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Endoprothetikzentrum (\n                      <jats:italic>endoCert<\/jats:italic>\n                      ) zertifiziert werden k\u00f6nnen. Geriatrische Patienten mit dislozierten Schenkelhalsfrakturen stellen eine hochrelevante Entit\u00e4t dar. Die Struktur- und Prozessqualit\u00e4t wird im Rahmen einer Zertifizierung als AltersTraumaZentrum DGU\u00ae (\n                      <jats:italic>ATZ<\/jats:italic>\n                      ) bzw. Endoprothetikzentrum (\n                      <jats:italic>EPZ<\/jats:italic>\n                      ) validiert, dies stellt einen methodisch spannenden Ansatz zur Analyse der Versorgungsrealit\u00e4t dar.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Fragestellung<\/jats:title>\n                    <jats:p>\n                      Existiert zwischen zertifizierten\n                      <jats:italic>ATZ<\/jats:italic>\n                      und dual zertifizierten\n                      <jats:italic>ATZ<\/jats:italic>\n                      \u202f\n                      <jats:italic>+<\/jats:italic>\n                      \u2009\n                      <jats:italic>EPZ<\/jats:italic>\n                      eine Varianz der Versorgung im Hinblick auf gelenkerhaltende bzw. -ersetzende Operationsverfahren bei geriatrischen dislozierten Schenkelhalsfrakturen sowie Kurzzeitkomplikationen?\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material und Methoden<\/jats:title>\n                    <jats:p>\n                      Daten des AltersTraumaRegister DGU\u00ae (\n                      <jats:italic>ATR-DGU<\/jats:italic>\n                      ) wurden aus 46\u00a0Kliniken mit\n                      <jats:italic>ATZ<\/jats:italic>\n                      und 52\u00a0Kliniken mit\n                      <jats:italic>ATZ<\/jats:italic>\n                      \u202f\n                      <jats:italic>+<\/jats:italic>\n                      \u2009\n                      <jats:italic>EPZ<\/jats:italic>\n                      analysiert. Der Beobachtungszeitraum umfasste den station\u00e4ren Klinikaufenthalt und ein 120-t\u00e4giges Nachbeobachtungsintervall. Der prim\u00e4re Endpunkt war die Mortalit\u00e4t, sekund\u00e4re Endpunkte umfassten die Mobilit\u00e4t, Reoperationen und den Gesundheitsstatus. Es erfolgten univariate und multivariate Analysen zur Identifikation von Odds ratios (OR) nach Adjustierung f\u00fcr Alter, Geschlecht, ASA-Score und Begleitverletzungen.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ergebnisse<\/jats:title>\n                    <jats:p>\n                      Das mediane Alter des Kollektivs (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u20097389) betrug 84\u00a0Jahre, 29,6\u202f% bzw. 29,8\u202f% waren m\u00e4nnlich, die mediane Dauer bis zur Operation betrug 20,9\u202fh (\n                      <jats:italic>ATZ<\/jats:italic>\n                      ) bzw. 20,5\u202fh (\n                      <jats:italic>ATZ<\/jats:italic>\n                      \u202f\n                      <jats:italic>+<\/jats:italic>\n                      \u2009\n                      <jats:italic>EPZ<\/jats:italic>\n                      ), und die mediane Liegedauer betrug in beiden Versorgungsstrukturen 15,1 Tage. Die Zahl gelenkerhaltender Eingriffe war in\n                      <jats:italic>ATZ<\/jats:italic>\n                      signifikant gegen\u00fcber Kliniken mit dualer Zertifizierung erh\u00f6ht (\n                      <jats:italic>ATZ<\/jats:italic>\n                      : 8,6\u202f% vs.\n                      <jats:italic>ATZ<\/jats:italic>\n                      \u202f\n                      <jats:italic>+<\/jats:italic>\n                      \u2009\n                      <jats:italic>EPZ<\/jats:italic>\n                      : 2,6\u202f%; OR\u202f=\u20093,63). Die Reoperationsrate war im Prim\u00e4raufenthalt vergleichbar (3,7\u202f% vs.\u00a03,9\u202f%), im 120-Tages Verlauf jedoch signifikant in\n                      <jats:italic>ATZ<\/jats:italic>\n                      \u202f\n                      <jats:italic>+<\/jats:italic>\n                      \u2009\n                      <jats:italic>EPZ<\/jats:italic>\n                      -Kliniken erh\u00f6ht (4,1\u202f% vs.\u00a06,0\u202f%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090,022). Revisionen aufgrund von periprothetischen Frakturen erfolgten signifikant h\u00e4ufiger in\n                      <jats:italic>ATZ<\/jats:italic>\n                      ohne\n                      <jats:italic>EPZ<\/jats:italic>\n                      (8,2\u202f% vs.\u00a03,5\u202f%). In der multivariaten Analyse zeigte sich f\u00fcr Kliniken mit dualer Zertifizierung in der Akutphase eine erh\u00f6hte Mortalit\u00e4t (OR 1,26; 1,02\u20131,56;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090,031), im 120-Tages Verlauf eine erh\u00f6hte Rate an Reoperationen (OR 1,45; 1,06\u20132,02;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090,024) und station\u00e4ren Wiederaufnahmen (OR\u00a01,42, 1,02\u20132,00;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090,043).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Schlussfolgerung<\/jats:title>\n                    <jats:p>In Deutschland besteht bei geriatrischen dislozierten Schenkelhalsfrakturen eine institutionelle Versorgungsvarianz. In alterstraumatologisch zertifizierten Kliniken ohne Endoprothetikzentrum zeigt sich eine signifikant erh\u00f6hte Rate an gelenkerhaltenden Versorgungen mit Unterschieden in Bezug auf die Morbidit\u00e4t und Mortalit\u00e4t in der Akutphase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphic abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00113-025-01619-1","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T11:59:48Z","timestamp":1756123188000},"page":"926-936","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Varianz der operativen Versorgung bei dislozierten Schenkelhalsfrakturen in zertifizierten AltersTraumaZentren DGU\u00ae und Endoprothetikzentren in Deutschland","Surgical treatment variation of displaced femoral neck fractures in certified centers for geriatric trauma DGU\u00ae and arthroplasty centers in Germany"],"prefix":"10.1007","volume":"128","author":[{"given":"Yasmin","family":"Hartmann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Rascher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel","family":"Pishnamaz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Migliorini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klemens","family":"Horst","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Knobe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Hildebrand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian David","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"AltersTraumaRegister DGU","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"issue":"3","key":"1619_CR1","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.emc.2016.04.004","volume":"34","author":"C Reske-Nielsen","year":"2016","unstructured":"Reske-Nielsen\u00a0C, Medzon\u00a0R (2016) Geriatric trauma. 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