TY - JOUR
T1 - Operative Volume of Newborn Surgery in German University Hospitals
T2 - High Volume Versus Low Volume Centers
AU - Lacher, Martin
AU - Barthlen, Winfried
AU - Eckoldt, Felicitas
AU - Fitze, Guido
AU - Fuchs, Jörg
AU - Hosie, Stuart
AU - Kaiser, Martin M.
AU - Meyer, Thomas
AU - Muensterer, Oliver J.
AU - Reinshagen, Konrad
AU - Rothe, Karin
AU - Seitz, Guido
AU - Stuhldreier, Gerhard
AU - Troebs, Ralf Bodo
AU - Ure, Benno
AU - Von Schweinitz, Dietrich
AU - Wessel, Lucas
AU - Wünsch, Lutz
AU - Rolle, Udo
N1 - Publisher Copyright:
© 2022 Georg Thieme Verlag. All rights reserved.
PY - 2022/9/16
Y1 - 2022/9/16
N2 - Introduction Adequate patient volume is essential for the maintenance of quality, meaningful research, and training of the next generation of pediatric surgeons. The role of university hospitals is to fulfill these tasks at the highest possible level. Due to decentralization of pediatric surgical care during the last decades, there is a trend toward reduction of operative caseloads. The aim of this study was to assess the operative volume of the most relevant congenital malformations at German academic pediatric surgical institutions over the past years. Methods Nineteen chairpersons representing university-chairs in pediatric surgery in Germany submitted data on 10 index procedures regarding congenital malformations or neonatal abdominal emergencies over a 3-year period (2015 through 2017). All institutions were categorized according to the total number of respective cases into high, medium, and low volume centers by terciles. Some operative numbers were verified using data from health insurance companies, when available. Finally, the ratio of cumulative case load versus prevalence of the particular malformation was calculated for the study period. Results From 2015 through 2017, a total 2,162 newborns underwent surgery for congenital malformations and neonatal abdominal emergencies at German academic medical centers, representing 51% of all expected newborn cases nationwide. The median of cases per center within the study period was 101 (range 18-258). Four institutions (21%) were classified as high volume centers, four (21%) as medium volume centers, and 11 (58%) as low volume centers. The proportion of patients operated on in high-volume centers varied per disease category: esophageal atresia/tracheoesophageal fistula: 40%, duodenal atresia: 40%, small and large bowel atresia: 39%, anorectal malformations: 40%, congenital diaphragmatic hernia: 56%, gastroschisis: 39%, omphalocele: 41%, Hirschsprung disease: 45%, posterior urethral valves: 39%, and necrotizing enterocolitis (NEC)/focal intestinal perforation (FIP)/gastric perforation (GP): 45%. Conclusion This study provides a national benchmark for neonatal surgery performed in German university hospitals. The rarity of these cases highlights the difficulties for individual pediatric surgeons to gain adequate clinical and surgical experience and research capabilities. Therefore, a discussion on the centralization of care for these rare entities is necessary.
AB - Introduction Adequate patient volume is essential for the maintenance of quality, meaningful research, and training of the next generation of pediatric surgeons. The role of university hospitals is to fulfill these tasks at the highest possible level. Due to decentralization of pediatric surgical care during the last decades, there is a trend toward reduction of operative caseloads. The aim of this study was to assess the operative volume of the most relevant congenital malformations at German academic pediatric surgical institutions over the past years. Methods Nineteen chairpersons representing university-chairs in pediatric surgery in Germany submitted data on 10 index procedures regarding congenital malformations or neonatal abdominal emergencies over a 3-year period (2015 through 2017). All institutions were categorized according to the total number of respective cases into high, medium, and low volume centers by terciles. Some operative numbers were verified using data from health insurance companies, when available. Finally, the ratio of cumulative case load versus prevalence of the particular malformation was calculated for the study period. Results From 2015 through 2017, a total 2,162 newborns underwent surgery for congenital malformations and neonatal abdominal emergencies at German academic medical centers, representing 51% of all expected newborn cases nationwide. The median of cases per center within the study period was 101 (range 18-258). Four institutions (21%) were classified as high volume centers, four (21%) as medium volume centers, and 11 (58%) as low volume centers. The proportion of patients operated on in high-volume centers varied per disease category: esophageal atresia/tracheoesophageal fistula: 40%, duodenal atresia: 40%, small and large bowel atresia: 39%, anorectal malformations: 40%, congenital diaphragmatic hernia: 56%, gastroschisis: 39%, omphalocele: 41%, Hirschsprung disease: 45%, posterior urethral valves: 39%, and necrotizing enterocolitis (NEC)/focal intestinal perforation (FIP)/gastric perforation (GP): 45%. Conclusion This study provides a national benchmark for neonatal surgery performed in German university hospitals. The rarity of these cases highlights the difficulties for individual pediatric surgeons to gain adequate clinical and surgical experience and research capabilities. Therefore, a discussion on the centralization of care for these rare entities is necessary.
KW - Germany
KW - centralization
KW - newborn surgery
KW - pediatric surgery
UR - http://www.scopus.com/inward/record.url?scp=85129843590&partnerID=8YFLogxK
U2 - 10.1055/s-0041-1740479
DO - 10.1055/s-0041-1740479
M3 - Article
C2 - 35026856
AN - SCOPUS:85129843590
SN - 0939-7248
VL - 32
SP - 391
EP - 398
JO - European Journal of Pediatric Surgery
JF - European Journal of Pediatric Surgery
IS - 5
ER -