The frequency and complexity of pediatric hospitalizations to pediatric and adult departments in Germany.

BACKGROUND: Germany’s upcoming hospital reform aims to restructure inpatient services by assigning hospitals to defined “care groups” that determine which services they may provide in the future. While pediatric care will continue to receive infrastructural readiness funding, the reform eliminates a dedicated care group for specialized pediatric medicine. As a result, subspecialized pediatric services will no longer be distinctly designated or planned for. This has raised concerns about future access to specialized inpatient care for children and adolescents, given the complexity and diversity of pediatric conditions. The aim of this study was to contribute objective data to the ongoing debate by investigating how pediatric patients are distributed between pediatric (PD) and adult departments (AD) and assessing case complexity. METHODS: We conducted a retrospective observational study using data from the German nationwide hospital discharge dataset from 2016 to 2022, comprising all public hospitals. 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. The main outcome was admission to pediatric versus adult department. Case complexity was assessed using the Pediatric Complex Chronic Conditions (PCCC) score and an exploratory modified PCCC model incorporating a logistic S-curve to reflect increasing complexity with multiple chronic conditions. RESULTS: Of 7,896,283 analyzed pediatric cases, 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. CONCLUSIONS: The majority of pediatric patients—especially those with complex non-surgical conditions—were treated in pediatric departments. These findings highlight the central role of pediatric inpatient structures in managing complex care needs. Preserving the visibility and planning relevance of pediatric subspecialty care is essential to safeguard age-appropriate, complexity-appropriate services for children and adolescents.