Pediatric Surgical Research Output in Germany in the Last 30 Years – An Assessment and International Comparison of Three Dedicated Paediatric Surgical Journals

Sochaczewski, Christina Oetzmann von; Muensterer, Oliver J.

doi:10.3389/fped.2020.00152

Cited by 5 publications

(3 citation statements)

References 48 publications

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“…In a previous report from Germany, population-based data were assessed using only the number of coded ICD-10-GM diagnoses of infantile hypertrophic pyloric stenosis to describe the reduction in cases [ 7 ]. As the number of paediatric surgeons [ 25 ] and paediatric surgical units [ 26 ] has increased substantially since then, counting patients twice due to referral from one hospital to the other may have influenced the results. However, the small difference between diagnoses and procedures remained almost constant during the study period and is thus unlikely to have exerted a relevant influence on the results.…”

Section: Discussionmentioning

confidence: 99%

The incidence of infantile hypertrophic pyloric stenosis nearly halved from 2005 to 2017: analysis of German administrative data

Sochaczewski

Muensterer

2021

Pediatr Surg Int

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Purpose Some paediatric surgical diseases showed a declining incidence in recent years, among which hypertrophic pyloric stenosis has been particularly striking shortly in the years after the millennium. We aimed to assess whether this development continued over the following decade, as it might offer the chance to better understand the underlying reasons. Methods We analysed data files obtained from the German federal statistics office for principal diagnosis of hypertrophic pyloric stenosis and pyloromyotomies from 2005 to 2017. Changes over time were assessed via linear regression for incidences per 1000 live births. Results In the respective time interval, there were a mean of 1009 pyloromyotomies (95% CI 906–1112) per year, of which a mean of 835 (95% CI 752–917) were performed in boys. The incidence of hypertrophic pyloric stenosis per 1000 live births almost halved between 2005 and 2017: it decreased by 0.12 pylorotomies annually (95% CI 0.09–0.14; P < 0.0001) in boys—from a maximum of 2.96 to a minimum of 1.63–and 0.03 pyloromyotomies annually (95% CI 0.02–0.04; P < 0.0001) in girls—from a maximum of 0.64 to a minimum of 0.28. There was considerable regional variation in incidences between the German länder. Conclusion The decreasing incidence of hypertrophic pyloric stenosis noted around the millenium continued into the following decades. The underlying reasons are unclear, which should prompt further research on the subject matter.

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Section: Discussionmentioning

confidence: 99%

The incidence of infantile hypertrophic pyloric stenosis nearly halved from 2005 to 2017: analysis of German administrative data

Sochaczewski

Muensterer

2021

Pediatr Surg Int

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“…This suggests a tendency to stick with the approach that one is proficient with, because there is a relevant learning curve to learn the open [ 39 ] or the transabdominal laparoscopic approach [ 40 ]. Taking into account the steadily increasing number of paediatric surgeons in Germany [ 41 ] would support the notion that their expertise in treating children becomes more broadly available and thus supplant adult surgeons using their approach of hernioplasty.…”

Section: Discussionmentioning

confidence: 99%

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

et al. 2021

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Background Contrary to adult inguinal hernia surgery, large-scale investigations using registries or administrative data are missing in paediatric surgery. We aimed to fill this gap by analysing German administrative hospital data to describe the current reality of inpatient hernia surgery in children. Methods We analysed aggregated data files bought from the German federals statistics office on hospital reimbursement data separately for principal diagnoses of inguinal hernia in children and for herniotomies in inpatients. Developments over time were assessed via regression and differences between groups with nonparametric comparisons. Results Principal diagnoses of hernias were decreasing over time with the exception of male bilateral and female bilateral incarcerated hernias in the first year of life which increased. The vast majority of operations were conducted via the open approach and laparoscopy was increasingly only used for females older than 1 year of age. Recurrent hernia repair was scarce. Rates of inguinal hernia repair were higher in both sexes the younger the patient was, but were also decreasing in all age groups despite a population growth since 2012. The amount of inguinal hernia repairs by paediatric surgeons compared to adult surgeons increased by 1.5% per year. Conclusions Our results corroborate previous findings of age and sex distribution. It demonstrates that inpatient hernia repair is primarily open surgery with herniorrhaphy and that recurrences seem to be rare. We observed decreasing rates of hernia repairs over time and as this has been described before in England, future studies should try to elucidate this development. Level of evidence III.

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“…For example, despite a recommendation of one pediatric surgical unit to serve every 2 million people, there is one unit for every million citizens in Italy, 23 whereas it is 1.6 per million people in Germany. 24 Thus, while in Germany and the UK there are 4,547 25 and 3,637 pediatric surgeons per million population under the age of 14 years, respectively; South Africa has only 260 per million despite a much younger population. 26 In Italy, the relative oversupply of pediatric surgeons is recognized, with experts noting that “the presence of so many surgeons may imply a lack of broad exposure to paediatric surgical pathology” and that “too many centres, and too many surgeons for too few patients may be ultimately detrimental to the specialization and excellence of care.” 23…”

Section: Discussionmentioning

confidence: 99%

Globalization in Pediatric Surgical Training: The Benefit of an International Fellowship in a Low-to-Middle–Income Country Academic Hospital

et al. 2021

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Objective A relative oversupply of pediatric surgeons led to increasing difficulties in surgical training in high-income countries (HIC), popularizing international fellowships in low-to-middle–income countries (LMIC). The aim of this study was to evaluate the benefit of an international fellowship in an LMIC for the training of pediatric surgery trainees from HICs. Methods We retrospectively reviewed and compared the prospectively maintained surgical logbooks of international pediatric surgical trainees who completed a fellowship at Chris Hani Baragwanath Academic Hospital in the last 10 years. We analyzed the number of surgeries, type of involvement, and level of supervision in the operations. Data are provided in mean differences between South Africa and the respective home country. Results Seven fellows were included. Operative experience was higher in South Africa in general (Δx̅ = 381; 95% confidence interval [CI]: 236–656; p < 0.0001) and index cases (Δx̅ = 178; 95% CI: 109–279; p < 0.0001). In South Africa, fellows performed more index cases unsupervised (Δx̅ = 71; 95% CI: 42–111; p < 0.0001), but a similar number under supervision (Δx̅ = –1; 95% CI: –25–24; p = 0.901). Fellows were exposed to more surgical procedures in each pediatric surgical subspecialty. Conclusion An international fellowship in a high-volume subspecialized unit in an LMIC can be highly beneficial for HIC trainees, allowing exposure to higher caseload, opportunity to operate independently, and to receive a wider exposure to the different fields of pediatric surgery. The associated benefit for the local trainees is some reduction in their clinical responsibilities due to the additional workforce, providing them with the opportunity for protected academic and research time.

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Pediatric Surgical Research Output in Germany in the Last 30 Years – An Assessment and International Comparison of Three Dedicated Paediatric Surgical Journals

Cited by 5 publications

References 48 publications

The incidence of infantile hypertrophic pyloric stenosis nearly halved from 2005 to 2017: analysis of German administrative data

The incidence of infantile hypertrophic pyloric stenosis nearly halved from 2005 to 2017: analysis of German administrative data

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

Globalization in Pediatric Surgical Training: The Benefit of an International Fellowship in a Low-to-Middle–Income Country Academic Hospital

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