Geographical accessibility and case loads in subarachnoid hemorrhage care: a nationwide study of German hospitals

This observational cross-sectional study aims to investigate the accessibility of German hospitals in the event of an aneurysmal subarachnoid hemorrhage (SAH). Specifically, it analyzes the average travel time to hospitals of varying care levels (level 2 = advanced, level 3 = comprehensive), defined as facilities equipped with neurosurgical and/or neurointerventional treatment capacities essential for SAH management, and examines the role of university hospitals in SAH management. Furthermore, the association between accessibility and socioeconomic deprivation will be evaluated. Data from all German hospital cases in 2022 were analyzed, based on Section 136b of the Social Code Book V as outlined by the G-BA. Hospital infrastructure and accessibility metrics were sourced from the trinovis VISION platform (trinovis GmbH, Hannover, Germany) using the tools "hospitals" and "accessibility". A total of 7,855 SAH cases were treated in 794 hospitals across Germany. Among these, 27.3% of hospitals provided extended emergency care (treating 1,249 cases), and 19.6% offered comprehensive care (treating 4,279 cases). In total, 78,576 cerebral angiographies and 4,929 selective embolizations were performed. The average travel time to an SAH-capable hospital was 13.6 minutes, with 97% of the population within a 60-minute reach. A significant correlation was found between geographic accessibility and socioeconomic deprivation, with more deprived areas experiencing longer travel times. This cross-sectional study highlights disparities in access to aneurysmal SAH care across Germany. The findings demonstrate that while most of the population lives within a 60-minute travel time to appropriate hospitals, individuals in socioeconomically deprived areas face longer travel times and potentially reduced access to timely, specialized care. Given the high prehospital mortality associated with SAH, these accessibility gaps may contribute to worse outcomes in disadvantaged regions. To improve equity in emergency neurosurgical care, targeted political and structural interventions are required - especially for underserved populations in geographically and socioeconomically isolated areas.