Decentralized surgery of abdominal wall defects in Germany

Abstract

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.

Keywords: Child; Gastroschisis; Mortality; Neonatal surgery outcome; Omphalocele.

Fig. 1

Gastroschisis: association with non-survival the first year of life. Forest plot shows the unadjusted odds ratio in base-10 log scale. Non-Surv non-survivors, CI confidence interval, Pp value

Fig. 2

Omphalocele: association with non-survival during the first year of life. The forest plot shows the unadjusted odds ratio on a base-10 log scale. Non-Surv non-survivors, CI confidence interval, Pp value

Fig. 3

Omphalocele: forest plot showing the adjusted odds ratio associated with non-survival in the first year of life on a base-10 log scale. Non-Surv non-survivors, CI confidence interval, Pp value

Fig. 4

Gastroschisis. Cumulative incidence curves for hospital discharge. The curves do not reach 100% because fatalities before discharge were considered competing risks

Fig. 5

Omphalocele. Cumulative incidence curves for hospital discharge. The curves do not reach 100% because fatalities before discharge were considered competing risks. It was not possible to calculate a median for omphalocele patients with lung hypoplasia, and trisomy 18 and 21 because 78% and 87% of the patients died before discharge