Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany

Christina Oetzmann Von Sochaczewski,Jan Gödeke

doi:10.1007/s00384-021-03944-4

Abstract

PurposeCollective evidence from single-centre studies suggests an increasing incidence of pilonidal sinus disease in the last decades, but population-based data is scarce.MethodsWe analysed administrative case–based principal diagnoses of pilonidal sinus disease and its surgical therapy between 2005 and 2017 in inpatients. Changes were addressed via linear regression.ResultsThe mean rate of inpatient episodes of pilonidal sinus disease per 100,000 men increased from 43 in 2005 to 56 in 2017. In females, the mean rate of inpatient episodes per 100,000 women rose from 14 in 2005 to 18 in 2017. In the whole population, for every case per 100,000 females, there were 3.1 cases per 100,000 males, but the numbers were highly variable between the age groups. There was considerable regional variation within Germany. Rates of inpatient episodes of pilonidal sinus disease were increasing in almost all age groups and both sexes by almost a third. Surgery was dominated by excision of pilonidal sinus without reconstructive procedures, such as flaps, whose share was around 13% of all procedures, despite recommendations of the national guidelines to prefer flap procedures.ConclusionRates of inpatient episodes of pilonidal sinus disease in Germany rose across almost all age groups and both sexes with relevant regional variation. The underlying causative factors are unknown. Thus, patient-centred research is necessary to explore them. This should also take cases into account that are solely treated office-based in order to obtain a full-spectrum view of pilonidal sinus disease incidence rates.

Highlights

The incidence of pilonidal sinus disease is on the rise globally [1]
Study reporting an incidence rate based on a single institution with its surrounding population gets cited again and again [6], even in national guidelines [7] and Cochrane collaboration reviews on pilonidal sinus disease [8]
The cumulative number of diagnoses increased by 133 cases per year (P < 0.0001) (Fig. 1b), of which 101 (Fig. 1d) occurred with a concurring abscess (P < 0.001) and 32 did not (P = 0.0002) (Fig. 1e). This overall increase in cases did correspond to an increasing rate of inpatient episodes of 1.16 cases per 100,000 males (P < 0.0001) (Fig. 2a) and 0.33

Summary

Introduction

The incidence of pilonidal sinus disease is on the rise globally [1]. Incidences are often reported from selected cohorts, either the military or in the age group known to have high incidences of the disease [2, 3], whereas population-based incidences are seldom reported [4, 5]. Study reporting an incidence rate based on a single institution with its surrounding population gets cited again and again [6], even in national guidelines [7] and Cochrane collaboration reviews on pilonidal sinus disease [8]. We explored German administrative data in order to describe populationbased rates of inpatient episodes separated by different age groups and investigated potential regional differences within a country

Methods

Results

Discussion

Conclusion