Home Medicine Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay
Article Open Access

Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay

  • Nils Lahmann EMAIL logo , Martha Feh Mayer and John Posnett
Published/Copyright: February 13, 2024
Download Article (PDF)
Open Medicine
From the journal Open Medicine Volume 19 Issue 1

Abstract

Objective

Hospital-acquired pressure ulcers are an important indicator of the quality of care. Most pressure ulcers are avoidable with a robust protocol for prevention, but prevention activities often have a low priority for senior management because the true costs to the hospital are not visible. Our aim was to raise awareness of the value of pressure ulcer prevention by estimating the excess length of inpatient stay associated with hospital-acquired pressure ulcers, and by assessing whether additional costs are covered by increased reimbursement.

Methods

National activity data for hospitals in Germany are available through the InEK Data Browser. Data were extracted covering discharges from German hospitals between January 1 and December 31, 2021. Cases were selected according to the presence of a pressure ulcer diagnosis using ICD-10-GM codes L89.0–L89.3. Information was extracted for the ten most common German Diagnosis-Related Group (G-DRG) codes in patients with a secondary pressure ulcer diagnosis on mean length of stay and average reimbursement. Ulcer-associated excess length of stay was estimated by comparing cases within the same G-DRG with and without a pressure ulcer diagnosis.

Results

Mean length of stay was higher in patients with a pressure ulcer than in patients with no ulcer by between 1.9 (all ages) and 2.4 days (patients aged ≥65) per case. In patients aged ≥65 years, 22.1% of cases with a pressure ulcer had a length of stay above the norm for the DRG. In the German system length of stay above the norm is not normally reimbursed. Excess length of stay between 1.9 and 2.4 days leads to a potential cost to a hospital of between 1,633€ and 2,074€ per case.

Conclusion

Hospital-acquired pressure ulcers represent an important source of cost for a hospital which highlights the potential value of effective prevention.

Keywords: Germany; pressure ulcer; hospital-acquired; length of stay; reimbursement; G-DRG

1 Introduction

The incidence of hospital-acquired pressure ulcers is an important indicator of the quality of care [1]. Pressure ulceration typically results from a sustained period of localised pressure which restricts blood-flow to the skin and subcutaneous tissues, leading ultimately to cell death. In severe cases pressure damage can lead to a deep wound extending through to bone [2]. Most pressure ulcers should be avoidable with a robust protocol for prevention [3], but prevention activities often have a low priority for senior management because the true costs to the hospital are not visible.

According to the IQTIG quality indicators report for 2020 [4], 21.6% of pressure ulcers treated in German hospitals were not present on admission, and this suggests that more than 82,000 of the 395,980 pressure ulcers treated in 2021 were hospital-acquired. In the 10 years between 2012 and 2021, an average of 743 patients died annually in Germany from complications of pressure ulceration [5]. Apart from the impact on patient welfare, pressure ulceration can also have an impact on the hospital because of the costs of delayed discharge, readmission and/or higher intensity of nursing care. The aim of this analysis was to raise awareness of the value of investments in pressure ulcer prevention by estimating the excess length of stay associated with a hospital-acquired pressure ulcer, and assessing whether additional bed-day costs are covered by increased reimbursement.

2 Materials and methods

2.1 Materials

Hospitals in Germany are obliged to provide activity data annually to the German Institute for the Reimbursement System in Hospitals (InEK GmbH), and these data are made available to researchers in anonymised form through the InEK Data Browser [6]. Our analysis was based on data extracted from the Data Browser in January 2023, covering inpatient cases discharged from German hospitals in the period January 1 to December 31, 2021. Cases are classified by primary and secondary diagnosis using the modified ICD-10-GM classification system [7] mapped to a unique German Diagnosis-Related Group (G-DRG) code.

Cases for analysis were selected according to the presence of a pressure ulcer diagnosis using ICD-10-GM codes L89.0–L89.3 corresponding to pressure ulcer stages 1–4, and code L89.9 assigned when the stage of the ulcer is not known (Table 1). Information was extracted for G-DRG codes in the analysis population on average (mean) length of inpatient stay, the proportion of cases with length of stay above or below the norm for the DRG and the fixed-rate reimbursement amount. InEK also provides information on episode costs from a sample of around 300 hospitals, and this cost collection forms the basis of the G-DRG fixed-rate payment. Reimbursement values for each G-DRG are available in the InEK Data Browser and the analysis uses reimbursement values for 2023.

Table 1

ICD-10 GM pressure ulcer diagnosis codes

ICD-10-GM pressure ulcer code Definition Brief description
L89.0 Decubitus, stage 1 Pressure zone with redness which cannot be pushed away with intact skin
L89.1 Decubitus, stage 2 Pressure ulcer with blister (serum-filled) (open) (ruptured). Partial loss of skin including epidermis and/or dermis
L89.2 Decubitus, stage 3 Pressure ulcer with loss of all skin layers with damage or necrosis of subcutaneous tissue that may extend to underlying fascia
L89.3 Decubitus, stage 4 Pressure ulcer with necrosis of muscles, bones or supporting structures (e.g., tendons or joint capsules)
L89.9 Decubitus, stage unspecified Pressure ulcer without indication of stage

Source: www.dimdi.de/static/de/klassifikationen/icd/icd-10-gm/kode-suche/htmlgm2023/.

Information on the incidence of hospital-acquired pressure ulcers in Germany was derived from the literature and from a quality indicator report published by the Institut für Qualitätssicherung und Transparenz im Gesundheitswesen [4]. Average daily hospital costs per occupied bed-day in 2020 were sourced from AOK-Bundesverband [8]. The daily cost includes the full running costs (variable costs) but excludes costs for capital investment.

2.2 Methods

Our study is a form of cost analysis [9] which aims to estimate the opportunity cost to a hospital in Germany of patients who develop a pressure ulcer after admission. The perspective is acute general hospitals in Germany and the time horizon is from patient admission to discharge. Opportunity cost is estimated by first comparing inpatient length of stay of patients with a secondary pressure ulcer diagnosis with the length of stay of patients in the same G-DRG without an ulcer. The second part of the analysis compares reimbursement for the G-DRG code based on the primary diagnosis, with the opportunity cost to the hospital associated with the additional ulcer-associated length of stay. The opportunity cost is expressed in terms of annual ulcer-associated bed-days lost valued at (a) an average cost per occupied bed-day (864€) [8] or (b) in terms of the number of additional cases which could be treated if the number of incident pressure ulcers was reduced. Because InEK data are presented in aggregated form it is not possible to estimate confidence intervals around differences in length of stay or to test the statistical significance of observed differences. However, since the data represent the total population and not a sample, these inferential statistical measures are to be regarded as subordinate. Therefore, the means and median values can be interpreted directly.

In the G-DRG system, each patient is assigned a primary diagnosis at admission and potentially several secondary diagnoses at admission or throughout the inpatient stay. The InEK data do not distinguish between diagnosis codes assigned at admission or discharge, but they do distinguish between cases in which pressure ulcer was the primary diagnosis (and likely reason for admission) and cases in which pressure ulcer was a secondary diagnosis. A G-DRG code is assigned at discharge based on the complete patient episode. Our analysis estimates the difference in length of stay between cases with the same G-DRG code and no pressure ulcer, and cases with pressure ulcer as a secondary diagnosis.

  • All the cases in the Data Browser where a pressure ulcer was coded either as a primary (n = 12,856) or secondary diagnosis (n = 383,124) were selected (including L89.9, stage unspecified).

  • For cases where pressure ulcer was a secondary diagnosis, the ten most frequently occurring G-DRG codes were selected, ranked by the number of cases.

  • For these G-DRG codes, average (mean) length of stay was extracted from the data and compared between cases with no pressure ulcer diagnosis and cases with a secondary pressure ulcer diagnosis, to estimate the ulcer-associated excess length of stay.

The per case reimbursement was estimated for each of the ten most frequent G-DRGs and compared with the cost per case calculated by combining the reimbursement with the additional cost associated with excess length of stay for cases with a secondary ulcer diagnosis.

In the German system, hospital reimbursement per case is determined by two factors: a flat-rate payment which depends on the G-DRG code, plus a daily amount to cover nursing costs which varies with length of stay. The flat-rate payment does not change if a patient develops a pressure ulcer after admission, except in cases where interventions to treat the ulcer involve a higher effort (higher complexity) than the primary diagnosis [10]. This will normally occur only if the incident ulcer is in the most severe category (stage 4), and because stage 4 ulcers represented less than 10% of cases with a secondary pressure ulcer diagnosis in Germany in 2021 this will be relatively rare (Table 2).

Table 2

Pressure ulcers in German hospitals, 2021

Stage of ulcer Pressure ulcer as secondary diagnosis Pressure ulcer as primary diagnosis All pressure ulcer cases
N % Length of stay* N % Length of stay* N %
Stage 1 64,654 16.9 19.43 49 0.4 9.05 64,703 16.3
Stage 2 207,872 54.3 21.46 737 5.7 10.39 208,609 52.7
Stage 3 77,181 20.1 22.15 3,362 26.2 15.1 80,543 20.3
Stage 4 28,319 7.4 23.73 8,617 67.0 20.40 36,936 9.3
Unspecified 5,098 1.3 18.41 91 0.7 9.6 5,189 1.3
Total 383,124 100.00 12,856 100.00 395,980 100.0
Mean 21.04 12.91
Median 21.46 10.39

Source: InEK Data Browser, 2021, *days.

The flat-rate payment is partly based on an assumed normal (average) length of stay for each G-DRG code. When length of stay is longer than the norm for the G-DRG a hospital incurs an additional cost if the average cost per bed-day exceeds the daily nursing time payment.

3 Results

In 2021, 395,980 cases were recorded in German hospitals of patients with at least one pressure ulcer. Most of these ulcers involved an open wound (stage 2 or higher) and more than 90% were cases where the ulcer was a secondary diagnosis (Table 2). In the analysis population 12,856 cases were recorded in German hospitals of patients with a primary diagnosis of pressure ulcer. Mean length of stay for these patients ranged from 9.1 to 20.4 days depending on the category of ulcer, with an overall mean of 12.9 days (median 10.4 days) (Table 2). The number of cases recorded with at least one secondary diagnosis of pressure ulcer was 383,124. Mean length of stay ranged from 18.4 to 23.7 days depending on the category of ulcer, with an overall mean of 21.0 days (median 21.5 days) (Table 2). Not all cases with a secondary pressure ulcer diagnosis were hospital-acquired, but the IQTIG Quality indicators report for 2020 [4] suggests that 21.6% of pressure ulcers in hospitalised patients were not present on admission. In 2021 the ten most frequent G-DRG codes for cases with a secondary pressure ulcer diagnosis (all ages) accounted for 1.32 million cases, of which 61,661 were cases with a secondary pressure ulcer diagnosis (Figure 1). Mean length of stay for cases without a pressure ulcer was 11.6 days (median 9.3 days) compared with a mean of 13.4 days (median 11.2 days) for cases with an ulcer, a difference of 1.9 days per case (Table 3). The mean number of cases exceeding the normal length of stay was 7.0% (median 6.6%). In cases with a pressure ulcer the number was 14.6% (median 14.8%), a difference of between 7.6 and 8.2 percentage points (Table 3).

Figure 1 Flow diagram. Case numbers for the period January 1 to December 31, 2021.
Figure 1

Flow diagram. Case numbers for the period January 1 to December 31, 2021.

Table 3

Top ten G-DRG codes, cases with a secondary diagnosis of pressure ulcer, all ages

DRG code Short description Average LOS Average LOS with PU Δ LOS with PU Long stays Long stays with PU Δ Long stays with PU No. of cases No. of cases with PU
Days Days Days % % N N
F62C Heart failure and shock w/out severe CC 8.4 10.8 +2.4 6.75 15.92 +9.17 309,315 11,819
E79C Infections and inflammations of respiratory organs 6.7 8.5 +1.8 6.39 14.26 +7.87 247,931 10,998
L63E Infections of the urinary organs w/out extremely severe CC 5.7 7.6 +1.9 8.14 18.25 +10.11 147,107 7,179
I41Z Geriatric early rehabilitation, complex treatment for diseases and disorders of the musculoskeletal system 19.8 21.1 +1.3 5.35 8.94 +3.59 68,244 6,866
K62C Various metabolic diseases except para/tetraplegia w/out complicated diagnosis 5.2 7.2 +2.0 6.51 15.34 +8.83 140,994 6,168
G67B Esophagitis, gastroenteritis, gastrointestinal haemorrhage, ulcer disease with complicating factors or extremely serious CC 4.0 6.5 +2.5 6.24 22.66 +16.42 265,218 3,884
I34Z Geriatric early rehabilitation, complex treatment with specific OR procedure for diseases of the musculoskeletal system 23.7 25.7 +2.0 5.82 10.85 +5.03 42,840 3,871
E79A Infections and inflammations of the respiratory organs with complex diagnosis or extremely severe CC 11.1 12.7 +1.6 6.81 10.72 +3.91 29,062 3,770
T60E Sepsis without complicating constellation, except for condition after organ transplantation 10.2 11.6 +1.4 10.92 17.21 +6.29 31,709 3,648
F48Z Geriatric early rehabilitation, complex treatment for diseases of the circulatory system 20.7 22.7 +2.0 6.76 11.71 +4.95 33,427 3,458
Mean 11.6 13.4 +1.9 7.0 14.6 +7.6
Median 9.3 11.2 +1.9 6.6 14.8 +8.2
Total 1,315,847 61,661

Source: InEK Data Browser, 2021.

PU = pressure ulcer; LOS = length of stay; Long stays = percent of cases with length of stay longer than the norm for the DRG.

Bold values indicate to highlight points of interest.

The difference between reimbursement and nominal costs for the ten G-DRG codes is shown in Table 4. Total reimbursement per case at 2023 values is the flat-rate payment for the relevant DRG plus nursing cost reimbursement for the actual length of stay rounded to the nearest day. Nursing costs are reimbursed at a reference value of 230€ per day which varies between hospitals and according to the G-DRG code [11]. The mean reimbursement was 6,153€ (median 4,756€) per case (range 2,485–14,974€). The opportunity cost to the hospital was calculated by multiplying the excess ulcer-associated length of stay by an estimate of the average cost per occupied bed-day in German hospitals (864€) [8]. The difference between reimbursement and the estimated cost for patients with pressure ulceration was 1,633€ (median 1,649€) per case (Table 4).

Table 4

Top ten G-DRG codes, cases with a secondary diagnosis of pressure ulcer; average reimbursement, cost and excess cost per case, all ages

DRG code Fixed rate DRG reimbursement* (€) Nursing reimbursement per day** (€) Total case reimbursement at rounded average LOS (€) Cost at rounded excess LOS*** (€) Excess cost per case (€)
F62C 2,700 180.55 4144.40 6218.00 2073.60
E79C 2,420 227.01 4009.07 5564.27 1555.20
L63E 1,900 185.22 3011.31 4652.91 1641.60
I41Z 5,476 158.19 8639.88 9763.08 1123.20
K62C 1,944 199.53 2941.63 4669.63 1728.00
G67B 1,752 183.33 2485.33 4645.33 2160.00
I34Z 10,552 180.09 14974.16 16602.16 1728.00
E79A 4,132 236.69 6735.62 8118.02 1382.40
T60E 3,248 211.99 5367.91 6577.51 1209.60
F48Z 5,856 165.07 9322.49 11050.49 1728.00
Mean 6153.18 7786.14 1632.96
Median 4756.16 6404.96 1648.80

*Calculated using the 2023 federal base value (4,000€). Case values may differ slightly depending on the region. **Calculated using the 2023 federal nursing base value of 230€. Case values may differ between hospitals. ***Calculated at an average 2020 value of 864€ per additional pressure ulcer-associated bed-day (Table 3).

Bold values indicate to highlight points of interest.

According to the IQTIG quality report [4], more than 80% of stage 2–4 hospital-acquired ulcers occurred in patients aged 60 years or more and 45% occurred in patients aged at least 80 years (Table 5). Because a large proportion of hospital-acquired pressure ulcers occur in the elderly population the analysis of InEK data was repeated for a population aged ≥65 years. The ten most frequent G-DRG codes in the InEK population aged ≥65 years accounted for 1.42 million cases, of which 41,044 had a secondary pressure ulcer diagnosis (Figure 1). The mean length of stay for cases without a pressure ulcer was 5.4 days (median 5.0 days) compared with a mean of 7.8 days (median 7.3 days) for cases with pressure ulcer as a secondary diagnosis, a difference of 2.4 days per case. The number of cases exceeding the normal length of stay for the G-DRG was 7.1% (median 6.9%), compared with a mean of 22.1% (median 18.6%) for cases with an ulcer, a difference of between 11.7 and 15.0 percentage points. The mean reimbursement was 3,302€ (median 2,809€) per case (range 1,992–7,294€). The difference between reimbursement and the estimated cost for patients with pressure ulceration was 2,074€ (median 1.814€) per case.

Table 5

Patients treated in German hospitals with at least one hospital-acquired pressure ulcer stage 2–4, by age (2020)

Age distribution Number of patients with at least one hospital-acquired pressure ulcer stage 2–4 %
20–59 years 6,784 11.35
60–69 years 10,108 16.90
70–79 years 16,141 26.99
≥80 years 26,764 44.76
Total* 59,797 100.0

Source: IQTIG, 2021.

*Total refers to stage 2–4 only, and is based on the IQTIG sample population.

4 Discussion

In each of the ten G-DRGs, average length of stay was higher in patients with a pressure ulcer than in patients with no ulcer by between 1.9 (all ages) and 2.4 days (age ≥65) per case. In patients aged ≥65, 22.1% of cases had a length of stay above the norm for the DRG compared with 7.1% of patients without an ulcer. Valued at an average cost per occupied bed-day, the excess cost per case would be between 1,633€ and 2,074€ (26 and 62% above the average reimbursement for these cases). Excess length of stay is not the only source of cost to the hospital. When a hospital-acquired ulcer develops complications, the G-DRG code will only rarely be reclassified to reflect the additional costs. Similarly, where a patient discharged with a pressure ulcer is readmitted within 30 days for treatment of the ulcer, the hospital will not normally receive an additional payment because reimbursement is subsumed within the original episode.

Estimates of the ulcer-associated excess length of stay derived from German national data are consistent with estimates from other studies [12]. In a sample of more than 27 million hospital admissions of patients ≥18 years in the United States in 2006, the excess length of stay for hospitalisations principally for the treatment of pressure ulcers was 9.1 days, and for hospitalisations with pressure ulcer as a secondary diagnosis was 7.7 days [13]. A cross-sectional study of medical records of all inpatients treated in 273 English hospitals between 2005/06 and 2009/10 analysed length of stay and excess bed-days for six patient-safety incidents (death in low-mortality DRGs, pressure ulcer, central line infection, postoperative hip fracture, deep vein thrombosis/pulmonary embolism and postoperative sepsis) [14]. The highest excess mortality risk and excess bed-days were associated with hospital-acquired pressure ulcers. The excess mortality risk was 15.4%, and excess bed-days 15.5 days per admission (95% CI 14.9–16.2).

It is not possible from observational data alone to know the direction of a causal link between the presence of a pressure ulcer and length of stay, because it is possible that patients with longer length of stay are more at risk of developing an ulcer. Several studies have tested for the presence of an independent effect. Graves [15] selected a random sample of 2,000 patients admitted to an acute hospital in Australia between October 2002 and January 2003. Regression methods were used to assess risk factors for excess length of stay. Having a pressure ulcer resulted in a median excess length of stay of 4.31 days (95% CI 1.85–6.78), and pressure ulceration was a statistically significant risk factor (p < 0.005). A retrospective observational study analysed data on 3,198 patients aged ≥75 years admitted to University Hospital Aachen in 2008 and 2009 [16]. Patients with a pressure ulcer had a mean excess length of stay of 2.6 days. Several variables had a statistically significant effect on length of stay in a regression model: age, type of admission, ICU stay, ventilation >24 h, infection with multi-resistant pathogens, death during hospitalisation and pressure ulceration (p = 0.0011).

Estimates of the incidence of hospital-acquired pressure ulcers among hospitalised patients vary widely. German hospitals have an obligation to report on a series of quality indicators, including the number of hospital-acquired pressure ulcers at stage 2–4 [4]. In 2020, 59,661 hospital-acquired pressure ulcers at stage 2–4 were recorded in a population of 15.043 million inpatient admissions aged ≥20 years, a rate of 0.40% [4]. Adjusting these figures to include stage 1 ulcers at 16.9% (Table 2), the overall recorded incidence was approximately 0.48%. Because hospitals have no incentive to report hospital-acquired ulcers, this may be an underestimate. For example, Lahmann et al. [17] reported a direct comparison of pressure ulcer incidence estimates in German hospitals from two different nationwide multicentre studies. The Kinexus™ PS survey involved observation of patients in participating hospitals by a trained study team, with data recorded on a standardised survey instrument. Pressure ulcer prevalence was recorded on the day of the study, and the incidence of new ulcers was estimated by repeating the observation 1 week later. In 2007 German hospitals were required to report pressure ulcer incidence to the Einrichtungsübergreifenden Qualitätssiche-Rung (EQS), as part of a federal quality assurance initiative. Pressure ulcer status was reported at admission and at discharge to estimate the incidence of hospital-acquired ulcers. Combining data from 2007 and 2008, the incidence of stage 1–4 pressure ulcers in the EQS report was 1.3% compared with 6.7% reported in the Kinexus PS survey [17]. The difference was statistically significant.

Estimates based on observation of patients by trained nurses are likely to be more accurate than statutory reporting. The interdisciplinary decubitus project at Essen University Clinics has been ongoing since 2002 [18]. Pressure ulcer prevalence and incidence were obtained as part of a process in which all inpatients in randomly selected wards were physically assessed by specially trained nurses. The mean age of patients included in the surveys in the 4 years 2003/4 to 2006/7 was 49 years. In this period the incidence of hospital-acquired pressure ulcers ranged from 0.56 to 0.65%. In another study, a database analysis was carried out for all inpatient admissions to University Hospital Dresden between January 2007 and December 2011 [19]. Patients were screened by specialist nurses at regular intervals to assess skin condition. The incidence of hospital-acquired pressure ulcers in the all ages population was 0.78%.

Incidence rates are heavily influenced by the age profile of the surveyed population. The Dresden study also analysed incidence rates by age and by different departments in the hospital. In the age group ≥65 incidence was 1.43% compared with 0.78% overall. In the group aged 80–89 incidence was 2.24, and 6.25% age ≥90 years. The average incidence for medical departments was 1.42%, for surgical specialities it was 2.76%. The incidence among patients in intensive care was 4.78% [19]. A similar study analysed data collected as part of a routine surveillance programme at University Hospital Aachen in 2008 and 2009 [16]. The incidence of hospital-acquired pressure ulcers was 3.4% in an inpatient population aged ≥75 years (mean age 81.6 years). Charité University Hospital, Berlin has been supporting routine pressure ulcer surveillance in a sample of nursing homes and hospitals throughout Germany since 2001. On the day of the survey trained nurses assess patients according to a standardised survey instrument. In 2015 seven hospitals took part in the survey covering 1,133 inpatients. The mean age of included patients was 70 years. The incidence of hospital-acquired ulcers was 2% for ulcers stage 2–4 and 1.4% for stage 1: 3.4% overall [20].

It makes sense to focus preventive strategies on patients with the highest risk, and the evidence from our study suggests that patients aged ≥65 have a higher incidence rate and a longer excess length of stay than other patients. According to the IQTIG quality indicators report for 2020 [4] the most common anatomical locations for incident ulcers were the sacrum (40.19% of the total) and heels (21.87%). Focussing screening resources on these anatomies, older age groups and other patient groups with a similar risk profile is likely to be an effective strategy. For example, for every 5,000 inpatients admitted annually in the ≥65 group, a hospital might conservatively expect between 100 and 150 to develop a new ulcer (2–3%). At an average excess length of stay of 2.5 days, 100–150 new ulcers represent between 250 and 375 bed-days. Valued at an average cost per occupied bed-day (864€), the cost to the hospital would be between 216,000€ and 324,000€ annually. More realistically, saving some of the excess bed-days by preventing pressure ulcers could be used to generate revenue by increasing throughput. The average length of stay in German hospitals in 2020 was 7.2 days [8], and 250–375 bed-days could release sufficient capacity to treat up to an additional 52 cases annually. Assuming an average reimbursement of 3,000€ per case (Table 4), the revenue potential would be up to 156,000€. Even a small reduction in incidence could have an important impact on resource efficiency. Although the focus here is on the impact of pressure ulcers on a hospital, in 2020 almost 87% of pressure ulcers in hospitalised patients were present on discharge [4], and this highlights the fact that most of the resource and cost impact of hospital-acquired ulcers falls on community-based healthcare facilities.

Our study has generated important new data on the impact of pressure ulceration on hospital length of stay without the need for a costly or time-consuming prospective study. Nonetheless, important limitations of this study are the fact that it is not possible from the InEK data to separate ulcers which were hospital-acquired from all the cases with pressure ulcer as a secondary diagnosis. In our analysis we have assumed that the length of stay, and stage distribution characteristics of incident ulcers are the same as for other pressure ulcers recorded as a secondary diagnosis. Because InEK data are presented in aggregated form it is not possible to estimate confidence intervals around differences in length of stay or to test for the statistical significance of observed differences.

5 Conclusion

Our evidence shows that under the German DRG system the resource impact of hospital-acquired pressure ulcers is important, and this impact is likely to be underestimated because additional costs associated with readmission, outpatient visits and/or the need for surgical intervention have not been included. Pressure ulcer prevention activities often have a low priority for senior management because the true costs of incident ulcers are not visible. This analysis highlights the value of effective prevention, both for patient welfare and for efficiency in the use of hospital resources.

  1. Funding information: This research was supported by an unrestricted grant from ArjoHuntleigh. The sponsor had no influence over the selection or analysis of data, or over the contents of this report.

  2. Conflict of interest: None of the authors has any conflict of interest.

  3. Data availability statement: InEK data are the only publicly available source of cost and performance data for German hospitals. The data are available through the InEK website. https://www.g-drg.de/.

References

[1] Calianno C. Pressure ulcers in acute care: a quality issue. Nurs Manag. 2007;38(5):42–51.10.1097/01.LPN.0000269820.04673.70Search in Google Scholar PubMed

[2] Peart J. The aetiology of deep tissue injury: a literature review. Br J Nurs. 2016;25(15):840–3.10.12968/bjon.2016.25.15.840Search in Google Scholar PubMed

[3] Barker AL, Kamar J, Tyndall TJ, White L, Hutchinson A, Klopfer N, et al. Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study. Int Wound J. 2013;10(3):313–20.10.1111/j.1742-481X.2012.00979.xSearch in Google Scholar PubMed PubMed Central

[4] IQTIG. Institut für Qualitätssicherung und Transparenz im Gesundheitswesen. Care: pressure ulcer prophylaxis. Quality indicators and key figures. 2021. https://iqtig.org/downloads/auswertung/2020/dek/QSKH_DEK_2020_BUAW_V01_2021-08-10.pdf.Search in Google Scholar

[5] National Statistics. Patient deaths with a pressure ulcer diagnosis (L89*). Gesundheitsberichterstattung des Bundes. 2021. https://www.gbe-bund.de/gbe/!pkg_olap_tables.prc_set_page?p_uid=gast&p_aid=409699&p_sprache=D&p_help=2&p_indnr=6&p_ansnr=23858910&p_version=18&D.000=3743&D.001=1000001&D.002=1000002&D.003=1000004&D.004=1000006&D.011=44302.Search in Google Scholar

[6] InEK Data Browser. Institut für das Entgeltsystem im Krankenhaus (InEK GmbH). 2021. https://datenbrowser.inek.org/nutzungsbedingungen.Search in Google Scholar

[7] ICD-10-GM. 2023. www.dimdi.de/static/de/klassifikationen/icd/icd-10-gm/kode-suche/htmlgm2023/.Search in Google Scholar

[8] AOK. Facts and Figures in Healthcare. 2020 (accessed January 2023). AOK-Bundesxerband Die gesundheitskasse. https://www.aok-bv.de/hintergrund/zahlen-fakten/#krankenhaus.Search in Google Scholar

[9] Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. 4th edn. Oxford, UK: Oxford University Press; 2015.Search in Google Scholar

[10] Webgrouper, DRG Research Group. https://www.drg-research-group.de/index.php?option=com_webgrouper&view=webgrouper&Itemid=112.Search in Google Scholar

[11] Fallpauschalen-Katalog. Fallpauschalen-Katalog gemäß § 17b Absatz 1 Satz 4 des Krankenhausfinanzierungsgesetzes, Katalog ergänzender Zusatzentgelte gemäß § 17b Absatz 1 Satz 7 des Krankenhausfinanzierungsgesetzes, Pflegeerlöskatalog gemäß § 17b Absatz 4 Satz 5 des Krankenhausfinanzierungsgesetzes. 2023. https://www.g-drg.de/ag-drg-system-2023/fallpauschalen-katalog/fallpauschalen-katalog-20232.Search in Google Scholar

[12] Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised patients: a systematic review and meta-analysis. Int J Nurs Stud. 2020;105:103546.10.1016/j.ijnurstu.2020.103546Search in Google Scholar PubMed

[13] Russo CA, Steiner C, Spector W. Hospitalizations related to pressure ulcers among adults 18 years and older. Agency for Healthcare Research and Quality, Healthcare Cost and Utilisation Project. Rockville, USA; 2006. Statistical Brief #64, December 2008.Search in Google Scholar

[14] Hauck KD, Wang S, Vincent C, Smith P. Healthy life-years lost and excess bed-days due to 6 patient safety incidents: empirical evidence from English hospitals. Med Care. 2017;55(2):125–30.10.1097/MLR.0000000000000631Search in Google Scholar PubMed PubMed Central

[15] Graves N. Effects of pressure ulcers on length of stay. Infect Control Hosp Epidemiol. 2005;26:293–7.10.1086/502542Search in Google Scholar PubMed

[16] Theisen S, Drabik A, Stock S. Pressure ulcers in older hospitalised patients and its impact on length of stay: a retrospective observational study. J Clin Nurs. 2012;21(3–4):380–97.10.1111/j.1365-2702.2011.03915.xSearch in Google Scholar PubMed

[17] Lahmann N, Dassen T, Kottner J. Frequency of pressure ulcers in German hospitals (article in German). Gesundheitswesen. 2012;74:793–7.10.1055/s-0031-1299778Search in Google Scholar PubMed

[18] Stausberg J, Lehmann N, Kroger K, Maier I, Schneider H, Niebel W. Increasing pressure ulcer rates and changes in delivery of care: a retrospective analysis at a University Clinic. J Clin Nurs. 2010;19:1504–9.10.1111/j.1365-2702.2010.03231.xSearch in Google Scholar PubMed

[19] Eberlein-Gonska M, Petzold T, Helaβ G, Albrecht DM, Schmitt J. The incidence and determinants of decubitus ulcers in hospital care: an analysis of routine quality management at a University Hospital. Dtsch Arztebl Int. 2013;110(33–34):550–6.10.3238/arztebl.2013.0550Search in Google Scholar PubMed PubMed Central

[20] Lahmann N, Dassen T. Care problems in Germany: results of 15 years of research in nursing homes and clinics. Berlin: Charité University Hospital; 2015. https://www.charite.de/en/.Search in Google Scholar
Received: 2023-07-04
Revised: 2023-10-06
Accepted: 2023-10-22
Published Online: 2024-02-13

© 2024 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Research Articles
  2. EDNRB inhibits the growth and migration of prostate cancer cells by activating the cGMP-PKG pathway
  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
  4. Association of SOX6 gene polymorphisms with Kashin-Beck disease risk in the Chinese Han population
  5. The pyroptosis-related signature predicts prognosis and influences the tumor immune microenvironment in dedifferentiated liposarcoma
  6. METTL3 attenuates ferroptosis sensitivity in lung cancer via modulating TFRC
  7. Identification and validation of molecular subtypes and prognostic signature for stage I and stage II gastric cancer based on neutrophil extracellular traps
  8. Novel lumbar plexus block versus femoral nerve block for analgesia and motor recovery after total knee arthroplasty
  9. Correlation between ABCB1 and OLIG2 polymorphisms and the severity and prognosis of patients with cerebral infarction
  10. Study on the radiotherapy effect and serum neutral granulocyte lymphocyte ratio and inflammatory factor expression of nasopharyngeal carcinoma
  11. Transcriptome analysis of effects of Tecrl deficiency on cardiometabolic and calcium regulation in cardiac tissue
  12. Aflatoxin B1 induces infertility, fetal deformities, and potential therapies
  13. Serum levels of HMW adiponectin and its receptors are associated with cytokine levels and clinical characteristics in chronic obstructive pulmonary disease
  14. METTL3-mediated methylation of CYP2C19 mRNA may aggravate clopidogrel resistance in ischemic stroke patients
  15. Understand how machine learning impact lung cancer research from 2010 to 2021: A bibliometric analysis
  16. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay
  17. Metformin plus L-carnitine enhances brown/beige adipose tissue activity via Nrf2/HO-1 signaling to reduce lipid accumulation and inflammation in murine obesity
  18. Downregulation of carbonic anhydrase IX expression in mouse xenograft nasopharyngeal carcinoma model via doxorubicin nanobubble combined with ultrasound
  19. Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement
  20. miR-335-3p improves type II diabetes mellitus by IGF-1 regulating macrophage polarization
  21. The analyses of human MCPH1 DNA repair machinery and genetic variations
  22. Activation of Piezo1 increases the sensitivity of breast cancer to hyperthermia therapy
  23. Comprehensive analysis based on the disulfidptosis-related genes identifies hub genes and immune infiltration for pancreatic adenocarcinoma
  24. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis
  25. The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
  26. Development and validation of a novel model to predict pulmonary embolism in cardiology suspected patients: A 10-year retrospective analysis
  27. Downregulation of lncRNA XLOC_032768 in diabetic patients predicts the occurrence of diabetic nephropathy
  28. Circ_0051428 targeting miR-885-3p/MMP2 axis enhances the malignancy of cervical cancer
  29. Effectiveness of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke
  30. The construction of a novel prognostic prediction model for glioma based on GWAS-identified prognostic-related risk loci
  31. Evaluating the impact of childhood BMI on the risk of coronavirus disease 2019: A Mendelian randomization study
  32. Lactate dehydrogenase to albumin ratio is associated with in-hospital mortality in patients with acute heart failure: Data from the MIMIC-III database
  33. CD36-mediated podocyte lipotoxicity promotes foot process effacement
  34. Efficacy of etonogestrel subcutaneous implants versus the levonorgestrel-releasing intrauterine system in the conservative treatment of adenomyosis
  35. FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage
  36. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study
  37. Let-7 family regulates HaCaT cell proliferation and apoptosis via the ΔNp63/PI3K/AKT pathway
  38. Phospholipid transfer protein ameliorates sepsis-induced cardiac dysfunction through NLRP3 inflammasome inhibition
  39. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy
  40. Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction
  41. High SEC61A1 expression predicts poor outcome of acute myeloid leukemia
  42. Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis
  43. Secreted frizzled-related protein 5 protects against renal fibrosis by inhibiting Wnt/β-catenin pathway
  44. Pan-cancer and single-cell analysis of actin cytoskeleton genes related to disulfidptosis
  45. Overexpression of miR-532-5p restrains oxidative stress response of chondrocytes in nontraumatic osteonecrosis of the femoral head by inhibiting ABL1
  46. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model
  47. Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
  48. Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study
  49. No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study
  50. Identification and validation of autophagy-related genes in SSc
  51. Long non-coding RNA SRA1 suppresses radiotherapy resistance in esophageal squamous cell carcinoma by modulating glycolytic reprogramming
  52. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study
  53. The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis
  54. Compilation of a self-management assessment scale for postoperative patients with aortic dissection
  55. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation
  56. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study
  57. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2
  58. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli
  59. High STAT4 expression correlates with poor prognosis in acute myeloid leukemia and facilitates disease progression by upregulating VEGFA expression
  60. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study
  61. HOXD10 regulates intestinal permeability and inhibits inflammation of dextran sulfate sodium-induced ulcerative colitis through the inactivation of the Rho/ROCK/MMPs axis
  62. Mesenchymal stem cell-derived exosomal miR-26a induces ferroptosis, suppresses hepatic stellate cell activation, and ameliorates liver fibrosis by modulating SLC7A11
  63. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
  64. ANO6 (TMEM16F) inhibits gastrointestinal stromal tumor growth and induces ferroptosis
  65. Prognostic value of EIF5A2 in solid tumors: A meta-analysis and bioinformatics analysis
  66. The role of enhanced expression of Cx43 in patients with ulcerative colitis
  67. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance
  68. Role of ICAM-1 in triple-negative breast cancer
  69. Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2
  70. HLA-DRB5 promotes immune thrombocytopenia via activating CD8+ T cells
  71. Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome
  72. Efficacy of tacrolimus monotherapy in primary membranous nephropathy
  73. Mechanisms of Tripterygium wilfordii Hook F on treating rheumatoid arthritis explored by network pharmacology analysis and molecular docking
  74. FBXO45 levels regulated ferroptosis renal tubular epithelial cells in a model of diabetic nephropathy by PLK1
  75. Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns
  76. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss
  77. Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study
  78. CD1d affects the proliferation, migration, and apoptosis of human papillary thyroid carcinoma TPC-1 cells via regulating MAPK/NF-κB signaling pathway
  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
  80. Immune response analysis of solid organ transplantation recipients inoculated with inactivated COVID-19 vaccine: A retrospective analysis
  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
  82. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets
  83. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
  88. Expression levels and clinical significance of serum miR-19a/CCL20 in patients with acute cerebral infarction
  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
  94. Comprehensive landscape of integrator complex subunits and their association with prognosis and tumor microenvironment in gastric cancer
  95. New target-HMGCR inhibitors for the treatment of primary sclerosing cholangitis: A drug Mendelian randomization study
  96. Population pharmacokinetics of meropenem in critically ill patients
  97. Comparison of the ability of newly inflammatory markers to predict complicated appendicitis
  98. Comparative morphology of the cruciate ligaments: A radiological study
  99. Immune landscape of hepatocellular carcinoma: The central role of TP53-inducible glycolysis and apoptosis regulator
  100. Serum SIRT3 levels in epilepsy patients and its association with clinical outcomes and severity: A prospective observational study
  101. SHP-1 mediates cigarette smoke extract-induced epithelial–mesenchymal transformation and inflammation in 16HBE cells
  102. Acute hyper-hypoxia accelerates the development of depression in mice via the IL-6/PGC1α/MFN2 signaling pathway
  103. The GJB3 correlates with the prognosis, immune cell infiltration, and therapeutic responses in lung adenocarcinoma
  104. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program
  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
  108. Reproductive outcomes in women with BRCA 1/2 germline mutations: A retrospective observational study and literature review
  109. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population
  110. Prognostic and diagnostic value of circulating IGFBP2 in pancreatic cancer
  111. Postural stability after operative reconstruction of the AFTL in chronic ankle instability comparing three different surgical techniques
  112. Research trends related to emergence agitation in the post-anaesthesia care unit from 2001 to 2023: A bibliometric analysis
  113. Frequency and clinicopathological correlation of gastrointestinal polyps: A six-year single center experience
  114. ACSL4 mediates inflammatory bowel disease and contributes to LPS-induced intestinal epithelial cell dysfunction by activating ferroptosis and inflammation
  115. Affibody-based molecular probe 99mTc-(HE)3ZHER2:V2 for non-invasive HER2 detection in ovarian and breast cancer xenografts
  116. Effectiveness of nutritional support for clinical outcomes in gastric cancer patients: A meta-analysis of randomized controlled trials
  117. The relationship between IFN-γ, IL-10, IL-6 cytokines, and severity of the condition with serum zinc and Fe in children infected with Mycoplasma pneumoniae
  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
  138. Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
https://doi.org/10.1515/med-2023-0839
Keywords for this article
Germany; pressure ulcer; hospital-acquired; length of stay; reimbursement; G-DRG
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. EDNRB inhibits the growth and migration of prostate cancer cells by activating the cGMP-PKG pathway
  3. STK11 (LKB1) mutation suppresses ferroptosis in lung adenocarcinoma by facilitating monounsaturated fatty acid synthesis
  4. Association of SOX6 gene polymorphisms with Kashin-Beck disease risk in the Chinese Han population
  5. The pyroptosis-related signature predicts prognosis and influences the tumor immune microenvironment in dedifferentiated liposarcoma
  6. METTL3 attenuates ferroptosis sensitivity in lung cancer via modulating TFRC
  7. Identification and validation of molecular subtypes and prognostic signature for stage I and stage II gastric cancer based on neutrophil extracellular traps
  8. Novel lumbar plexus block versus femoral nerve block for analgesia and motor recovery after total knee arthroplasty
  9. Correlation between ABCB1 and OLIG2 polymorphisms and the severity and prognosis of patients with cerebral infarction
  10. Study on the radiotherapy effect and serum neutral granulocyte lymphocyte ratio and inflammatory factor expression of nasopharyngeal carcinoma
  11. Transcriptome analysis of effects of Tecrl deficiency on cardiometabolic and calcium regulation in cardiac tissue
  12. Aflatoxin B1 induces infertility, fetal deformities, and potential therapies
  13. Serum levels of HMW adiponectin and its receptors are associated with cytokine levels and clinical characteristics in chronic obstructive pulmonary disease
  14. METTL3-mediated methylation of CYP2C19 mRNA may aggravate clopidogrel resistance in ischemic stroke patients
  15. Understand how machine learning impact lung cancer research from 2010 to 2021: A bibliometric analysis
  16. Pressure ulcers in German hospitals: Analysis of reimbursement and length of stay
  17. Metformin plus L-carnitine enhances brown/beige adipose tissue activity via Nrf2/HO-1 signaling to reduce lipid accumulation and inflammation in murine obesity
  18. Downregulation of carbonic anhydrase IX expression in mouse xenograft nasopharyngeal carcinoma model via doxorubicin nanobubble combined with ultrasound
  19. Feasibility of 3-dimensional printed models in simulated training and teaching of transcatheter aortic valve replacement
  20. miR-335-3p improves type II diabetes mellitus by IGF-1 regulating macrophage polarization
  21. The analyses of human MCPH1 DNA repair machinery and genetic variations
  22. Activation of Piezo1 increases the sensitivity of breast cancer to hyperthermia therapy
  23. Comprehensive analysis based on the disulfidptosis-related genes identifies hub genes and immune infiltration for pancreatic adenocarcinoma
  24. Changes of serum CA125 and PGE2 before and after high-intensity focused ultrasound combined with GnRH-a in treatment of patients with adenomyosis
  25. The clinical value of the hepatic venous pressure gradient in patients undergoing hepatic resection for hepatocellular carcinoma with or without liver cirrhosis
  26. Development and validation of a novel model to predict pulmonary embolism in cardiology suspected patients: A 10-year retrospective analysis
  27. Downregulation of lncRNA XLOC_032768 in diabetic patients predicts the occurrence of diabetic nephropathy
  28. Circ_0051428 targeting miR-885-3p/MMP2 axis enhances the malignancy of cervical cancer
  29. Effectiveness of ginkgo diterpene lactone meglumine on cognitive function in patients with acute ischemic stroke
  30. The construction of a novel prognostic prediction model for glioma based on GWAS-identified prognostic-related risk loci
  31. Evaluating the impact of childhood BMI on the risk of coronavirus disease 2019: A Mendelian randomization study
  32. Lactate dehydrogenase to albumin ratio is associated with in-hospital mortality in patients with acute heart failure: Data from the MIMIC-III database
  33. CD36-mediated podocyte lipotoxicity promotes foot process effacement
  34. Efficacy of etonogestrel subcutaneous implants versus the levonorgestrel-releasing intrauterine system in the conservative treatment of adenomyosis
  35. FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage
  36. Challenges in treating primary immune thrombocytopenia patients undergoing COVID-19 vaccination: A retrospective study
  37. Let-7 family regulates HaCaT cell proliferation and apoptosis via the ΔNp63/PI3K/AKT pathway
  38. Phospholipid transfer protein ameliorates sepsis-induced cardiac dysfunction through NLRP3 inflammasome inhibition
  39. Postoperative cognitive dysfunction in elderly patients with colorectal cancer: A randomized controlled study comparing goal-directed and conventional fluid therapy
  40. Long-pulsed ultrasound-mediated microbubble thrombolysis in a rat model of microvascular obstruction
  41. High SEC61A1 expression predicts poor outcome of acute myeloid leukemia
  42. Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis
  43. Secreted frizzled-related protein 5 protects against renal fibrosis by inhibiting Wnt/β-catenin pathway
  44. Pan-cancer and single-cell analysis of actin cytoskeleton genes related to disulfidptosis
  45. Overexpression of miR-532-5p restrains oxidative stress response of chondrocytes in nontraumatic osteonecrosis of the femoral head by inhibiting ABL1
  46. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model
  47. Clinical analysis of incomplete rupture of the uterus secondary to previous cesarean section
  48. Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study
  49. No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study
  50. Identification and validation of autophagy-related genes in SSc
  51. Long non-coding RNA SRA1 suppresses radiotherapy resistance in esophageal squamous cell carcinoma by modulating glycolytic reprogramming
  52. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study
  53. The possible role of oxidative stress marker glutathione in the assessment of cognitive impairment in multiple sclerosis
  54. Compilation of a self-management assessment scale for postoperative patients with aortic dissection
  55. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation
  56. Effect of anterior femoral cortical notch grade on postoperative function and complications during TKA surgery: A multicenter, retrospective study
  57. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2
  58. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli
  59. High STAT4 expression correlates with poor prognosis in acute myeloid leukemia and facilitates disease progression by upregulating VEGFA expression
  60. Factors influencing cardiovascular system-related post-COVID-19 sequelae: A single-center cohort study
  61. HOXD10 regulates intestinal permeability and inhibits inflammation of dextran sulfate sodium-induced ulcerative colitis through the inactivation of the Rho/ROCK/MMPs axis
  62. Mesenchymal stem cell-derived exosomal miR-26a induces ferroptosis, suppresses hepatic stellate cell activation, and ameliorates liver fibrosis by modulating SLC7A11
  63. Endovascular thrombectomy versus intravenous thrombolysis for primary distal, medium vessel occlusion in acute ischemic stroke
  64. ANO6 (TMEM16F) inhibits gastrointestinal stromal tumor growth and induces ferroptosis
  65. Prognostic value of EIF5A2 in solid tumors: A meta-analysis and bioinformatics analysis
  66. The role of enhanced expression of Cx43 in patients with ulcerative colitis
  67. Choosing a COVID-19 vaccination site might be driven by anxiety and body vigilance
  68. Role of ICAM-1 in triple-negative breast cancer
  69. Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2
  70. HLA-DRB5 promotes immune thrombocytopenia via activating CD8+ T cells
  71. Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome
  72. Efficacy of tacrolimus monotherapy in primary membranous nephropathy
  73. Mechanisms of Tripterygium wilfordii Hook F on treating rheumatoid arthritis explored by network pharmacology analysis and molecular docking
  74. FBXO45 levels regulated ferroptosis renal tubular epithelial cells in a model of diabetic nephropathy by PLK1
  75. Optimizing anesthesia strategies to NSCLC patients in VATS procedures: Insights from drug requirements and patient recovery patterns
  76. Alpha-lipoic acid upregulates the PPARγ/NRF2/GPX4 signal pathway to inhibit ferroptosis in the pathogenesis of unexplained recurrent pregnancy loss
  77. Correlation between fat-soluble vitamin levels and inflammatory factors in paediatric community-acquired pneumonia: A prospective study
  78. CD1d affects the proliferation, migration, and apoptosis of human papillary thyroid carcinoma TPC-1 cells via regulating MAPK/NF-κB signaling pathway
  79. miR-let-7a inhibits sympathetic nerve remodeling after myocardial infarction by downregulating the expression of nerve growth factor
  80. Immune response analysis of solid organ transplantation recipients inoculated with inactivated COVID-19 vaccine: A retrospective analysis
  81. The H2Valdien derivatives regulate the epithelial–mesenchymal transition of hepatoma carcinoma cells through the Hedgehog signaling pathway
  82. Clinical efficacy of dexamethasone combined with isoniazid in the treatment of tuberculous meningitis and its effect on peripheral blood T cell subsets
  83. Comparison of short-segment and long-segment fixation in treatment of degenerative scoliosis and analysis of factors associated with adjacent spondylolisthesis
  84. Lycopene inhibits pyroptosis of endothelial progenitor cells induced by ox-LDL through the AMPK/mTOR/NLRP3 pathway
  85. Methylation regulation for FUNDC1 stability in childhood leukemia was up-regulated and facilitates metastasis and reduces ferroptosis of leukemia through mitochondrial damage by FBXL2
  86. Correlation of single-fiber electromyography studies and functional status in patients with amyotrophic lateral sclerosis
  87. Risk factors of postoperative airway obstruction complications in children with oral floor mass
  88. Expression levels and clinical significance of serum miR-19a/CCL20 in patients with acute cerebral infarction
  89. Physical activity and mental health trends in Korean adolescents: Analyzing the impact of the COVID-19 pandemic from 2018 to 2022
  90. Evaluating anemia in HIV-infected patients using chest CT
  91. Ponticulus posticus and skeletal malocclusion: A pilot study in a Southern Italian pre-orthodontic court
  92. Causal association of circulating immune cells and lymphoma: A Mendelian randomization study
  93. Assessment of the renal function and fibrosis indexes of conventional western medicine with Chinese medicine for dredging collaterals on treating renal fibrosis: A systematic review and meta-analysis
  94. Comprehensive landscape of integrator complex subunits and their association with prognosis and tumor microenvironment in gastric cancer
  95. New target-HMGCR inhibitors for the treatment of primary sclerosing cholangitis: A drug Mendelian randomization study
  96. Population pharmacokinetics of meropenem in critically ill patients
  97. Comparison of the ability of newly inflammatory markers to predict complicated appendicitis
  98. Comparative morphology of the cruciate ligaments: A radiological study
  99. Immune landscape of hepatocellular carcinoma: The central role of TP53-inducible glycolysis and apoptosis regulator
  100. Serum SIRT3 levels in epilepsy patients and its association with clinical outcomes and severity: A prospective observational study
  101. SHP-1 mediates cigarette smoke extract-induced epithelial–mesenchymal transformation and inflammation in 16HBE cells
  102. Acute hyper-hypoxia accelerates the development of depression in mice via the IL-6/PGC1α/MFN2 signaling pathway
  103. The GJB3 correlates with the prognosis, immune cell infiltration, and therapeutic responses in lung adenocarcinoma
  104. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program
  105. Exploring anesthetic-induced gene expression changes and immune cell dynamics in atrial tissue post-coronary artery bypass graft surgery
  106. Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism
  107. Analysis of the risk factors of the radiation-induced encephalopathy in nasopharyngeal carcinoma: A retrospective cohort study
  108. Reproductive outcomes in women with BRCA 1/2 germline mutations: A retrospective observational study and literature review
  109. Evaluation of upper airway ultrasonographic measurements in predicting difficult intubation: A cross-section of the Turkish population
  110. Prognostic and diagnostic value of circulating IGFBP2 in pancreatic cancer
  111. Postural stability after operative reconstruction of the AFTL in chronic ankle instability comparing three different surgical techniques
  112. Research trends related to emergence agitation in the post-anaesthesia care unit from 2001 to 2023: A bibliometric analysis
  113. Frequency and clinicopathological correlation of gastrointestinal polyps: A six-year single center experience
  114. ACSL4 mediates inflammatory bowel disease and contributes to LPS-induced intestinal epithelial cell dysfunction by activating ferroptosis and inflammation
  115. Affibody-based molecular probe 99mTc-(HE)3ZHER2:V2 for non-invasive HER2 detection in ovarian and breast cancer xenografts
  116. Effectiveness of nutritional support for clinical outcomes in gastric cancer patients: A meta-analysis of randomized controlled trials
  117. The relationship between IFN-γ, IL-10, IL-6 cytokines, and severity of the condition with serum zinc and Fe in children infected with Mycoplasma pneumoniae
  118. Paraquat disrupts the blood–brain barrier by increasing IL-6 expression and oxidative stress through the activation of PI3K/AKT signaling pathway
  119. Sleep quality associate with the increased prevalence of cognitive impairment in coronary artery disease patients: A retrospective case–control study
  120. Dioscin protects against chronic prostatitis through the TLR4/NF-κB pathway
  121. Association of polymorphisms in FBN1, MYH11, and TGF-β signaling-related genes with susceptibility of sporadic thoracic aortic aneurysm and dissection in the Zhejiang Han population
  122. Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy
  123. Laboratory variables‐based artificial neural network models for predicting fatty liver disease: A retrospective study
  124. Decreased BIRC5-206 promotes epithelial–mesenchymal transition in nasopharyngeal carcinoma through sponging miR-145-5p
  125. Sepsis induces the cardiomyocyte apoptosis and cardiac dysfunction through activation of YAP1/Serpine1/caspase-3 pathway
  126. Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis
  127. Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures
  128. The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial
  129. Long intergenic noncoding RNA for IGF2BP2 stability suppresses gastric cancer cell apoptosis by inhibiting the maturation of microRNA-34a
  130. Role of FOXM1 and AURKB in regulating keratinocyte function in psoriasis
  131. Parental control attitudes over their pre-school children’s diet
  132. The role of auto-HSCT in extranodal natural killer/T cell lymphoma
  133. Significance of negative cervical cytology and positive HPV in the diagnosis of cervical lesions by colposcopy
  134. Echinacoside inhibits PASMCs calcium overload to prevent hypoxic pulmonary artery remodeling by regulating TRPC1/4/6 and calmodulin
  135. ADAR1 plays a protective role in proximal tubular cells under high glucose conditions by attenuating the PI3K/AKT/mTOR signaling pathway
  136. The risk of cancer among insulin glargine users in Lithuania: A retrospective population-based study
  137. The unusual location of primary hydatid cyst: A case series study
  138. Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation
  139. Obesity and risk of placenta accreta spectrum: A meta-analysis
  140. Shikonin alleviates asthma phenotypes in mice via an airway epithelial STAT3-dependent mechanism
  141. NSUN6 and HTR7 disturbed the stability of carotid atherosclerotic plaques by regulating the immune responses of macrophages
  142. The effect of COVID-19 lockdown on admission rates in Maternity Hospital
  143. Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China
  144. Luteolin alleviates cerebral ischemia/reperfusion injury by regulating cell pyroptosis
  145. Therapeutic role of respiratory exercise in patients with tuberculous pleurisy
  146. Effects of CFTR-ENaC on spinal cord edema after spinal cord injury
  147. Irisin-regulated lncRNAs and their potential regulatory functions in chondrogenic differentiation of human mesenchymal stem cells
  148. DMD mutations in pediatric patients with phenotypes of Duchenne/Becker muscular dystrophy
  149. Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
  150. Significant role and the underly mechanism of cullin-1 in chronic obstructive pulmonary disease
  151. Ferroptosis-related prognostic model of mantle cell lymphoma
  152. Observation of choking reaction and other related indexes in elderly painless fiberoptic bronchoscopy with transnasal high-flow humidification oxygen therapy
  153. A bibliometric analysis of Prader-Willi syndrome from 2002 to 2022
  154. The causal effects of childhood sunburn occasions on melanoma: A univariable and multivariable Mendelian randomization study
  155. Oxidative stress regulates glycogen synthase kinase-3 in lymphocytes of diabetes mellitus patients complicated with cerebral infarction
  156. Role of COX6C and NDUFB3 in septic shock and stroke
  157. Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990–2019
  158. Purinergic P2X7 receptor mediates hyperoxia-induced injury in pulmonary microvascular endothelial cells via NLRP3-mediated pyroptotic pathway
  159. Investigating the role of oviductal mucosa–endometrial co-culture in modulating factors relevant to embryo implantation
  160. Analgesic effect of external oblique intercostal block in laparoscopic cholecystectomy: A retrospective study
  161. Elevated serum miR-142-5p correlates with ischemic lesions and both NSE and S100β in ischemic stroke patients
  162. Correlation between the mechanism of arteriopathy in IgA nephropathy and blood stasis syndrome: A cohort study
  163. Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture
  164. Predictive role of neuron-specific enolase and S100-β in early neurological deterioration and unfavorable prognosis in patients with ischemic stroke
  165. The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia
  166. Fluoxetine inhibited RANKL-induced osteoclastic differentiation in vitro
  167. Detection of serum FOXM1 and IGF2 in patients with ARDS and their correlation with disease and prognosis
  168. Rhein promotes skin wound healing by activating the PI3K/AKT signaling pathway
  169. Differences in mortality risk by levels of physical activity among persons with disabilities in South Korea
  170. Review Articles
  171. Cutaneous signs of selected cardiovascular disorders: A narrative review
  172. XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis
  173. A narrative review on adverse drug reactions of COVID-19 treatments on the kidney
  174. Emerging role and function of SPDL1 in human health and diseases
  175. Adverse reactions of piperacillin: A literature review of case reports
  176. Molecular mechanism and intervention measures of microvascular complications in diabetes
  177. Regulation of mesenchymal stem cell differentiation by autophagy
  178. Molecular landscape of borderline ovarian tumours: A systematic review
  179. Advances in synthetic lethality modalities for glioblastoma multiforme
  180. Investigating hormesis, aging, and neurodegeneration: From bench to clinics
  181. Frankincense: A neuronutrient to approach Parkinson’s disease treatment
  182. Sox9: A potential regulator of cancer stem cells in osteosarcoma
  183. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients
  184. Advanced neuroimaging and criminal interrogation in lie detection
  185. Maternal factors for neural tube defects in offspring: An umbrella review
  186. The chemoprotective hormetic effects of rosmarinic acid
  187. CBD’s potential impact on Parkinson’s disease: An updated overview
  188. Progress in cytokine research for ARDS: A comprehensive review
  189. Utilizing reactive oxygen species-scavenging nanoparticles for targeting oxidative stress in the treatment of ischemic stroke: A review
  190. NRXN1-related disorders, attempt to better define clinical assessment
  191. Lidocaine infusion for the treatment of complex regional pain syndrome: Case series and literature review
  192. Trends and future directions of autophagy in osteosarcoma: A bibliometric analysis
  193. Iron in ventricular remodeling and aneurysms post-myocardial infarction
  194. Case Reports
  195. Sirolimus potentiated angioedema: A case report and review of the literature
  196. Identification of mixed anaerobic infections after inguinal hernia repair based on metagenomic next-generation sequencing: A case report
  197. Successful treatment with bortezomib in combination with dexamethasone in a middle-aged male with idiopathic multicentric Castleman’s disease: A case report
  198. Complete heart block associated with hepatitis A infection in a female child with fatal outcome
  199. Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
  200. Four years of natural progressive course: A rare case report of juvenile Xp11.2 translocations renal cell carcinoma with TFE3 gene fusion
  201. Advancing prenatal diagnosis: Echocardiographic detection of Scimitar syndrome in China – A case series
  202. Outcomes and complications of hemodialysis in patients with renal cancer following bilateral nephrectomy
  203. Anti-HMGCR myopathy mimicking facioscapulohumeral muscular dystrophy
  204. Recurrent opportunistic infections in a HIV-negative patient with combined C6 and NFKB1 mutations: A case report, pedigree analysis, and literature review
  205. Letter to the Editor
  206. Letter to the Editor: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery
  207. Erratum
  208. Erratum to “Bladder-embedded ectopic intrauterine device with calculus”
  209. Retraction
  210. Retraction of “XRCC1 and hOGG1 polymorphisms and endometrial carcinoma: A meta-analysis”
  211. Corrigendum
  212. Corrigendum to “Investigating hormesis, aging, and neurodegeneration: From bench to clinics”
  213. Corrigendum to “Frankincense: A neuronutrient to approach Parkinson’s disease treatment”
  214. Special Issue The evolving saga of RNAs from bench to bedside - Part II
  215. Machine-learning-based prediction of a diagnostic model using autophagy-related genes based on RNA sequencing for patients with papillary thyroid carcinoma
  216. Unlocking the future of hepatocellular carcinoma treatment: A comprehensive analysis of disulfidptosis-related lncRNAs for prognosis and drug screening
  217. Elevated mRNA level indicates FSIP1 promotes EMT and gastric cancer progression by regulating fibroblasts in tumor microenvironment
  218. Special Issue Advancements in oncology: bridging clinical and experimental research - Part I
  219. Ultrasound-guided transperineal vs transrectal prostate biopsy: A meta-analysis of diagnostic accuracy and complication rates
  220. Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer
  221. SENP7 inhibits glioblastoma metastasis and invasion by dissociating SUMO2/3 binding to specific target proteins
  222. MARK1 suppress malignant progression of hepatocellular carcinoma and improves sorafenib resistance through negatively regulating POTEE
  223. Analysis of postoperative complications in bladder cancer patients
  224. Carboplatin combined with arsenic trioxide versus carboplatin combined with docetaxel treatment for LACC: A randomized, open-label, phase II clinical study
  225. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part I
  226. Comprehensive pan-cancer investigation of carnosine dipeptidase 1 and its prospective prognostic significance in hepatocellular carcinoma
  227. Identification of signatures associated with microsatellite instability and immune characteristics to predict the prognostic risk of colon cancer
  228. Single-cell analysis identified key macrophage subpopulations associated with atherosclerosis
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Winner of the OpenAthens UX Award 2026
Winner of the OpenAthens UX Award 2026
Have an idea on how to improve our website?
Please write us.
© 2026 De Gruyter Brill
Downloaded on 7.3.2026 from https://www.degruyterbrill.com/document/doi/10.1515/med-2023-0839/html
Scroll to top button