Decentralized surgery of abdominal wall defects in Germany

Abstract

Purpose Neonatal surgery for abdominal wall defects is not performed in a centralized manner in Germany. The aim of this study was to investigate whether treatment for abdominal wall defects in Germany is equally effective compared to international results despite the decentralized care. Methods All newborn patients who were clients of the major statutory health insurance company in Germany between 2009 and 2013 and who had a diagnosis of gastroschisis or omphalocele were included. Mortality during the first year of life was analysed. Results The 316 patients with gastroschisis were classified as simple (82%) or complex (18%) cases. The main associated anomalies in the 197 patients with omphalocele were trisomy 18/21 (8%), cardiac anomalies (32%) and anomalies of the urinary tract (10%). Overall mortality was 4% for gastroschisis and 16% for omphalocele. Significant factors for non-survival were birth weight below 1500 g for both groups, complex gastroschisis, volvulus and anomalies of the blood supply to the intestine in gastroschisis, and female gender, trisomy 18/21 and lung hypoplasia in omphalocele. Conclusions Despite the fact that paediatric surgical care is organized in a decentralized manner in Germany, the mortality rates for gastroschisis and omphalocele are equal to those reported in international data.

Anterior abdominal wall defects: Demographic and clinical profile and outcome at a tertiary care hospital

“…Schmedding et al reported similar results with 82 % of gastroschisis as simple and mainly associated anomalies in omphalocele were trisomies (18 and 21), cardiac anomalies, and urinary tract anomalies. [18] Our non-GI anomaly rate in gastroschisis was similar to that reported by Payne et al [15,19] [16,19] We, however, have mostly term neonates in our series. We had 5 preterm neonates in our study including 4 with gastroschisis.…”

“…There was a huge difference in our mortality rates as compared to various other studies. [15][16][17][18][19][20][21][22][23][24] These differences might be due to various demographic and environmental factors in middle-income countries like India. Wright et al emphasized the role of surgical intervention in the survival of gastroschisis and documented a high mortality rate with contrasting statistics.…”

Abdominal Wall Defects—Current Treatments

“…Gastroschisis is typically accompanied by intestinal non-rotation and may be associated with intestinal atresia and/or perforations. In contrast to omphalocele, gastroschisis is rarely associated with other congenital or chromosomal anomalies [ 11 ]. As the midgut is freely floating in the amniotic fluid, the intestine is typically thickened, edematous and foreshortened [ 12 ].…”

“…Complex (as compared to simple) gastroschisis occurs in about 11–28% of cases and is defined by the presence of intestinal complications including atresia, perforation or necrosis. Intestinal atresia is the most common anomaly associated with gastroschisis occurring in about 10–15% of patients [ 11 , 12 , 13 , 14 ].…”

Epidemiology and One-Year Follow-Up of Neonates with CDH-Data from Health Insurance Claims in Germany

“…Insurance companies increasingly evaluate their routine patient data, especially with respect to diagnoses, procedures, mortality and length of hospital stay. These datasets have been successfully used for epidemiological research [ 6 , 7 , 8 ].…”