Lucas Wennemann, Jochen Blaser, Sören Wiesner, Jan Zeidler, Mikal Obed, Johannes Weidner, Adan Chari Jirmo, Jens Dingemann, Nagoud Schukfeh
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引用次数: 0
摘要
胸腔镜下食管闭锁(EA)修复是一项要求很高的手术。与开放手术相比,它为患者提供了长期的好处,包括更好的美容效果和更少的肌肉骨骼后遗症。除了技术上的挑战,人们还担心胸腔镜会增加治疗费用。然而,在德国,EA的手术治疗并不集中,每年有90多个儿科外科单位为200名预期的EA患者提供治疗。我们的目的是评估胸腔镜下EA修复率与德国治疗医院、手术方式和治疗费用的特点有关。研究人员分析了来自六家健康保险公司的保险索赔数据(2020年1月至2024年6月),这些公司约占德国人口的三分之一(2850万)。在数据库中查询特定的ICD-10-GM(国际疾病和相关健康问题统计分类,第十次修订,德国修订)和OPS (Operationen- und prozedurenschlssel)编码。评估治疗医院的特点、住院时间和医疗费用。对149例EA的重建方法进行了分析。经胸腔镜行食管吻合11例(7%)。所有的胸腔镜手术在一个专门的中心进行。开腹和胸腔镜手术的平均住院时间分别为76天和79天(p < 0.05)。平均治疗费用分别为142,741欧元和150,238欧元(p < 0.05)。在德国胸腔镜下的EA修复仍然是例外。胸腔镜只在专科医院进行。住院时间和治疗费用与开放手术相当,假设只有无合并症的无并发症患者才考虑进行胸腔镜检查。我们建议在专门的中心进行手术治疗,以使所有EA患者都能获得手术优势。
Esophageal Atresia Repair in Germany: Utilization Patterns, Hospital Characteristics and Costs.
Thoracoscopic esophageal atresia (EA) repair is a demanding procedure. It provides long-term benefits for patients including better cosmesis and less musculoskeletal sequelae compared with open surgery. Besides technical challenges, there is concern that thoracoscopy increases treatment costs. However, surgical treatment of EA in Germany is not centralized with more than 90 pediatric surgical units offering treatment for 200 expected EA patients yearly. Our aim was to evaluate the rate of thoracoscopic EA repair regarding characteristics of treating hospitals, surgical approach and treatment costs in Germany.Insurance claims data (January 2020 to June 2024) from six health insurance companies representing about one-third (28.5 million) of the German population were analyzed. The database was queried for specific ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification) and OPS (Operationen- und Prozedurenschlüssel) coding. Characteristics of treating hospitals, length of hospital stay and medical treatment costs were assessed.A total of 149 reconstructive procedures for EA were analyzed. Eleven esophageal anastomoses were performed thoracoscopically (7%). All thoracoscopic procedures were performed in a specialized center. Mean length of hospital stay for open and thoracoscopic surgery was 76 versus 79 days, respectively (p > 0.05). Mean treatment costs were 142,741 € versus 150,238 €, respectively (p > 0.05).Thoracoscopic EA repair remains the exception in Germany. Thoracoscopy is exclusively performed in specialized hospitals. Length of hospital stay and treatment costs are comparable to open surgery, assumingly due to only uncomplicated patients without comorbidities being considered for thoracoscopy. We recommend surgical treatment in specialized centers to enable surgical advantages to all patients with EA.
期刊介绍:
This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements.
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Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.