{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T06:51:29Z","timestamp":1781679089828,"version":"3.54.5"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a descriptive longitudinal epidemiologic analysis of mandatory German hospital quality reports (2006\u20132023). 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 (\u201cProcedures for purposes other than remedying health states\u201d). Inpatient volumes were benchmarked against ISAPS national estimates to determine the \u201chospital share\u201d of the total market.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1813408","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:51:52Z","timestamp":1781675512000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Gaps in public health surveillance of elective surgery: a national analysis of inpatient data, COVID-19 impact, and coding validity in Germany (2006\u20132023)"],"prefix":"10.3389","volume":"14","author":[{"given":"Maximilian","family":"Jacobi","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, University Hospital Muenster","place":["Muenster, Germany"]},{"name":"Department of Plastic and Reconstructive Surgery, Institute for Musculoskeletal Medicine, University of Muenster","place":["Muenster, Germany"]},{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide","place":["Muenster, Germany"]},{"name":"Department of Plastic Surgery, University Medical Center Groningen and University of Groningen","place":["Groningen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Ro\u00dflenbroich","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster (UKM)","place":["Muenster, Germany"]},{"name":"Niels-Stensen Clinics, St. Mary's Hospital Osnabrueck","place":["Osnabrueck, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Ro\u00dflenbroich","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University Hospital Muenster","place":["Muenster, Germany"]},{"name":"Department of Plastic and Reconstructive Surgery, Institute for Musculoskeletal Medicine, University of Muenster","place":["Muenster, Germany"]},{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide","place":["Muenster, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Kueckelhaus","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University Hospital Muenster","place":["Muenster, Germany"]},{"name":"Department of Plastic and Reconstructive Surgery, Institute for Musculoskeletal Medicine, University of Muenster","place":["Muenster, Germany"]},{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide","place":["Muenster, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Giebeler","sequence":"additional","affiliation":[{"name":"Reimbursement Institute","place":["Huerth, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University Hospital Muenster","place":["Muenster, Germany"]},{"name":"Department of Plastic and Reconstructive Surgery, Institute for Musculoskeletal Medicine, University of Muenster","place":["Muenster, Germany"]},{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide","place":["Muenster, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hinne","family":"Rakhorst","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University Medical Center Groningen and University of Groningen","place":["Groningen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Wellenbrock","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University Hospital 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