{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:14:28Z","timestamp":1793726068321,"version":"4.6.1"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008967","name":"Philipps-Universit\u00e4t Marburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008967","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Orthognathic surgery (OS) has become a widely used treatment option for moderate to severe dento-skeletal malocclusions. The aim of this study was to analyze the incidence and time trends of OS and potential influencing factors in the German healthcare system. Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. We estimated age-gender standardized incidence of OS-associated procedures between 2005 and 2022 and evaluated age- and gender-adjusted time trends using Poisson regression analysis. The total standardized incidence rate of OS-associated procedures in the observational period 2005\u20132022 was 11.1 (\u264013.0; \u2642 9.2) per 100,000 person years. A significant increase of 61.8% (\u2640+48.7%; \u2642+82.9%) in OS-associated procedures was observed within the observational period, mainly due to the increase of the procedures in the age groups 15\u201334 years (+\u200953.6%), 35\u201359 years (+\u200966.7%) and 60\u201379 years (+\u200920.0%). Mandibular procedures increased by 45.0%, while maxillary procedures increased by 88.2%. There were significant differences of the incidence of OS-associated procedures between the various federal states in Germany, indicating a higher incidence and stronger increase in more affluent regions. The age- and gender-standardized incidence of OS-associated procedures increased among all genders and the most relevant age groups in Germany in the last two decades. There is an ongoing trend to implement maxillary and combined procedures. These effects are limited to more affluent regions only, reflecting the impact of socioeconomic and regional factors on healthcare accessibility.<\/jats:p>","DOI":"10.1038\/s41598-025-90889-1","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T11:15:46Z","timestamp":1740050146000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Epidemiologic trends and increasing inequalities in orthognathic surgery in Germany: a nationwide analysis 2005\u20132022"],"prefix":"10.1038","volume":"15","author":[{"given":"Axel","family":"Meisgeier","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Pienkohs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin","family":"Salomia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Moosdorf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Neff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"90889_CR1","first-page":"337","volume":"39","author":"E Boutremans","year":"2018","unstructured":"Boutremans, E., Gossiaux, C. & Loeb, I. Evolution of the indications of orthognathic surgery. Rev. Med. Brux. 39, 337\u2013340 (2018).","journal-title":"Rev. Med. Brux"},{"key":"90889_CR2","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1016\/j.joms.2023.03.006","volume":"81","author":"Y Balel","year":"2023","unstructured":"Balel, Y. The last 40 years of orthognathic surgery: a bibliometric analysis. J. Oral Maxillofac. Surg. 81, 841\u2013854. https:\/\/doi.org\/10.1016\/j.joms.2023.03.006 (2023).","journal-title":"J. Oral Maxillofac. Surg."},{"key":"90889_CR3","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1007\/s12285-021-00340-3","volume":"15","author":"B Lohn","year":"2021","unstructured":"Lohn, B. et al. Aktuelle Situation Und k\u00fcnftige M\u00f6glichkeiten in Der Dysgnathiechirurgie. Der MKG-Chirurg. 15, 2\u201313. https:\/\/doi.org\/10.1007\/s12285-021-00340-3 (2021).","journal-title":"Der MKG-Chirurg"},{"key":"90889_CR4","unstructured":"Reyneke, J. P. Essentials of Orthognathic Surgery. 3rd edn (Quintessence Publishing Co, Inc, 2021)."},{"key":"90889_CR5","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/j.cps.2007.05.012","volume":"34","author":"PK Patel","year":"2007","unstructured":"Patel, P. K. & Novia, M. V. The Surgical tools: the LeFort I, bilateral Sagittal Split Osteotomy of the Mandible, and the Osseous Genioplasty. Clin. Plast. Surg. 34, 447\u2013475. https:\/\/doi.org\/10.1016\/j.cps.2007.05.012 (2007).","journal-title":"Clin. Plast. Surg."},{"key":"90889_CR6","unstructured":"Mitchell, D. A. & Kanatas, A. N. An Introduction to Oral and Maxillofacial Surgery. 2nd edn, (CRC Press, Taylor & Francis Group, 2015)."},{"key":"90889_CR7","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.jcms.2021.01.024","volume":"49","author":"M Belusic Gobic","year":"2021","unstructured":"Belusic Gobic, M. et al. Dentofacial deformity and orthognatic surgery: influence on self-esteem and aspects of quality of life. J. Cranio-Maxillofacial Surg. 49, 277\u2013281. https:\/\/doi.org\/10.1016\/j.jcms.2021.01.024 (2021).","journal-title":"J. Cranio-Maxillofacial Surg."},{"key":"90889_CR8","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1016\/j.ijom.2016.07.003","volume":"45","author":"K Kurabe","year":"2016","unstructured":"Kurabe, K., Kojima, T., Kato, Y., Saito, I. & Kobayashi, T. Impact of orthognathic surgery on oral health-related quality of life in patients with jaw deformities. Int. J. Oral Maxillofac. Surg. 45, 1513\u20131519. https:\/\/doi.org\/10.1016\/j.ijom.2016.07.003 (2016).","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"90889_CR9","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1016\/j.ajodo.2015.01.027","volume":"147","author":"A Gavric","year":"2015","unstructured":"Gavric, A. et al. Craniodentofacial characteristics, dental esthetics\u2013related quality of life, and self-esteem. Am. J. Orthod. Dentofac. Orthop. 147, 711\u2013718. https:\/\/doi.org\/10.1016\/j.ajodo.2015.01.027 (2015).","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"90889_CR10","doi-asserted-by":"publisher","first-page":"249","DOI":"10.3109\/00016357.2010.494618","volume":"68","author":"OME Alanko","year":"2010","unstructured":"Alanko, O. M. E., Svedstr\u00f6m-Oristo, A. L. & Tuomisto, M. T. Patients\u2019 perceptions of orthognathic treatment, well-being, and psychological or psychiatric status: a systematic review. Acta Odontol. Scand. 68, 249\u2013260. https:\/\/doi.org\/10.3109\/00016357.2010.494618 (2010).","journal-title":"Acta Odontol. Scand."},{"key":"90889_CR11","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1016\/j.ijom.2013.03.023","volume":"42","author":"CL Soh","year":"2013","unstructured":"Soh, C. L. & Narayanan, V. Quality of life assessment in patients with dentofacial deformity undergoing orthognathic surgery\u2014A systematic review. Int. J. Oral Maxillofac. Surg. 42, 974\u2013980. https:\/\/doi.org\/10.1016\/j.ijom.2013.03.023 (2013).","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"90889_CR12","doi-asserted-by":"publisher","unstructured":"Zammit, D., Ettinger, R. E., Sanati-Mehrizy, P. & Susarla, S. M. Current trends in orthognathic surgery. Medicina 59 https:\/\/doi.org\/10.3390\/medicina59122100 (2023).","DOI":"10.3390\/medicina59122100"},{"key":"90889_CR13","first-page":"233","volume":"69","author":"M Freidel","year":"1998","unstructured":"Freidel, M. [Regarding orthognathic surgery]. Orthod. Fr. 69, 233\u2013236 (1998).","journal-title":"Orthod. Fr."},{"key":"90889_CR14","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1093\/ejo\/cjp034","volume":"31","author":"ZB Al-Bitar","year":"2009","unstructured":"Al-Bitar, Z. B., Al-Omari, I. K., Al-Ahmad, H. T., Maaytah, E., Cunningham, S. J. & M. A. & A comparison of health-related quality of life between Jordanian and British orthognathic patients. Eur. J. Orthod. 31, 485\u2013489. https:\/\/doi.org\/10.1093\/ejo\/cjp034 (2009).","journal-title":"Eur. J. Orthod."},{"key":"90889_CR15","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1016\/j.ajodo.2017.12.008","volume":"153","author":"M Bengtsson","year":"2018","unstructured":"Bengtsson, M., Wall, G., Larsson, P., Becktor, J. P. & Rasmusson, L. Treatment outcomes and patient-reported quality of life after orthognathic surgery with computer-assisted 2- or 3-dimensional planning: a randomized double-blind active-controlled clinical trial. Am. J. Orthod. Dentofac. Orthop. 153, 786\u2013796. https:\/\/doi.org\/10.1016\/j.ajodo.2017.12.008 (2018).","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"90889_CR16","doi-asserted-by":"publisher","first-page":"297","DOI":"10.5927\/jjjd.20.297","volume":"20","author":"Y Oguri","year":"2010","unstructured":"Oguri, Y. et al. Clinical Survey of Surgical-orthodontics cases treated in the past Decade at the Orthodontic Department, Niigata University Medical and Dental Hospital. Japanese J. Jaw Deformities. 20, 297\u2013304. https:\/\/doi.org\/10.5927\/jjjd.20.297 (2010).","journal-title":"Japanese J. Jaw Deformities"},{"key":"90889_CR17","doi-asserted-by":"publisher","first-page":"e361","DOI":"10.1097\/scs.0000000000010109","volume":"35","author":"RY Al-Rawee","year":"2024","unstructured":"Al-Rawee, R. Y., Tawfeeq, B. A. & Tawfek, Z. S. Orthognathic surgery trending: retrospective ten years cases analysis in Nineveh Province, Iraq. J. Craniofac. Surg. 35, e361\u2013e367. https:\/\/doi.org\/10.1097\/scs.0000000000010109 (2024).","journal-title":"J. Craniofac. Surg."},{"key":"90889_CR18","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.ajoms.2019.03.008","volume":"31","author":"Y Hamada","year":"2019","unstructured":"Hamada, Y. et al. A 27-year retrospective clinical analysis of 2640 orthognathic surgery cases in the Tokyo Dental College. J. Oral Maxillofacial Surg. Med. Pathol. 31, 305\u2013310. https:\/\/doi.org\/10.1016\/j.ajoms.2019.03.008 (2019).","journal-title":"J. Oral Maxillofacial Surg. Med. Pathol."},{"key":"90889_CR19","doi-asserted-by":"publisher","first-page":"269","DOI":"10.2319\/043016-349.1","volume":"87","author":"SJ Lee","year":"2016","unstructured":"Lee, S. J., Seo, B. M., Park, H. H. & Lee, C. H. Modern trends in Class III orthognathic treatment: a time series analysis. Angle Orthod. 87, 269\u2013278. https:\/\/doi.org\/10.2319\/043016-349.1 (2016).","journal-title":"Angle Orthod."},{"key":"90889_CR20","unstructured":"Keim, R. G., Gottlieb, E. L., Vogels, D. S. & Vogels, P. B. 3rd JCO study of orthodontic diagnosis and treatment procedures, Part 1: results and trends. J. Clin. Orthod. 48, 607\u2013630 (2014)."},{"key":"90889_CR21","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1097\/PRS.0b013e31817d543c","volume":"122","author":"JE Zins","year":"2008","unstructured":"Zins, J. E., Morrison, C. M., Gonzalez, A. M., Altus, G. D. & Bena, J. Follow-up: orthognathic surgery. Is there a future? A national survey. Plast. Reconstr. Surg. 122, 555\u2013562. https:\/\/doi.org\/10.1097\/PRS.0b013e31817d543c (2008).","journal-title":"Plast. Reconstr. Surg."},{"key":"90889_CR22","doi-asserted-by":"publisher","unstructured":"Meisgeier, A., Pienkohs, S., Durrschnabel, F., Moosdorf, L. & Neff, A. Epidemiologic trends in maxillofacial trauma surgery in Germany-insights from the National DRG database 2005\u20132022. J. Clin. Med. 13 https:\/\/doi.org\/10.3390\/jcm13154438 (2024).","DOI":"10.3390\/jcm13154438"},{"key":"90889_CR23","unstructured":"UNDP. Human Development Report 2023-24. UNDP (United Nations Development Programme, 2024)."},{"key":"90889_CR24","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1037\/0003-066x.58.1.78","volume":"58","author":"JF Hemphill","year":"2003","unstructured":"Hemphill, J. F. Interpreting the magnitudes of correlation coefficients. Am. Psychol. 58, 78\u201379. https:\/\/doi.org\/10.1037\/0003-066x.58.1.78 (2003).","journal-title":"Am. Psychol."},{"key":"90889_CR25","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","volume":"57","author":"Y Benjamini","year":"1995","unstructured":"Benjamini, Y. & Hochberg, Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J. Royal Stat. Soc. Ser. B: Stat. Methodol. 57, 289\u2013300. https:\/\/doi.org\/10.1111\/j.2517-6161.1995.tb02031.x (1995).","journal-title":"J. Royal Stat. Soc. Ser. B: Stat. Methodol."},{"key":"90889_CR26","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.bjoms.2008.10.019","volume":"47","author":"SJ Cunningham","year":"2009","unstructured":"Cunningham, S. J. & Moles, D. R. A national review of mandibular orthognathic surgery activity in the National Health Service in England over a nine year period. Br. J. Oral Maxillofac. Surg. 47, 274\u2013278. https:\/\/doi.org\/10.1016\/j.bjoms.2008.10.019 (2009).","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"90889_CR27","doi-asserted-by":"publisher","DOI":"10.1007\/s10006-013-0396-3","author":"FRL Sato","year":"2013","unstructured":"Sato, F. R. L., Mannarino, F. S., Asprino, L. & de Moraes, M. Prevalence and treatment of dentofacial deformities on a multiethnic population: a retrospective study. Oral Maxillofacial Surg. https:\/\/doi.org\/10.1007\/s10006-013-0396-3 (2013).","journal-title":"Oral Maxillofacial Surg."},{"key":"90889_CR28","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1043\/0003-3219(2006","volume":"76","author":"MT Chew","year":"2006","unstructured":"Chew, M. T. Spectrum and management of dentofacial deformities in a multiethnic Asian population. Angle Orthod. 76, 806\u2013809. https:\/\/doi.org\/10.1043\/0003-3219(2006 (2006). )076[0806:SAMODD]2.0.CO;2.","journal-title":"Angle Orthod."},{"key":"90889_CR29","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1016\/j.bjoms.2008.10.020","volume":"47","author":"DR Moles","year":"2009","unstructured":"Moles, D. R. & Cunningham, S. J. A national review of mandibular orthognathic surgery activity in the National Health Service in England over a nine year period: part 1\u2013service factors. Br. J. Oral Maxillofac. Surg. 47, 268\u2013273. https:\/\/doi.org\/10.1016\/j.bjoms.2008.10.020 (2009).","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"90889_CR30","doi-asserted-by":"publisher","first-page":"530","DOI":"10.5177\/ntvt.2023.12.23060","volume":"130","author":"SA Steenen","year":"2023","unstructured":"Steenen, S. A. & Hermans, A. M. [Towards perfection: the ethical downside of the ideal of beauty]. Ned Tijdschr Tandheelkd. 130, 530\u2013536. https:\/\/doi.org\/10.5177\/ntvt.2023.12.23060 (2023).","journal-title":"Ned Tijdschr Tandheelkd"},{"key":"90889_CR31","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1007\/s00266-021-02554-3","volume":"46","author":"RH Padley","year":"2022","unstructured":"Padley, R. H. & Di Pace, B. The psychological impact of remote communication on body-image perception: cosmetic: Cosmetic surgery on the rise. Aesthetic Plast. Surg. 46, 1507\u20131509. https:\/\/doi.org\/10.1007\/s00266-021-02554-3 (2022).","journal-title":"Aesthetic Plast. Surg."},{"key":"90889_CR32","first-page":"108","volume":"10","author":"LT Bailey","year":"1995","unstructured":"Bailey, L. T., Proffit, W. R. & White, R. P. Jr. Trends in surgical treatment of Class III skeletal relationships. Int. J. Adult Orthodon Orthognath Surg. 10, 108\u2013118 (1995).","journal-title":"Int. J. Adult Orthodon Orthognath Surg."},{"key":"90889_CR33","doi-asserted-by":"publisher","unstructured":"Velez Avenda\u00f1o, G. R., Benalcazar, B., Sant\u2019ana, B. K., Neto, E. M., Moura, R. F. & G. & Ortho-surgical procedure involving mandible, maxilla, mento and associations: a systematic review. MedNEXT J. Med. Health Sci. 3 https:\/\/doi.org\/10.54448\/mdnt22S207 (2022).","DOI":"10.54448\/mdnt22S207"},{"key":"90889_CR34","doi-asserted-by":"publisher","unstructured":"Zawislak, E. et al. Current trends in Orthognathic surgery in Poland\u2014A retrospective analysis of 124 cases. Appl. Sci. 11 https:\/\/doi.org\/10.3390\/app11146439 (2021).","DOI":"10.3390\/app11146439"},{"key":"90889_CR35","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1177\/074880680502200405","volume":"22","author":"SD Urban","year":"2005","unstructured":"Urban, S. D. & Waite, P. D. Management of facial asymmetry. Am. J. Cosmet. Surg. 22, 249\u2013259. https:\/\/doi.org\/10.1177\/074880680502200405 (2005).","journal-title":"Am. J. Cosmet. Surg."},{"key":"90889_CR36","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s40510-019-0287-8","volume":"20","author":"C Lorente","year":"2019","unstructured":"Lorente, C., Hernandez-Alfaro, F., Perez-Vela, M., Lorente, P. & Lorente, T. Surgical-orthodontic approach for facial rejuvenation based on a reverse facelift. Prog Orthod. 20, 34. https:\/\/doi.org\/10.1186\/s40510-019-0287-8 (2019).","journal-title":"Prog Orthod."},{"key":"90889_CR37","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s00784-023-05430-3","volume":"28","author":"Z Feng","year":"2023","unstructured":"Feng, Z. et al. Evolution, current status, and future trends of maxillary skeletal expansion: a bibliometric analysis. Clin. Oral Investig. 28, 14. https:\/\/doi.org\/10.1007\/s00784-023-05430-3 (2023).","journal-title":"Clin. Oral Investig"},{"key":"90889_CR38","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1080\/00016357.2022.2164352","volume":"81","author":"G St\u00e5lhand","year":"2023","unstructured":"St\u00e5lhand, G., Abdiu, A., Rasmusson, L. & Abtahi, J. Distribution of orthognathic surgery among the Swedish population: a retrospective register-based study. Acta Odontol. Scand. 81, 414\u2013421. https:\/\/doi.org\/10.1080\/00016357.2022.2164352 (2023).","journal-title":"Acta Odontol. Scand."},{"key":"90889_CR39","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1016\/j.bjoms.2018.10.271","volume":"56","author":"SJW Kent","year":"2018","unstructured":"Kent, S. J. W. & Morrison, R. Rural and urban differences in orthognathic surgical patients in the north east of Scotland. Br. J. Oral Maxillofac. Surg. 56, 931\u2013935. https:\/\/doi.org\/10.1016\/j.bjoms.2018.10.271 (2018).","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"90889_CR40","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.oooo.2012.09.003","volume":"115","author":"V Allareddy","year":"2013","unstructured":"Allareddy, V. et al. Longitudinal trends in discharge patterns of orthognathic surgeries: is there a regionalization of procedures in teaching hospitals? Oral surgery, oral medicine. Oral Pathol. Oral Radiol. 115, 583\u2013588. https:\/\/doi.org\/10.1016\/j.oooo.2012.09.003 (2013).","journal-title":"Oral Pathol. Oral Radiol."},{"key":"90889_CR41","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1007\/s00784-024-05663-w","volume":"28","author":"A Meisgeier","year":"2024","unstructured":"Meisgeier, A., Pienkohs, S., Durrschnabel, F., Neff, A. & Halling, F. Rising incidence of severe maxillofacial space infections in Germany. Clin. Oral Investig. 28, 264. https:\/\/doi.org\/10.1007\/s00784-024-05663-w (2024).","journal-title":"Clin. Oral Investig"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-90889-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-90889-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-90889-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T22:49:12Z","timestamp":1740091752000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-90889-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,20]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["90889"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-90889-1","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,20]]},"assertion":[{"value":"20 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 February 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was waived as this is a purely observational study. The Research Ethics Committee of the Medical Faculty of the Philipps-University-Marburg has confirmed that no approval and no informed consent is required (24-351Anz; December 13th, 2024). No administrative permission was required to access the analyzed dataset. The data is generically anonymous. The study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"6223"}}