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.

Hypertrophic pyloric stenosis masked by kidney failure in a male infant with a contiguous gene deletion syndrome at Xp22.31 involving the steroid sulfatase gene: case report

“…IHPS is the most common form of gastrointestinal obstruction in infancy (1:700), five times more frequent in males than in females and hereditably is high as 87% [ 19 , 20 ]. Isolated and syndromic IHPS are described [ 21 ].…”

Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany

“…This completeness does, however, only apply to cases that were treated on an inpatient basis. Contrary to diagnoses of hip fractures in adults [ 37 ] or hypertrophic pyloric stenosis in infants [ 15 ], operations for pilonidal sinus disease are on the list of procedures that may be conducted either as inpatient or office-based procedures and their methods—such as pit picking—that are specifically used for office-based procedures [ 38 ], as recommended by the S3 guideline for pilonidal sinus disease [ 31 , 32 ]. While it is difficult to conduct less complex inguinal hernia repair cost-covering on inpatients [ 39 ], the financial spread between the inpatient and office-based operation is much smaller for pilonidal sinus disease [ 40 ] and, thus, the incentive to conduct surgery preferably on inpatients is smaller than that for other diagnoses.…”

“…Statistical analyses were conducted using R (RRID: SCR_001905) (version 3.5.3) with its generic stats4 package [11], if not stated otherwise. Differences over time were assessed using linear regression, which has been deemed suitable for these type of data [12][13][14][15]. The necessary prerequisites of linear regression-normality of errors and homogeneity of variances-were tested using the Kolmogorov-Smirnov test and the Breusch-Pagan test from the olsrr package (version 0.5.3) [16] supported by visual analysis of QQ plots.…”

“…Confidence intervals for point estimates were calculated using the t distribution via the Rmisc package (version 1.5) [ 17 , 18 ]. Shape data—to visualise regional differences in the rate of inpatient episodes—were obtained from the Bundesamt für Kartographie und Geodäsie (Federal Agency for Cartography and Geodesy) [ 19 ] as described before [ 15 ]. Colour palettes from the viridis package (version 0.5.3) were used to draw colour-blind friendly figures [ 20 ].…”

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

“…Statistical analysis was conducted using R (RRID: SCR_001905) (version 3.5.3) with its generic stats4package (version 3.5.3) unless explicitly stated otherwise [13]. Changes over time were assessed via ordinary least squares linear regression if its assumptions were fulfilled, as performed before on similar data [14][15][16]. We checked normality of residuals with the Kolmogorow-Smirnowtest, homoscedasticity with the F-Test-both supported by visual analysis of QQ-plots [17]-and searched for outliers with the Bonferroni outlier test supported by the use of Cook's distance using the olsrr-package (version 0.5.3) [18].…”