Eur J Pediatr Surg
DOI: 10.1055/s-0041-1740479
Original Article

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

Martin Lacher
1   Department of Pediatric Surgery, University of Leipzig, Germany
Winfried Barthlen
2   Department of Pediatric Surgery Greifswald, University of Greifswald, Mecklenburg-Vorpommern, Germany
Felicitas Eckoldt
3   Department of Pediatric Surgery, Universitätsklinikum Jena, Jena, Thüringen, Germany
Guido Fitze
4   Department of Pediatric Surgery, University of Dresden, Dresden, Saxony, Germany
Jörg Fuchs
5   Department of Pediatric Surgery and Pediatric Urology, University Tuebingen, Tuebingen, Germany
Stuart Hosie
6   Muenchen Klinik gGmbH, Muenchen, Klinik Schwabing, Technische Universitaet Muenchen, Bavaria, Germany
Martin M. Kaiser
7   Department of Paediatric Surgery, Martin Luther University Halle Wittenberg, Halle, Sachsen-Anhalt, Germany
Thomas Meyer
8   Pediatric Surgery Unit, University Hospital Würzburg, Würzburg, Germany
9   Department of Pediatric Surgery, University Medicine Mainz, Johannes Gutenberg University Mainz, Rhineland-Palatinate, Germany
10   Department of Pediatric Surgery, Ludwig-Maximilians-Universität München, München, Bavaria, Germany
Konrad Reinshagen
11   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf Hamburg, Hamburg, Germany
Karin Rothe
12   Department of Pediatric Surgery, Charité Universitätsmedizin Berlin, Pediatric Surgery, Berlin, Germany
Guido Seitz
13   Department of Pediatric Surgery, University Hospital Giessen/Marburg, Marburg, Germany
Gerhard Stuhldreier
14   Department of Pediatric Surgery, University of Rostock, Rostock, Germany
Ralf-Bodo Troebs
15   Department of Pediatric Surgery, Ruhr-Universität Bochum, Bochum, Nordrhein-Westfalen, Germany
Benno Ure
16   Department of Pediatric Surgery, Medical School Hannover, Hannover, Germany
Dietrich von Schweinitz
10   Department of Pediatric Surgery, Ludwig-Maximilians-Universität München, München, Bavaria, Germany
Lucas Wessel
17   Department of Pediatric Surgery, Klinikum Mannheim gGmbH, Universitätsklinikum Medizinische Fakultät Mannheim der Universitat Heidelberg, Mannheim, Baden-Württemberg, Germany
Lutz Wünsch
18   Department of Pediatric Surgery, University Hospital Schleswig-Holstein, Luebeck, Germany
19   Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt, Frankfurt/M., Germany
› Author Affiliations


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.

Publication History

Received: 13 July 2021

Accepted: 05 October 2021

Article published online:
13 January 2022

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