Proportion and complexity of children and adolescents treated in pediatric versus adult departments in Germany 2016 - 2022

Abstract Background: Germany’s upcoming hospital reform proposes a restructuring of inpatient services, potentially limiting infrastructural funding to general pediatric services while excluding the pediatric subspecialties. This has raised concerns about future access to specialized inpatient care for children and adolescents, especially given the complexity and diversity of pediatric conditions. To contribute objective data to this debate, we analyzed how pediatric patients are distributed between pediatric (PD) and adult departments (AD) and assessed the complexity of treated cases. Methods: We conducted a retrospective observational study using data from the German nationwide hospital discharge dataset (GHD) from 2016 to 2022. Hospitalized cases aged >28 days and <18 years were included and classified as surgical or non-surgical based on operation and procedure codes, while department classification relied on department codes. Case complexity was assessed using the Pediatric Complex Chronic Conditions (PCCC) score and a modified PCCC model incorporating a logistic S-curve to reflect increasing complexity with multiple chronic conditions. Results: A total of 7,896,283 pediatric cases were analyzed. Most patients (74.1%) were treated in PDs, 23.4% in ADs, and 2.5% in interdisciplinary settings. While 87.0% of non-surgical cases were treated in PDs, 58.9% of surgical cases were managed in ADs. Case complexity was highest in interdisciplinary cases, followed by PDs and ADs. The modified PCCC revealed a deflation of cumulative complexity in ADs and inflation in PDs, suggesting an underestimation of complexity from chronic conditions in standard scoring. PDs consistently treated more complex non-surgical and surgical cases. Conclusion: The majority of pediatric patients—especially those with complex non-surgical conditions—were treated in PDs. These findings support the ongoing need for adequately funded pediatric inpatient structures and underscore the importance of protecting pediatric subspecialty care in upcoming healthcare reforms.