtained from electronic health records and patient questionnaires. Results: Sixty-two patients (90.3 % female, mean age at time of RYGB 40.2 ± 9.5 years, mean BMI 47.4 ± 7.9 kg/m ² ) underwent PRRA at a mean interval of 56.3 ± 34.6 months after RYGB. DS was the leading indication (74.2 %), followed by recurrent weight gain (24.2 %) and primary suboptimal clinical response (1.6%). Following PRRA, 62.8 % of patients (n = 45) reported long-term improvement in DS-related symptoms, and 79 % (n = 57) achieved renewed weight loss. Long-term weight stabilization was observed, with only modest recurrent weight gain (+2.1± 5.4 kg/m ² from post-PRRA nadir weight) after a mean follow-up of 48.6± 40.0 months. Ring removal was required in 25.8 % of patients, predominantly due to dysphagia and regurgitation. Conclusions: PRRA is an effective revisional option for managing DS symptoms after RYGB and contributes to sustained weight stability in patients with recurrent weight gain. However, ring-related adverse effects may necessitate removal in a subset of patients.

Background: While timely blood transfusion is critical for restoring oxygen-carrying capacity after coronary artery bypass grafting (CABG), allogeneic blood product transfusions are independently associated with increased long-term mortality, necessitating a risk-stratified approach to balance oxygen delivery against immunological complications and infection risks. Methods: We retrospectively analyzed 3376 patients undergoing isolated CABG between 2005 and 2023 at a single tertiary center. Patients who died during their perioperative hospital stay within 30 days were excluded. Transfusion burden was assessed both as the absolute number of blood product units (packed red blood cells, platelet transfusion, fresh frozen plasma) and as a percentage of calculated patient blood volume. The primary outcome was all-cause mortality at 5 years. Flexible Cox regression with penalized smoothing splines, adjusted for EuroSCORE II, was used to model dose–response relationships. Results: From our cohort of 3376 patients, a total of 137 patients (4.05%) received >10 units of packed red blood cells (PRBC) perioperatively. These patients were older (median 71 vs. 68 years, p < 0.001), more often female (29% vs. 15%, p < 0.001), and had higher preoperative risk (EuroSCORE II: 2.53 vs. 1.41, p < 0.001). After 5 years, mortality was 42% in the massive transfusion group versus 10% in controls. Spline regression revealed an exponential increase in mortality with transfused units: 14 units yielded a 1.5-fold higher hazard of death (HR 1.46, 95% CI 1.31–1.64), rising to HR 2.71 (95% CI 2.12–3.47) at 30 units. When transfusion was indexed to blood volume, this relationship became linear and more tightly correlated with mortality, with lower maximum hazard ratios and narrower confidence intervals. Conclusions: Indexing transfusion burden to the percentage of patient blood volume replaced provides a more accurate and clinically actionable predictor of 5-year mortality after CABG than absolute unit counts. Our findings support a shift toward individualized, volume-based transfusion strategies to optimize patient outcomes and resource stewardship in a time of limited availability of blood products.