Nationwide utilization patterns and perioperative outcomes of minimally invasive pediatric nephrectomy in Germany.
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INTRODUCTION: Minimally invasive nephrectomy is the favored approach for pediatric nephrectomies (74%) according to recent literature. However, data on treatment costs when compared to open nephrectomy are lacking. Our aim was to investigate the rate of minimally invasive pediatric nephrectomies in Germany and to assess treatment costs depending on different approaches. MATERIALS AND METHODS: Our study was based on data of the German statutory health care insurance company Techniker Krankenkasse from 01/2019-05/2024. After ethical approval, data of all patients up to the age of 18 years who underwent nephrectomy were analyzed with focus on surgical approach, malignancy, complications, ventilation hours, length of hospital stay and treatment costs. Database was queried for specific ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification) and OPS (Operationen- und Prozedurenschlüssel) coding. To enable international comparison, a literature search was conducted. RESULTS: 209 nephrectomies were performed in 209 patients during the study period. Out of these, 32% were minimally invasive. Postoperative blood transfusions (1 vs. 39) and readmissions within 90 days after discharge (18 vs. 84) were lower after minimally invasive nephrectomy. Postoperative ventilation hours were significantly lower after minimally invasive compared to open nephrectomies (0 vs. 5.9 ± 24.4 h, p < 0.0175). Minimally invasive nephrectomies were associated with almost half the length stay (7.9 ± 7 vs. 14.2 ± 21.7days, p < 0.0001) and half the treatment costs (10,782 ± 3,924€ vs. 21,240 ± 29,407€, p < 0.0001). CONCLUSION: In this nationwide administrative database, minimally invasive nephrectomy accounted for approximately one-third of pediatric nephrectomies. Descriptively, shorter hospital stays and lower hospital costs were recorded among patients undergoing minimally invasive nephrectomy. Given the descriptive nature of this analysis and the limited clinical detail available in the administrative database, these observations should not be interpreted as evidence of comparative effectiveness or causality and may, in part, reflect differences in case selection.