择期手术公共卫生监测的差距：德国住院数据、新冠肺炎影响和编码有效性的全国分析（2006-2023年）

摘要(中文译文)

行政住院数据集是健康监测的基石工具，但其在追踪择期、自费手术市场方面的有效性仍不明确。本研究通过量化18年趋势、评估COVID-19大流行的影响，并将医院捕获率与全国估计值进行基准比较以识别关键的公共卫生监测缺口，来评价全国住院数据用于监测美容手术的效用。我们对德国强制性医院质量报告（2006—2023年）进行了描述性纵向流行病学分析。通过手术特异性编码识别了四种高手术量术式（吸脂术、眼睑成形术、隆乳术和腹壁成形术）。为评价诊断有效性，我们分析了ICD-10编码Z41.1（“非以治疗健康状态为目的的操作”）的使用情况。将住院手术量与国际美容整形外科学会（ISAPS）的全国估计值进行基准比较，以确定总市场中的“医院份额”。2006年至2023年间，共记录352 468例住院手术。年手术量从11 593例增至33 170例，增长至三倍。住院吸脂术（+611%）和腹壁成形术（+424%）大幅增长，而隆乳术下降33%。分段分析显示，吸脂术手术量在2020年未出现显著的即时水平下降，并在大流行后时期持续增加。基准比较提示，医院对更广泛全国美容手术市场的可见度有限：至2023年，医院仅捕获全国隆乳术的2.0%和吸脂术的13.5%。ICD-10 Z41.1仅在0.4%的病例中使用，提示其作为适应证特异性监测标志物的效用有限。尽管医院数据是高复杂度病例的重要哨点，但住院手术量与全国估计值之间的巨大差异凸显了择期手术监测中的巨大数据缺口。Z41.1的有限使用提示，当前诊断编码框架本身不足以监测择期自费手术。向整合的跨部门登记系统和ICD-11过渡，对于准确的流行病学描绘和外科人力规划至关重要。

Abstract

Administrative inpatient datasets are cornerstone tools for health surveillance, yet their validity in tracking elective, self-pay surgical markets remain poorly defined. This study evaluates the utility of nationwide inpatient data for monitoring aesthetic surgery by quantifying 18-year trends, assessing the COVID-19 pandemic's impact, and benchmarking hospital capture rates against national estimates to identify critical public health surveillance gaps. We conducted a descriptive longitudinal epidemiologic analysis of mandatory German hospital quality reports (2006-2023). Four high-volume procedures (liposuction, blepharoplasty, breast augmentation, and abdominoplasty) were identified via procedure-specific codes. To evaluate diagnostic validity, we analyzed the usage of ICD-10 code Z41.1 ("Procedures for purposes other than remedying health states"). Inpatient volumes were benchmarked against ISAPS national estimates to determine the "hospital share" of the total market. Between 2006 and 2023, 352,468 inpatient procedures were recorded. Annual volumes tripled from 11,593 to 33,170. While inpatient liposuction (+611%) and abdominoplasty (+424%) surged, breast augmentation declined by 33%. Liposuction volumes showed no significant immediate 2020 level decline in segmented analysis and continued to increase during the post-pandemic period. Benchmarking suggested limited hospital visibility of the broader national aesthetic-surgery market: by 2023, hospitals captured only 2.0% of national breast augmentations and 13.5% of liposuctions. ICD-10 Z41.1 was utilized in only 0.4% of cases, suggesting limited utility as an indication-specific surveillance marker. While hospital data serve as a vital sentinel for high-complexity cases, the massive discrepancy between inpatient volumes and national estimates highlights a large data gap in elective surgery surveillance. The limited use of Z41.1 suggests that current diagnostic coding frameworks are insufficient, on their own, for monitoring elective self-pay procedures. Transitioning to integrated, cross-sectoral registries and ICD-11 is essential for accurate epidemiological mapping and surgical workforce planning.

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