Introduction Adequate patient volume is essential for the maintenance of quality, meaningful research, and training of the next generation of pediatric surgeons. The role of university hospitals is to fulfill these tasks at the highest possible level. Due to decentralization of pediatric surgical care during the last decades, there is a trend toward reduction of operative caseloads. The aim of this study was to assess the operative volume of the most relevant congenital malformations at German academic pediatric surgical institutions over the past years.

Methods Nineteen chairpersons representing university-chairs in pediatric surgery in Germany submitted data on 10 index procedures regarding congenital malformations or neonatal abdominal emergencies over a 3-year period (2015 through 2017). All institutions were categorized according to the total number of respective cases into “high,” “medium,” and “low” volume centers by terciles. Some operative numbers were verified using data from health insurance companies, when available. Finally, the ratio of cumulative case load versus prevalence of the particular malformation was calculated for the study period.

Results From 2015 through 2017, a total 2,162 newborns underwent surgery for congenital malformations and neonatal abdominal emergencies at German academic medical centers, representing 51% of all expected newborn cases nationwide. The median of cases per center within the study period was 101 (range 18–258). Four institutions (21%) were classified as “high volume” centers, four (21%) as “medium volume” centers, and 11 (58%) as “low volume” centers. The proportion of patients operated on in high-volume centers varied per disease category: esophageal atresia/tracheoesophageal fistula: 40%, duodenal atresia: 40%, small and large bowel atresia: 39%, anorectal malformations: 40%, congenital diaphragmatic hernia: 56%, gastroschisis: 39%, omphalocele: 41%, Hirschsprung disease: 45%, posterior urethral valves: 39%, and necrotizing enterocolitis (NEC)/focal intestinal perforation (FIP)/gastric perforation (GP): 45%.

Conclusion This study provides a national benchmark for neonatal surgery performed in German university hospitals. The rarity of these cases highlights the difficulties for individual pediatric surgeons to gain adequate clinical and surgical experience and research capabilities. Therefore, a discussion on the centralization of care for these rare entities is necessary.

引言 充足的患者数量对于维持下一代儿科外科医生的质量、有意义的研究和培训至关重要。大学医院的作用是尽最大可能完成这些任务。由于过去几十年儿科外科护理的分散化，有减少手术病例量的趋势。本研究的目的是评估过去几年德国学术儿科外科机构中最相关的先天性畸形的手术量。

方法 19 名代表德国儿科外科大学主席的主席提交了 3 年期间（2015 年至 2017 年）关于先天性畸形或新生儿腹部紧急情况的 10 项指标程序的数据。所有机构均根据个案总数按三分位数分为“高”、“中”和“低”容量中心。使用来自健康保险公司的数据（如果有的话）验证了一些手术人数。最后，计算研究期间的累积病例量与特定畸形患病率的比率。

结果 从 2015 年到 2017 年，共有 2,162 名新生儿在德国学术医疗中心接受了先天性畸形和新生儿腹部急症手术，占全国所有预期新生儿病例的 51%。研究期间每个中心的病例中位数为 101（范围 18-258）。4 个机构 (21%) 被归类为“高容量”中心，4 个 (21%) 被归类为“中等容量”中心，11 个 (58%) 被归类为“低容量”中心。在高容量中心接受手术的患者比例因疾病类别而异：食管闭锁/气管食管瘘：40%，十二指肠闭锁：40%，小肠和大肠闭锁：39%，肛门直肠畸形：40%，先天性膈疝： 56%，腹裂：39%，脐膨出：41%，先天性巨结肠：45%，后尿道瓣膜：39%，

结论 本研究为在德国大学医院进行的新生儿手术提供了国家基准。这些病例的罕见性凸显了个体儿外科医生难以获得足够的临床和手术经验以及研究能力。因此，有必要对这些罕见实体的集中护理进行讨论。