Research: Operative Volume of Newborn Surgery in German University Hospitals: High Volume Versus Low Volume Centers

Eur J Pediatr Surg

. 2022 Jan 13. doi: 10.1055/s-0041-1740479. Online ahead of print.

Operative Volume of Newborn Surgery in German University Hospitals: High Volume Versus Low Volume Centers

Martin Lacher 1Winfried Barthlen 2Felicitas Eckoldt 3Guido Fitze 4Jörg Fuchs 5Stuart Hosie 6Martin M Kaiser 7Thomas Meyer 8Oliver J Muensterer 9 10Konrad Reinshagen 11Karin Rothe 12Guido Seitz 13Gerhard Stuhldreier 14Ralf-Bodo Troebs 15Benno Ure 16Dietrich von Schweinitz 10Lucas Wessel 17Lutz Wünsch 18Udo Rolle 19Affiliations expand


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.

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