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Eur J Pediatr Surg 2022; 32(04): 327-333
DOI: 10.1055/s-0041-1731030
Original Article

Analysis of Pulmonary Surgery in Children and Adolescents in Germany: Who Is doing What?

Carla E. Böckle
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
,
Jochen Blaser
2   Techniker Krankenkasse (Health Insurance)-Representative Office of Lower Saxony, Hannover, Lower Saxony, Germany
,
Nagoud Schukfeh
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
,
Jan Zeidler
3   Leibniz University Hannover-Center for Health Economics Research Hannover (CHERH), Hannover, Lower Saxony, Germany
,
Benno M. Ure
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
,
Jens Dingemann 
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
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Abstract

Introduction In Germany, pediatric surgery is organized in a decentralized manner. A nationwide clinical registry does not exist. The aim of this research is to analyze the current status of pulmonary surgery in the country in respect of children and adolescents.

Materials and Methods Claims data have been extracted from two health insurance databases representing 34% of the German population. Operative diagnoses and procedures, as well as patients' characteristics, were recorded from 2016 to 2019.

Results The incidence of the four index diagnoses investigated matched the current literature in three of four entities. The main indications <8 years were congenital lung malformations (61%) and spontaneous pneumothorax at age 8 to 17 years (77%). Furthermore, 1,668 pediatric pulmonary procedures (0–17 years) were identified (668 pulmonary resections). Two age peaks were identified: 13% of patients were operated on before 1 year old and 50% of patients were between 15 and 17 years old. Video-assisted-thoracoscopic-surgery (VATS) for pulmonary resections was applied in 62% of cases. 96% of pulmonary resections in patients <1 year and 70% of pulmonary resections in children between 1 and 14 years were performed by pediatric surgeons. Of patients between 15 and 17 years old, only 14% were operated on in pediatric surgery. The estimated average pulmonary resection caseload was 3.2 cases per year and per institution for pediatric surgery and 1.5 for adult surgery.

Conclusion Indications for pulmonary surgery in children arise from rare diagnoses. In total, 66% of lung resections are performed in patients <1 year and >14 years. The majority of lung resections are performed as VATS. Patients ≤14 years are predominantly operated on by pediatric surgeons. The accessibility of pediatric pulmonary surgery is acceptable, but there is a low caseload per center.

Keywords

pediatric thoracic surgery - pediatric pulmonary surgery - lung malformations - video-assisted-thoracoscopic-surgery - insurance claims data


Publication History

Received: 08 March 2021

Accepted: 23 April 2021

Article published online:
20 June 2021

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