Download PDF
Eur J Pediatr Surg
DOI: 10.1055/a-2260-5124
Original Article

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

Miriam Wilms 
1   Patient Organization for People with Anorectal Malformations and Hirschsprung's Disease (SoMA e.V.), Munich, Germany
2   Department of General-, Visceral-, Thorax and Pediatric Surgery, Universitätsklinikum Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
,
Ekkehart Jenetzky 
3   Department of Research Methodology and Information Systems in the Integrative Medicine, University Witten Herdecke Faculty of Medicine, Witten, Nordrhein-Westfalen, Germany
4   Departement of Child and Adolescent Psychiatry, Johannes Gutenberg University Hospital Mainz, Mainz, Rheinland-Pfalz, Germany
,
Stefanie Märzheuser
5   Departement of Pediatric Surgery, Rostock University Medical Center Children and Youth Clinic, Rostock, Mecklenburg-Vorpommern, Germany
,
Reinhard Busse
6   Department of Health Care Management, Technische Universität Berlin, Berlin, Berlin, Germany
,
Ulrike Nimptsch
6   Department of Health Care Management, Technische Universität Berlin, Berlin, Berlin, Germany
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

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.

Keywords

anorectal malformation - volume–outcome relationship - quality of care

Note

The COI was subsequently added on 12th March, 2024.


Supplementary Material



Publication History

Received: 13 November 2023

Accepted: 01 February 2024

Accepted Manuscript online:
02 February 2024

Article published online:
29 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kröger J, Günster C, Heller G. et al. Prevalence and infant mortality of major congenital malformations stratified by birthweight. Neonatology 2022; 119 (01) 41-59
    Google Scholar
  • 2 Elrod J, Boettcher M, Mohr C, Reinshagen K. An analysis of the care structure for congenital malformations in Germany. Dtsch Arztebl Int 2021; 118 (35–36): 601-602
    Google Scholar
  • 3 Kancherla V, Sundar M, Tandaki L. et al. Prevalence and mortality among children with anorectal malformation: a multi-country analysis. Birth Defects Res 2023; 115 (03) 390-404
    Google Scholar
  • 4 Cuschieri A. EUROCAT Working Group. Anorectal anomalies associated with or as part of other anomalies. Am J Med Genet 2002; 110 (02) 122-130
    Google Scholar
  • 5 Bischoff A, Bealer J, Wilcox DT, Peña A. Error traps and culture of safety in anorectal malformations. Semin Pediatr Surg 2019; 28 (03) 131-134
    Google Scholar
  • 6 Pietryga S, Lock JF, Diers J. et al. Nationwide volume-outcome relationship concerning in-hospital mortality and failure-to-rescue in surgery of sigmoid diverticulitis. Int J Colorectal Dis 2023; 38 (01) 203
    Google Scholar
  • 7 Diers J, Wagner J, Baum P. et al. Nationwide in-hospital mortality following colonic cancer resection according to hospital volume in Germany. BJS Open 2019; 3 (05) 672-677
    Google Scholar
  • 8 Betalli P, Cheli M, Colusso MM. et al. Association between Kasai portoenterostomy at low caseload centres and transplant complications in children with biliary atresia. J Pediatr Surg 2022; 57 (09) 223-228
    Google Scholar
  • 9 Dingemann C, Eaton S, Aksnes G. et al. ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: diagnostics, preoperative, operative, and postoperative management. Eur J Pediatr Surg 2020; 30 (04) 326-336
    Google Scholar
  • 10 Kyrklund K, Sloots CEJ, de Blaauw I. et al. ERNICA guidelines for the management of rectosigmoid Hirschsprung's disease. Orphanet J Rare Dis 2020; 15 (01) 164
    Google Scholar
  • 11 Research Data Centers of the Federal Statistical Office and Statistical Offices of the Federal States. DRG statistics. Doi: 10.21242/23141.2016.00.00.1.1.0 to 10.21242/23141.2021.00.00.1.1.0, own calculations
    Google Scholar
  • 12 Federal Statistics by DESTATIS. Live births, deaths, excess births/deaths (from 1950). 2023 . Accessed February 10, 2024 at: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bevoelkerung/Sterbefaelle-Lebenserwartung/Tabellen/lrbev04.html#242408
    Google Scholar
  • 13 Ples L, Chicea R, Poenaru MO, Neacsu A, Sima RM, Micu R. Can anorectal atresia be diagnosed in the first trimester of pregnancy? A systematic literature review. Medicina (Kaunas) 2020; 56 (11) 583
    Google Scholar
  • 14 Evans-Barns HME, Porrett L, Hartmann PL. et al. Screening for VACTERL anomalies in children with anorectal malformations: outcomes of a standardized approach. J Pediatr Surg 2023; 58 (07) 1263-1268
    Google Scholar
  • 15 Holschneider A, Hutson J, Peña A. et al. Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations. J Pediatr Surg 2005; 40 (10) 1521-1526
    Google Scholar
  • 16 Levitt MA, Peña A. Anorectal malformations. Orphanet J Rare Dis 2007; 2: 33
    Google Scholar
  • 17 Schmiedeke E, Zwink N, Schwarzer N. et al. Unexpected results of a nationwide, treatment-independent assessment of fecal incontinence in patients with anorectal anomalies. Pediatr Surg Int 2012; 28 (08) 825-830
    Google Scholar
  • 18 Levitt MA, Peña A. Outcomes from the correction of anorectal malformations. Curr Opin Pediatr 2005; 17 (03) 394-401
    Google Scholar