Treatment of Anorectal Malformations in German Hospitals: Analysis of National Hospital Discharge Data from 2016 to 2021.

IF 1.5 3区 医学 Q2 PEDIATRICS European Journal of Pediatric Surgery Pub Date : 2024-12-01 Epub Date: 2024-02-02 DOI:10.1055/a-2260-5124
Miriam Wilms, Ekkehart Jenetzky, Stefanie Märzheuser, Reinhard Busse, Ulrike Nimptsch
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Abstract

Background:  Anorectal malformations (ARMs) are complex congenital anomalies. The corrective operation is demanding and schedulable. Based on complete national data, patterns of care have not been analyzed in Germany yet.

Methods:  All cases with ARM were analyzed (1) at the time of birth and (2) during the hospital stay for the corrective operation, based on the national hospital discharge data (DRG statistics). Patient's comorbidities, treatment characteristics, hospital structures, and the outcome of corrective operations were analyzed with respect to the hospitals' caseload.

Results:  From 2016 to 2021, 1,726 newborns with ARM were treated at the time of birth in 388 hospitals. Of these hospitals, 19% had neither a pediatric nor a pediatric surgical department. At least one additional congenital anomaly was present in 49% of cases and 7% of the newborns had a birthweight below 1,500 g.In all, 2,060 corrective operations for ARM were performed in 113 hospitals in the same time period. In 24.5% of cases, at least one major complication was documented. One-third of the operations were performed in 56 hospitals, one-third in 20 hospitals, and one-third in 10 hospitals with median annual case numbers of 2, 5, and 10, respectively.Hospitals with the highest caseload operated cloacal defects more often than hospitals with the lowest caseload (7 vs. 2%) and had more early complications than hospitals with the lowest caseload (30 vs. 21%). This difference was not statistically significant after risk adjustment.

Conclusions:  Children with ARM are multimorbid. Early complications after corrective surgery are common. Considering the large number of hospitals with a very low caseload, centralization of care for the complex and elective corrective surgery for ARM remains a key issue for quality of care.

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德国医院的肛门直肠畸形治疗:2016年至2021年全国医院出院数据分析。
背景:肛门直肠畸形(ARM)是一种复杂的先天性畸形。肛门直肠畸形(ARM)是一种复杂的先天性畸形,矫正手术要求高且时间紧。基于完整的全国数据,德国尚未对护理模式进行分析:方法:根据全国出院数据(DRG 统计),对所有 ARM 病例进行分析:1)出生时;2)矫正手术住院期间。根据医院的病例数分析了患者的合并症、治疗特点、医院结构以及矫正手术的结果:2016-2021年,388家医院共收治了1726名患有ARM的新生儿。其中,19%的医院既没有儿科也没有儿科外科。49%的病例中至少还存在一种先天性畸形,7%的新生儿出生体重低于1500克。同期,113 家医院共进行了 2060 例 ARM 矫正手术。在 24.5% 的病例中,至少有一种主要并发症被记录在案。三分之一的手术在 56 家医院进行,三分之一在 20 家医院进行,三分之一在 10 家医院进行,年手术例数中位数分别为 2 例与 5 例与 10 例。病例数最多的医院比病例数最少的医院更常进行泄殖腔缺损手术(7% 对 2%),其早期并发症也比病例数最少的医院多(30% 对 21%)。经过风险调整后,这一差异在统计学上并不显著:结论:ARM患儿多病。结论:ARM患儿多病缠身,矫正手术后的早期并发症很常见。考虑到大量医院的病例量非常低,对复杂的ARM选择性矫正手术进行集中护理仍是提高护理质量的关键问题。
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来源期刊
CiteScore
3.90
自引率
5.60%
发文量
66
审稿时长
6-12 weeks
期刊介绍: This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.
期刊最新文献
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