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Decentralized surgery of abdominal wall defects in Germany
Andrea Schmedding1, Boris Wittekind2, Emilia Salzmann-Manrique3
1Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. andrea.schmedding@kgu.de.
Insights
Neonatal surgery outcomes for gastroschisis and omphalocele in Germany match international standards, even with decentralized care. This study confirms effective treatment for these abdominal wall defects across the nation.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Neonatal surgery for abdominal wall defects in Germany is decentralized.
- Previous data on the effectiveness of decentralized care for these conditions is limited.
Purpose of the Study:
- To evaluate the effectiveness of decentralized neonatal surgical care for abdominal wall defects in Germany.
- To compare German outcomes for gastroschisis and omphalocele with international data.
Main Methods:
- Analysis of newborn patients diagnosed with gastroschisis or omphalocele between 2009-2013.
- Inclusion of patients covered by a major German statutory health insurance provider.
- Assessment of mortality rates within the first year of life.
Main Results:
- Overall mortality was 4% for gastroschisis and 16% for omphalocele.
- Factors influencing survival included birth weight, defect complexity, associated anomalies (e.g., trisomy 18/21, cardiac), and specific complications.
- 316 gastroschisis and 197 omphalocele cases were analyzed.
Conclusions:
- Decentralized pediatric surgical care in Germany yields mortality rates comparable to international benchmarks for gastroschisis and omphalocele.
- The study supports the effectiveness of the current decentralized model for managing these neonatal surgical conditions.
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.
