The incidence of infantile hypertrophic pyloric stenosis nearly halved from 2005 to 2017: analysis of German administrative data

Abstract

Purpose: Some paediatric surgical diseases showed a declining incidence in recent years, among which hypertrophic pyloric stenosis has been particularly striking shortly in the years after the millennium. We aimed to assess whether this development continued over the following decade, as it might offer the chance to better understand the underlying reasons.

Methods: We analysed data files obtained from the German federal statistics office for principal diagnosis of hypertrophic pyloric stenosis and pyloromyotomies from 2005 to 2017. Changes over time were assessed via linear regression for incidences per 1000 live births.

Results: In the respective time interval, there were a mean of 1009 pyloromyotomies (95% CI 906-1112) per year, of which a mean of 835 (95% CI 752-917) were performed in boys. The incidence of hypertrophic pyloric stenosis per 1000 live births almost halved between 2005 and 2017: it decreased by 0.12 pylorotomies annually (95% CI 0.09-0.14; P < 0.0001) in boys-from a maximum of 2.96 to a minimum of 1.63-and 0.03 pyloromyotomies annually (95% CI 0.02-0.04; P < 0.0001) in girls-from a maximum of 0.64 to a minimum of 0.28. There was considerable regional variation in incidences between the German länder.

Conclusion: The decreasing incidence of hypertrophic pyloric stenosis noted around the millenium continued into the following decades. The underlying reasons are unclear, which should prompt further research on the subject matter.

Keywords: Gastrointestinal surgery; Health services research; Hospital reimbursement; Inpatients; Paediatric surgery; Population-based.

Fig. 1

Pyloromyotomies per year. Data points represent individual yearly numbers of pyloromyotomies with mean and 95% confidence intervals

Fig. 2

Incidence of pyloromyotomies per 1000 live births. Estimation is based on ordinary least square linear regression. Data are presented as slope with 95% confidence interval

Fig. 3

Regional variation in incidences of hypertrophic pyloric stenosis between the Bundesländer (German federal states). Data represent incidences of infantile hypertrophic pyloric stenosis per 1000 live born children in the German federal states in 2005 (a, b), 2011 (c, d), and 2017 (e, f) separated between males (a, c, e) and females (b, d, f)