Esophageal Atresia Repair in Germany: Utilization Patterns, Hospital Characteristics and Costs

Lucas Wennemann; Jochen Blaser; Sören Wiesner; Jan Zeidler; Mikal Obed; Johannes Weidner; Adan Chari Jirmo; Jens Dingemann; Nagoud Schukfeh

doi:10.1055/a-2676-2933

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg
DOI: 10.1055/a-2676-2933

Original Article

Esophageal Atresia Repair in Germany: Utilization Patterns, Hospital Characteristics and Costs

Authors

Lucas Wennemann ^*

¹Department of Pediatric and Adolescent Surgery, Hannover Medical School, Hannover, Germany
Jochen Blaser^*

²Representative Office of Lower Saxony, Techniker Krankenkasse (Health Insurance), Hannover, Lower Saxony, Germany
Sören Wiesner

³Institute of Biostatistics, Hannover Medical School, Hannover, Germany
Jan Zeidler

⁴Center for Health Economics Research Hannover, Leibniz University Hannover, Hannover, Germany
Mikal Obed

¹Department of Pediatric and Adolescent Surgery, Hannover Medical School, Hannover, Germany
Johannes Weidner

¹Department of Pediatric and Adolescent Surgery, Hannover Medical School, Hannover, Germany
Adan Chari Jirmo

¹Department of Pediatric and Adolescent Surgery, Hannover Medical School, Hannover, Germany
Jens Dingemann

¹Department of Pediatric and Adolescent Surgery, Hannover Medical School, Hannover, Germany
Nagoud Schukfeh

¹Department of Pediatric and Adolescent Surgery, Hannover Medical School, Hannover, Germany

Abstract

Introduction

Thoracoscopic esophageal atresia (EA) repair is a demanding procedure. It provides long-term benefits for patients including better cosmesis and less musculoskeletal sequelae compared with open surgery. Besides technical challenges, there is concern that thoracoscopy increases treatment costs. However, surgical treatment of EA in Germany is not centralized with more than 90 pediatric surgical units offering treatment for 200 expected EA patients yearly. Our aim was to evaluate the rate of thoracoscopic EA repair regarding characteristics of treating hospitals, surgical approach and treatment costs in Germany.

Materials and Methods

Insurance claims data (January 2020 to June 2024) from six health insurance companies representing about one-third (28.5 million) of the German population were analyzed. The database was queried for specific ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification) and OPS (Operationen- und Prozedurenschlüssel) coding. Characteristics of treating hospitals, length of hospital stay and medical treatment costs were assessed.

Results

A total of 149 reconstructive procedures for EA were analyzed. Eleven esophageal anastomoses were performed thoracoscopically (7%). All thoracoscopic procedures were performed in a specialized center. Mean length of hospital stay for open and thoracoscopic surgery was 76 versus 79 days, respectively (p > 0.05). Mean treatment costs were 142,741 € versus 150,238 €, respectively (p > 0.05).

Conclusion

Thoracoscopic EA repair remains the exception in Germany. Thoracoscopy is exclusively performed in specialized hospitals. Length of hospital stay and treatment costs are comparable to open surgery, assumingly due to only uncomplicated patients without comorbidities being considered for thoracoscopy. We recommend surgical treatment in specialized centers to enable surgical advantages to all patients with EA.

Keywords

esophageal atresia - thoracoscopic repair - pediatric thoracic surgery - minimally invasive

Full Text

References

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