Abstract：
BACKGROUND: Hirschsprung\'s disease (HD) is a rare and complex malformation. The corrective operation is challenging and schedulable. The complete care situation for the corrective surgery for HD in Germany is uninvestigated.
METHODS: For the years 2016-2022, the microdata of the diagnosis-related groups (DRG) -statistics provided by the Research Data Center of the German Federal Statistical Office were accessed. All hospital stays for corrective surgery of HD in patients aged 0-17 were analyzed for patient\'s comorbidities, treatment characteristics and hospital structures. The occurrence of severe early postoperative complications during the hospital stay were documented.
RESULTS: The care structure for HD in Germany is decentralized with 109 hospitals performing 1199 corrective surgeries in 7 years. 75% of the participating hospitals performed three or less cases per year and 55 participating hospitals did not perform corrective surgery for HD each year. Early postoperative complications were common with at least one severe early complication in 18.6% of the cases. With an overall low case load per hospital, a volume outcome relationship cannot be established within Germany. Compared to international high volume centers the quality of outcomes for some of the investigated parameters was reduced. Despite the establishing of centers of expertise by the European reference network ERNICA for the treatment of HD no trend towards centralization occurred in Germany.
CONCLUSIONS: The corrective surgery for HD in Germany is decentralized and results in an overall high rate of early complications. The comparison with international studies from high-volume centers indicates potential for improvement for the corrective surgery of HD. Centralization remains essential for the improvement of care for patients with HD.
METHODS: For the years 2016-2022, the microdata of the diagnosis-related groups (DRG) -statistics provided by the Research Data Center of the German Federal Statistical Office were accessed. All hospital stays for corrective surgery of HD in patients aged 0-17 were analyzed for patient\'s comorbidities, treatment characteristics and hospital structures. The occurrence of severe early postoperative complications during the hospital stay were documented.
RESULTS: The care structure for HD in Germany is decentralized with 109 hospitals performing 1199 corrective surgeries in 7 years. 75% of the participating hospitals performed three or less cases per year and 55 participating hospitals did not perform corrective surgery for HD each year. Early postoperative complications were common with at least one severe early complication in 18.6% of the cases. With an overall low case load per hospital, a volume outcome relationship cannot be established within Germany. Compared to international high volume centers the quality of outcomes for some of the investigated parameters was reduced. Despite the establishing of centers of expertise by the European reference network ERNICA for the treatment of HD no trend towards centralization occurred in Germany.
CONCLUSIONS: The corrective surgery for HD in Germany is decentralized and results in an overall high rate of early complications. The comparison with international studies from high-volume centers indicates potential for improvement for the corrective surgery of HD. Centralization remains essential for the improvement of care for patients with HD.
摘要：
背景：先天性巨结肠（HD）是一种罕见且复杂的畸形。校正操作是具有挑战性的和可调度的。德国HD矫正手术的完整护理情况尚未调查。
方法：在2016-2022年期间，访问了德国联邦统计局研究数据中心提供的诊断相关组（DRG）微观数据-统计数据。对0-17岁的HD矫正手术患者的所有住院时间进行患者的合并症分析，治疗特点和医院结构。记录住院期间严重术后早期并发症的发生情况。
结果：德国HD的护理结构是分散的，有109家医院在7年内进行了1199例矫正手术。75％的参与医院每年进行3例或更少病例，55家参与医院每年未进行HD矫正手术。术后早期并发症很常见，其中18.6％的病例中至少有1例严重的早期并发症。每个医院的总体病例负荷较低，在德国内部无法建立数量结果关系。与国际高容量中心相比，某些研究参数的结果质量降低了。尽管欧洲参考网络ERNICA建立了治疗HD的专业中心，但德国并未出现集中化的趋势。
结论：德国的HD矫正手术是分散的，导致早期并发症的总体发生率很高。与来自高容量中心的国际研究的比较表明，改善HD矫正手术的潜力。集中化对于改善HD患者的护理仍然至关重要。
方法：在2016-2022年期间，访问了德国联邦统计局研究数据中心提供的诊断相关组（DRG）微观数据-统计数据。对0-17岁的HD矫正手术患者的所有住院时间进行患者的合并症分析，治疗特点和医院结构。记录住院期间严重术后早期并发症的发生情况。
结果：德国HD的护理结构是分散的，有109家医院在7年内进行了1199例矫正手术。75％的参与医院每年进行3例或更少病例，55家参与医院每年未进行HD矫正手术。术后早期并发症很常见，其中18.6％的病例中至少有1例严重的早期并发症。每个医院的总体病例负荷较低，在德国内部无法建立数量结果关系。与国际高容量中心相比，某些研究参数的结果质量降低了。尽管欧洲参考网络ERNICA建立了治疗HD的专业中心，但德国并未出现集中化的趋势。
结论：德国的HD矫正手术是分散的，导致早期并发症的总体发生率很高。与来自高容量中心的国际研究的比较表明，改善HD矫正手术的潜力。集中化对于改善HD患者的护理仍然至关重要。
