OPERATIVE VOLUME OF NEWBORN SURGERY in Germany | 19 university hospitals 2015-2017 | categorized by operative volume | Institutions | 2,162 NEONATAL SURGERIES | = 51% of expected cases nationwide | 28 to 258 cases per center | 4 high 4 medium 11 low volume | Trend | CASELOAD REDUCTION | CONGENITAL MALFORMATIONS & NEONATAL ABDOMINAL EMERGENCIES | operated on in HIGH VOLUME CENTERS | SWIPE | CLINICAL + SURGICAL EXPERIENCE RESEARCH CAPABILITIES QUALITY | NEEDS | CENTRALIZATION OF NEWBORN SURGERY | 56% CDH | 40% Bowel atresia | 45% Hirschsprung disease | 40% Anorectal malformations | 45% NEC/SIP/Gastric perforation | 40% Esophageal atresia | 39-41% Gastroschisis Omphalocele | 39% Posterior urethral valves | % per DISEASE OPERATED on in HIGH VOLUME CENTERS | Eur J Pediatr Surg, Jan 2022 | DOI: 10.1055/s-0041-1740479 | @StayCurrentMD | Thieme | @EJPS @EJPSR by Leah Bode
Operative Volume of Newborn Surgery in German University Hospitals: High Volume Versus Low Volume Centers
Infographic · Mar 2022 · 1 min read
In brief
In brief
German university hospitals performed only 51% of expected newborn surgeries for congenital malformations from 2015-2017, with 58% classified as low-volume centers. The study reveals significant decentralization of neonatal surgical care, raising concerns about adequate training opportunities and clinical experience for pediatric surgeons in rare conditions.
- Only 51% of expected newborn surgical cases are treated at German university hospitals, indicating significant care fragmentation.
- 58% of academic centers qualify as low-volume (median 101 cases over 3 years), limiting surgeon experience and training opportunities.
- High-volume centers handle only 39-56% of cases across malformation types, with no category exceeding 60% concentration.
- Decentralization threatens quality maintenance, research capacity, and adequate training for next-generation pediatric surgeons.
- National data supports need for centralization discussion to ensure adequate surgical volumes for rare congenital conditions.
Written by the GCMD Library team from the infographic.
Blue and white infographic with anatomical line drawings of organs (intestines, heart, bladder) scattered throughout. Layout uses triangular diagrams at top to show volume distribution, followed by sections highlighting specific congenital conditions with percentage data. Color scheme is primarily navy blue text on light blue and white backgrounds.
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.