TY - JOUR A1 - Diers, J. A1 - Wagner, J. A1 - Baum, P. A1 - Lichthardt, S. A1 - Kastner, C. A1 - Matthes, N. A1 - Matthes, H. A1 - Germer, C.‐T. A1 - Löb, S. A1 - Wiegering, A. T1 - Nationwide in‐hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany JF - BJS Open N2 - Background The impact of hospital volume after rectal cancer surgery is seldom investigated. This study aimed to analyse the impact of annual rectal cancer surgery cases per hospital on postoperative mortality and failure to rescue. Methods All patients diagnosed with rectal cancer and who had a rectal resection procedure code from 2012 to 2015 were identified from nationwide administrative hospital data. Hospitals were grouped into five quintiles according to caseload. The absolute number of patients, postoperative deaths and failure to rescue (defined as in‐hospital mortality after a documented postoperative complication) for severe postoperative complications were determined. Results Some 64 349 patients were identified. The overall in‐house mortality rate was 3·9 per cent. The crude in‐hospital mortality rate ranged from 5·3 per cent in very low‐volume hospitals to 2·6 per cent in very high‐volume centres, with a distinct trend between volume categories (P < 0·001). In multivariable logistic regression analysis using hospital volume as random effect, very high‐volume hospitals (53 interventions/year) had a risk‐adjusted odds ratio of 0·58 (95 per cent c.i. 0·47 to 0·73), compared with the baseline in‐house mortality rate in very low‐volume hospitals (6 interventions per year) (P < 0·001). The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue decreased significantly with increasing caseload (15·6 per cent after pulmonary embolism in the highest volume quintile versus 38 per cent in the lowest quintile; P = 0·010). Conclusion Patients who had rectal cancer surgery in high‐volume hospitals showed better outcomes and reduced failure to rescue rates for severe complications than those treated in low‐volume hospitals. KW - rectal resection KW - rectal cancer KW - mortality rate Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-212878 VL - 4 IS - 2 SP - 310 EP - 319 ER - TY - JOUR A1 - Diers, J. A1 - Wagner, J. A1 - Baum, P. A1 - Lichthardt, S. A1 - Kastner, C. A1 - Matthes, N. A1 - Löb, S. A1 - Matthes, H. A1 - Germer, C.-T. A1 - Wiegering, A. T1 - Nationwide in-hospital mortality following colonic cancer resection according to hospital volume in Germany JF - BJS Open N2 - Background: Colonic cancer is the most common cancer of the gastrointestinal tract. The aim of this study was to determine mortality rates following colonic cancer resection and the effect of hospital caseload on in-hospital mortality in Germany. Methods: Patients admitted with a diagnosis of colonic cancer undergoing colonic resection from 2012 to 2015 were identifed from a nationwide registry using procedure codes. The outcome measure was in-hospital mortality. Hospitals were ranked according to their caseload for colonic cancer resection, and patients were categorized into five subgroups on the basis of hospital volume. Results: Some 129 196 colonic cancer resections were reviewed. The overall in-house mortality rate was 5⋅8 per cent, ranging from 6⋅9 per cent (1775 of 25 657 patients) in very low-volume hospitals to 4⋅8 per cent (1239 of 25 825) in very high-volume centres (P < 0⋅001). In multivariable logistic regression analysis the risk-adjusted odds ratio for in-house mortality was 0⋅75 (95 per cent c.i. 0⋅66 to 0⋅84) in very high-volume hospitals performing a mean of 85⋅0 interventions per year, compared with that in very low-volume hospitals performing a mean of only 12⋅7 interventions annually, after adjustment for sex, age, co-morbidity, emergency procedures, prolonged mechanical ventilation and transfusion. Conclusion: In Germany, patients undergoing colonic cancer resections in high-volume hospitals had with improved outcomes compared with patients treated in low-volume hospitals Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-204385 VL - 3 IS - 5 ER - TY - JOUR A1 - Klemd, R. A1 - Matthes, S. A1 - Schüssler, Ulrich T1 - Reaction textures and fluid behaviour in very high-pressure calc-silicate rocks of the Münchberg gneiss complex, Bavaria, Germany N2 - Calc-silicate rocks occur as elliptical bands and boudins intimately interlayered with eclogites and high-pressure gneisses in the Munchberg gneiss complex of NE Bavaria. Core assemblages of the boudins consist of grossular-rich garnet, diopside, quartz, zoisite, clinozoisite, calcite, rutile and titanite. The polygonal granoblastic texture commonly displays mineral relics and reaction textures such as postkinematic grossular-rich garnet coronas. Reactions between these mineral phases have been modelled in the CaO-Al203-Si02-C02-H2 0 system with an internally consistent thermodynamic data base. High-pressure metamorphism in the calc-silicate rocks has been estimated at a minimum pressure of 31 kbar at a temperature of 630°C with X^oSQ.Gi. Small volumes of a C02-N2-rich fluid whose composition was buffered on a local scale were present at peak-metamorphic conditions. The P-T conditions for the onset of the amphibolite facies overprint are about 10 kbar at the same temperature. A'co., of the H20-rich fluid phase is regarded to have been <0.03 during amphibolite facies conditions. These P-T estimates are interpreted as representing different stages of recrystallization during isothermal decompression. The presence of multiple generations of mineral phases and the preservation of very high-pressure relics in single thin sections preclude pervasive post-peak metamorphic fluid flow as a cause of a re-equilibration within the calc-silicates. The preservation of eclogite facies, very high-pressure relics as well as amphibolite facies reactions textures in the presence of a fluid phase is in agreement with fast, tectonically driven unroofing of these rocks. KW - calc-silicate rocks; fluid behaviour; P-T path; reaction textures; Variscan basement; very high-pressure metamorphism Y1 - 1994 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-31035 ER - TY - RPRT A1 - Schüssler, Ulrich A1 - von Gehlen, K. A1 - Matthes, S. A1 - Okrusch, Martin A1 - Richter, P. A1 - Röhr, C. T1 - Ultramafische Einschaltungen in Metabasiten der KTB-Vorbohrung N2 - No abstract available KW - Kontinentales Tiefbohrprogramm Y1 - 1991 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-39206 ER - TY - JOUR A1 - von Gehlen, K. A1 - Matthes, S. A1 - Okrusch, Martin A1 - Richter, P. A1 - Röhr, C. A1 - Schüssler, Ulrich T1 - Metapyroxenite in der KTB-Vorbohrung N2 - No abstract available. KW - Kontinentales Tiefbohrprogramm der Bundesrepublik Deutschland Y1 - 1990 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-87539 ER -