Surgical Management and Hospital Care Structures of Posthemorrhagic Hydrocephalus (PHHC) in Infants—A German Claims Data Analysis

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Abstract
Background: We investigate the management patterns during the study period of pediatric posthemorrhagic hydrocephalus (PHHC) in pediatric (PD) and non-pediatric departments (non-PD). Methods: In this study, data were retrospectively extracted from two large German statutory health insurance funds (~5.2 million clients) between 2010 and 2016. Infants aged ≤12 months were identified using ICD-10-GM codes Q03.-, G91.-, Q04.6, G93.0, Q05.-, and P52.-. The follow-up period was two years. Results: Among 1480 infants with hydrocephalus-related diagnoses, 1043 (71%) had a documented intraventricular hemorrhage. In 395 PHHC cases (36%), treatment was provided by a university/maximum care (UM) hospital. In total, 103 patients (9%) required surgery: performed in PD (n = 84; 82%), non-PD (n = 14; 13%) and unspecified (n = 5; 5%). Primary surgical interventions consisted of external ventricular drainage (38%), cerebrospinal fluid reservoir implantation (39%), ventriculoperitoneal shunt placement (15%), and endoscopic third ventriculostomy (9%). During the first inpatient treatment, complications occurred in 48 patients (47%), with at least one revisional surgery in 98% of cases. After 24 months of follow-up, 77 patients (75%) who required surgical management of PHHC finally received a VPS. No significant differences in complication rates were observed between hospitals with different treating surgical specialties in their departmental structures. UM hospitals treated a higher number of preterms with HC below the 28th gestational week (25% vs. 17%; p < 0.001), and their mortality rate was significantly lower than in non-UM hospitals (4% vs. 7%; p = 0.018). Conclusions: The surgical volume for PHHC in Germany was equally distributed between UM and non-UM hospitals. No statistically significant differences in clinical outcomes were observed between patients treated in hospitals with pediatric versus non-pediatric surgical departmental structures. Non-UM hospitals treated fewer preterm infants below the 28th gestational week and exhibited higher mortality.
Funding Information
  • Leipzig University

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