Abstract
Introduction In Germany, pediatric surgery is organized in a decentralized manner. A nationwide
clinical registry does not exist. The aim of this research is to analyze the current
status of pulmonary surgery in the country in respect of children and adolescents.
Materials and Methods Claims data have been extracted from two health insurance databases representing
34% of the German population. Operative diagnoses and procedures, as well as patients'
characteristics, were recorded from 2016 to 2019.
Results The incidence of the four index diagnoses investigated matched the current literature
in three of four entities. The main indications <8 years were congenital lung malformations
(61%) and spontaneous pneumothorax at age 8 to 17 years (77%). Furthermore, 1,668
pediatric pulmonary procedures (0–17 years) were identified (668 pulmonary resections).
Two age peaks were identified: 13% of patients were operated on before 1 year old
and 50% of patients were between 15 and 17 years old. Video-assisted-thoracoscopic-surgery
(VATS) for pulmonary resections was applied in 62% of cases. 96% of pulmonary resections
in patients <1 year and 70% of pulmonary resections in children between 1 and 14 years
were performed by pediatric surgeons. Of patients between 15 and 17 years old, only
14% were operated on in pediatric surgery. The estimated average pulmonary resection
caseload was 3.2 cases per year and per institution for pediatric surgery and 1.5
for adult surgery.
Conclusion Indications for pulmonary surgery in children arise from rare diagnoses. In total,
66% of lung resections are performed in patients <1 year and >14 years. The majority
of lung resections are performed as VATS. Patients ≤14 years are predominantly operated
on by pediatric surgeons. The accessibility of pediatric pulmonary surgery is acceptable,
but there is a low caseload per center.
Keywords
pediatric thoracic surgery - pediatric pulmonary surgery - lung malformations - video-assisted-thoracoscopic-surgery
- insurance claims data
