Table of Contents

1. EUROPEAN HEALTHCARE OVERVIEW…………………………………………… 1-1
1.1 Healthcare Spending………………………………………………………………. 1-2
1.2 Healthcare Facilities and Personnel ………………………………………….. 1-5
1.3 Reimbursement Structures………………………………………………………. 1-6
1.4 Germany, National Healthcare Profile ……………………………………… 1-11
1.4.1 Healthcare Organization and Reform ………………………… 1-12
1.4.2 Hospital Services……………………………………………………. 1-14
1.4.3 Medical Device Reimbursement……………………………….. 1-17
Exhibit 1-1: European Healthcare Expenditures as a Percentage of
Gross Domestic Product, Selected Countries, 2005-2011 ……………. 1-4
Exhibit 1-2: European Union Population Statistics Comparison
for the Years 2010 and 2020 ……………………………………………………. 1-7
Exhibit 1-3: European Union, Medical Devices Risk Classification System…….. 1-10
Exhibit 1-4: 2008, Germany, Healthcare Expenditures,
by Category of Service/Goods………………………………………………… 1-15
Exhibit 1-5: Germany, Selected National Healthcare Statistics …………………….. 1-19
2. CARDIOVASCULAR/PERIPHERAL VASCULAR
SURGICAL PROCEDURES ……………………………………………………………… 2-1
2.1 Arrhythmia …………………………………………………………………………….. 2-2
2.1.1 Atrial Fibrillation……………………………………………………….. 2-2
2.1.2 Supraventricular Tachycardia…………………………………….. 2-3
2.1.3 Ventricular Fibrillation……………………………………………….. 2-4
2.1.4 Ventricular Tachycardia…………………………………………….. 2-4
2.2 Circulatory Disorders………………………………………………………………. 2-4
2.2.1 Coronary Artery Disease …………………………………………… 2-5
2.2.2 Myocardial Infarction ………………………………………………… 2-5
2.2.3 Angina Pectoris ……………………………………………………….. 2-6
2.2.4 Aortic Aneurysm ………………………………………………………. 2-6
2.2.5 Atherosclerosis………………………………………………………… 2-8
2.2.6 Hypercholesterolemia……………………………………………….. 2-9
2.2.7 Hypertension …………………………………………………………. 2-10
2.2.8 Venous Thromboembolism: Deep Vein Thrombosis
and Pulmonary Embolism………………………………………… 2-10
2.3 Myocardial Disorders…………………………………………………………….. 2-11
2.3.1 Congenital Heart Defects ………………………………………… 2-11
2.3.2 Heart Failure………………………………………………………….. 2-12
2.3.3 Rheumatic Heart Disease………………………………………… 2-13
2.3.4 Valvular Heart Disease……………………………………………. 2-13
2.4 Aneurysm Repair………………………………………………………………….. 2-16
2.5 Coronary Artery Disease Treatment………………………………………… 2-19
2.5.1 Coronary Artery Bypass Graft Surgery………………………. 2-21
2.5.1.1 Less Invasive Coronary Artery Bypass
Graft Techniques……………………………………… 2-22
2.5.2 Percutaneous Transluminal Coronary Angioplasty/
Coronary Stenting ………………………………………………….. 2-26
2.5.3 Transmyocardial Revascularization…………………………… 2-34
2.5.4 Atherectomy ………………………………………………………….. 2-37
2.5.5 Thrombectomy and Thrombolysis …………………………….. 2-40
2.6 Peripheral Artery Disease and Treatment ………………………………… 2-42
2.6.1 Femoropopliteal Bypass………………………………………….. 2-45
2.6.2 Percutaneous Peripheral Revascularization Techniques 2-46
2.6.2.1 Percutaneous Transluminal Angioplasty ……… 2-47
2.6.2.2 Peripheral Atherectomy…………………………….. 2-49
2.6.2.3 Peripheral Femoropopliteal Stenting …………… 2-49
2.7 Heart Defect Repair………………………………………………………………. 2-51
2.7.1 Congenital Heart Defect Repair………………………………… 2-51
2.7.2 Heart Valve Repair and Replacement ……………………….. 2-53
2.8 Cardiac Device Implantation…………………………………………………… 2-57
2.8.1 Cardiac Resynchronization Therapy …………………………. 2-57
2.8.2 Pacemakers ………………………………………………………….. 2-58
2.8.3 Implantable Cardioverter Defibrillators ………………………. 2-59
2.8.4 Ventricular Assist Devices……………………………………….. 2-60
Exhibit 2-1: Germany, Aneurysm Repair, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 2-20
Exhibit 2-2: Germany, Coronary Artery Bypass Graft Surgery,
Procedure Volumes Forecast, 2011-2018 ………………………………… 2-27
Exhibit 2-3: Major Milestones in the Development of Percutaneous
Coronary Intervention……………………………………………………………. 2-28
Exhibit 2-4: Germany, Percutaneous Coronary Interventions/Stenting,
Procedure Volumes Forecast, 2011-2018 ………………………………… 2-35
Exhibit 2-5: Germany, Transmyocardial Revascularization,
Procedure Volumes Forecast, 2011-2018 ………………………………… 2-38
Exhibit 2-6: Germany, Atherectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 2-41
Exhibit 2-7: Germany, Thrombectomy and Thrombolysis,
Procedure Volumes Forecast, 2011-2018 ………………………………… 2-43
Exhibit 2-8: Germany, Peripheral Artery Disease Treatment,
Procedure Volumes Forecast, 2011-2018 ………………………………… 2-52
Exhibit 2-9: Germany, Heart Defect Repair, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 2-56
Exhibit 2-10: Germany, Cardiac Device Implantation,
Procedure Volumes Forecast, 2011-2018 ………………………………… 2-63
3. COSMETIC SURGICAL PROCEDURES ……………………………………………. 3-1
3.1 Abdominoplasty……………………………………………………………………… 3-2
3.2 Blepharoplasty……………………………………………………………………….. 3-4
3.3 Breast Augmentation………………………………………………………………. 3-6
3.4 Breast Reduction……………………………………………………………………. 3-9
3.5 Liposuction ………………………………………………………………………….. 3-12
3.6 Mastopexy …………………………………………………………………………… 3-15
3.7 Rhinoplasty………………………………………………………………………….. 3-18
3.8 Rhytidectomy……………………………………………………………………….. 3-19
3.9 Other Cosmetic Surgical Procedures ………………………………………. 3-22
3.10 Combined Cosmetic Surgical Procedures ………………………………… 3-22
Exhibit 3-1: Germany, Abdominoplasty, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………….. 3-5
Exhibit 3-2: Germany, Blepharoplasty, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………….. 3-7
Exhibit 3-3: Germany, Breast Augmentation, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 3-10
Exhibit 3-4: Germany, Breast Reduction Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 3-13
Exhibit 3-5: Germany, Liposuction, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 3-16
Exhibit 3-6: Germany, Mastopexy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 3-17
Exhibit 3-7: Germany, Rhinoplasty, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 3-20
Exhibit 3-8: Germany, Rhytidectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 3-23
Procedure Volumes Forecast, 2011-2018 ………………………………… 3-24
Exhibit 3-10: Germany and Europe, Cosmetic Surgery,
Comparative Procedure Volumes Forecast, 2011-2018……………… 3-26
4. GENERAL SURGICAL PROCEDURES……………………………………………… 4-1
4.1 Adrenalectomy……………………………………………………………………….. 4-1
4.2 Appendectomy……………………………………………………………………….. 4-2
4.3 Bariatric Surgery…………………………………………………………………….. 4-5
4.4 Cholecystectomy ………………………………………………………………….. 4-10
4.5 Colectomy …………………………………………………………………………… 4-13
4.6 Esophagogastric Fundoplasty ………………………………………………… 4-16
4.7 Hemorrhoidectomy and Other Hemorrhoid Procedures ……………… 4-19
4.8 Inguinal Herniorrhaphy ………………………………………………………….. 4-22
4.9 Liver Biopsy…………………………………………………………………………. 4-26
Exhibit 4-1: Germany, Adrenalectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………….. 4-3
Exhibit 4-2: Germany, Appendectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………….. 4-6
Exhibit 4-3: Germany, Bariatric Surgery, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 4-11
Exhibit 4-4: Germany, Cholecystectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 4-14
Exhibit 4-5: Germany, Colectomy, Procedure Volumes Forecast, 2011-2018…. 4-17
Exhibit 4-6: Germany, Esophagogastric Fundoplasty,
Procedure Volumes Forecast, 2011-2018 ………………………………… 4-20
Exhibit 4-7: Germany, Hemorrhoidectomy and Other Hemorrhoid Treatments,
Procedure Volumes Forecast, 2011-2018 ………………………………… 4-23
Exhibit 4-8: Germany, Inguinal Herniorrhaphy,
Procedure Volumes Forecast, 2011-2018 ………………………………… 4-27
Exhibit 4-9: Germany, Liver Biopsy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 4-30
5. MAJOR ORGAN TRANSPLANTATION……………………………………………… 5-1
5.1 Heart Transplantation……………………………………………………………… 5-2
5.2 Kidney Transplantation……………………………………………………………. 5-2
5.3 Liver Transplantation………………………………………………………………. 5-3
5.4 Lung Transplantation………………………………………………………………. 5-3
5.5 Pancreas Transplantation………………………………………………………… 5-4
5.6 Small Bowel Transplantation ……………………………………………………. 5-4
5.7 Immunosuppressive Strategies ………………………………………………… 5-5
5.8 Organ Procurement and Donor Shortage…………………………………… 5-6
5.9 Organ Transplantation, Procedure Volumes …………………………….. 5-12
Exhibit 5-1: European Action Plan on Organ Donation
and Transplantation (2009-2015) ……………………………………………… 5-8
Exhibit 5-2: Germany, Patients Awaiting Organ Transplant, 2006-2011 ………… 5-11
Exhibit 5-3: Germany, Major Organ Transplantation,
Historical Procedure Volumes, 2002-2011 ……………………………….. 5-13
Exhibit 5-4: Germany, Major Organ Transplantation,
Procedure Volumes Forecast, 2011-2018 ………………………………… 5-15
6. NEUROSURGICAL PROCEDURES ………………………………………………….. 6-1
6.1 The Brain………………………………………………………………………………. 6-1
6.1.1 The Cerebrum …………………………………………………………. 6-1
6.1.2 The Cerebellum……………………………………………………….. 6-2
6.1.3 The Brainstem …………………………………………………………. 6-2
6.1.4 The Meninges………………………………………………………….. 6-4
6.1.5 The Ventricular System …………………………………………….. 6-4
6.1.6 Cerebrospinal Fluid ………………………………………………….. 6-7
6.1.7 The Hypothalamus …………………………………………………… 6-7
6.1.8 The Pineal Gland……………………………………………………… 6-7
6.1.9 The Pituitary Gland…………………………………………………… 6-7
6.2 Selected Disorders of the Central and Peripheral
Nervous Systems …………………………………………………………………… 6-8
6.2.1 Hydrocephalus ………………………………………………………… 6-8
6.2.2 Movement, Seizure, and Tremor Disorders………………… 6-10
6.2.2.1 Alzheimer’s Disease…………………………………. 6-10
6.2.2.2 Epilepsy………………………………………………….. 6-12
6.2.2.3 Multiple Sclerosis …………………………………….. 6-13
6.2.2.4 Parkinson’s Disease…………………………………. 6-15
©2013 Elsevier Business Intelligence vi #A628
Germany, Surgical Procedure Volumes Table of Contents
6.2.2.5 Treatment Options……………………………………. 6-15
6.2.2.5.1 Deep Brain Stimulation ………….. 6-15
6.2.2.5.2 Stereotactic Radiosurgery………. 6-17
6.2.3 Traumatic Brain Injury …………………………………………….. 6-17
6.3 The Cerebrovascular System and Selected Disorders……………….. 6-22
6.3.1 The Arterial System………………………………………………… 6-22
6.3.2 The Venous System ……………………………………………….. 6-24
6.3.3 Aneurysm ……………………………………………………………… 6-24
6.3.4 Arteriovenous Malformation……………………………………… 6-26
6.3.5 Stroke…………………………………………………………………… 6-29
Exhibit 6-1: Structural Relationship between the Cerebrum, Cerebellum,
and Brainstem ……………………………………………………………………….. 6-3
Exhibit 6-2: Structure of the Meninges ……………………………………………………….. 6-5
Exhibit 6-3: Ventricles of the Brain …………………………………………………………….. 6-6
Exhibit 6-4: Germany, Ventriculostomy and Ventricular Shunting,
Procedure Volumes Forecast, 2011-2018 ………………………………… 6-11
Exhibit 6-5: Germany, Deep Brain Stimulation and Stereotactic Radiosurgery,
Procedure Volumes Forecast, 2011-2018 ………………………………… 6-18
Exhibit 6-6: Germany, Evacuation of Subdural Hematoma,
Procedure Volumes Forecast, 2011-2018 ………………………………… 6-21
Exhibit 6-7: Germany, Cerebral Aneurysm Clipping,
Procedure Volumes Forecast, 2011-2018 ………………………………… 6-27
Exhibit 6-8: Germany, Arteriovenous Malformation Embolization,
Procedure Volumes Forecast, 2011-2018 ………………………………… 6-30
Exhibit 6-9: Germany, Carotid Endarterectomy and Carotid Artery Stenting,
Procedure Volumes Forecast, 2011-2018 ………………………………… 6-34
7. OBSTETRIC/GYNECOLOGIC SURGICAL PROCEDURES………………….. 7-1
7.1 Cesarean Section…………………………………………………………………… 7-1
7.2 Dilation and Curettage…………………………………………………………….. 7-3
7.3 Hysterectomy ………………………………………………………………………… 7-7
7.4 Hysteroscopy…………………………………………………………………………. 7-9
7.4.1 Endometrial Ablation ………………………………………………. 7-11
7.4.2 Endometrial Biopsy ………………………………………………… 7-14
7.4.3 Myomectomy …………………………………………………………. 7-16
©2013 Elsevier Business Intelligence vii #A628
Germany, Surgical Procedure Volumes Table of Contents
7.5 Oophorectomy……………………………………………………………………… 7-19
7.6 Salpingo-Oophorectomy………………………………………………………… 7-21
7.7 Tubal Ligation………………………………………………………………………. 7-25
Exhibit 7-1: Germany, Cesarean Section, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………….. 7-4
Exhibit 7-2: Germany, Dilation and Curettage, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………….. 7-6
Exhibit 7-3: Germany, Hysterectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 7-10
Exhibit 7-4: Germany, Endometrial Ablation, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 7-15
Exhibit 7-5: Germany, Endometrial Biopsy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 7-17
Exhibit 7-6: Germany, Myomectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 7-20
Exhibit 7-7: Germany, Oophorectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 7-22
Exhibit 7-8: Germany, Salpingo-Oophorectomy,
Procedure Volumes Forecast, 2011-2018 ………………………………… 7-24
Exhibit 7-9: Germany, Tubal Ligation, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 7-27
8. OPHTHALMIC SURGICAL PROCEDURES ……………………………………….. 8-1
8.1 Age-Related Macular Degeneration and Diabetic Retinopathy ……… 8-1
8.2 Cataract Surgery and Intraocular Implantation ……………………………. 8-6
8.3 Glaucoma ……………………………………………………………………………. 8-10
8.4 Refractive Surgery………………………………………………………………… 8-15
8.5 Strabismus Correction …………………………………………………………… 8-21
8.6 Vitrectomy …………………………………………………………………………… 8-25
Exhibit 8-1: Germany, Treatment for Age-Related Macular Degeneration and
Diabetic Retinopathy, Procedure Volumes Forecast, 2011-2018 …… 8-7
Exhibit 8-2: Germany, Cataract Surgery and Intraocular Implantation,
Procedure Volumes Forecast, 2011-2018 ………………………………… 8-11
Exhibit 8-3: Germany, Glaucoma Surgery, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 8-16
Exhibit 8-4: Germany, Refractive Surgery, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 8-22
Exhibit 8-5: Germany, Strabismus Correction, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 8-26
Exhibit 8-6: Germany, Vitrectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 8-28
9. ORTHOPEDIC/SPINE SURGICAL PROCEDURES……………………………… 9-1
9.1 Fractures and Fracture Management ………………………………………… 9-1
9.1.1 Types of Fractures …………………………………………………… 9-3
9.1.2 Arthritis and Fractures ………………………………………………. 9-4
9.1.3 Internal Fixation of Fractures……………………………………… 9-5
9.1.4 External Fixation/Fracture Repair……………………………….. 9-7
9.2 The Spine and Spine Surgery/Spinal Instrumentation………………….. 9-9
9.2.1 The Vertebral Column ………………………………………………. 9-9
9.2.1.1 Disorders of the Vertebral Column ……………… 9-11
9.2.1.1.1 Low Back Pain ……………………… 9-11
9.2.1.1.2 Scoliosis………………………………. 9-12
9.2.2 Anterior Cervical Plates…………………………………………… 9-13
9.2.3 Interbody Fusion Devices………………………………………… 9-13
9.2.4 Pedicle Screws………………………………………………………. 9-15
9.2.5 Laminectomy…………………………………………………………. 9-16
9.2.6 Microdiscectomy…………………………………………………….. 9-17
9.2.7 Balloon Kyphoplasty……………………………………………….. 9-18
9.2.8 Vertebroplasty ……………………………………………………….. 9-18
9.2.9 Spinal Fusion…………………………………………………………. 9-19
9.2.10 Prosthetic Intervertebral Disc Replacement ……………….. 9-21
9.2.11 Instrumented Spinal Deformity Correction………………….. 9-22
9.3 The Joints and Associated Diseases/Disorders and Injuries ……….. 9-29
9.3.1 Fibrous/Immoveable Joints………………………………………. 9-31
9.3.2 Cartilaginous Joints ………………………………………………… 9-31
9.3.3 Synovial Joints ………………………………………………………. 9-32
9.3.4 Joint Replacement………………………………………………….. 9-33
9.3.4.1 Total Hip Replacement……………………………… 9-33
9.3.4.2 Total Knee Replacement…………………………… 9-38
©2013 Elsevier Business Intelligence ix #A628
Germany, Surgical Procedure Volumes Table of Contents
9.3.4.3 Total Shoulder Replacement……………………… 9-42
9.3.4.3.1 Shoulder Hemiarthroplasty …….. 9-42
9.3.4.3.2 Revision Shoulder Arthroplasty.. 9-43
9.3.5 Arthroscopy …………………………………………………………… 9-44
9.3.5.1 Anterior Cruciate Ligament Repair ……………… 9-46
9.3.5.2 Carpal Tunnel Release……………………………… 9-48
9.3.5.3 Lavage and Debridement of the Knee…………. 9-50
9.3.5.4 Meniscal and Articular Cartilage Repair ………. 9-50
9.3.5.5 Rotator Cuff Repair ………………………………….. 9-52
Exhibit 9-1: Germany, Internal Fixation/Fracture Repair of the Femur
and Tibia/Fibula, Procedure Volumes Forecast, 2011-2018………….. 9-8
Exhibit 9-2: Germany, External Fixation/Fracture Repair,
Procedure Volumes Forecast, 2011-2018 ………………………………… 9-10
Exhibit 9-3: Classification of Anterior Cervical Plates ………………………………….. 9-14
Exhibit 9-4: Germany, Spine Surgery, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 9-25
Exhibit 9-5: Types of Synovial Joints………………………………………………………… 9-34
Exhibit 9-6: Illustrated Schematic of Total Hip Replacement Using a
Monoblock or Modular Femoral Stem………………………………………. 9-37
Exhibit 9-7: Germany, Total Hip Replacement, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 9-39
Exhibit 9-8: Germany, Total and Unicompartmental Knee Replacement,
Procedure Volumes Forecast, 2011-2018 ………………………………… 9-41
Exhibit 9-9: Germany, Total Shoulder Replacement,
Procedure Volumes Forecast, 2011-2018 ………………………………… 9-45
Exhibit 9-10: Germany, Selected Arthroscopic Surgery,
Procedure Volumes Forecast, 2011-2018 ………………………………… 9-53
10. OTORHINOLARYNGOLOGIC SURGICAL PROCEDURES………………… 10-1
10.1 Adenoidectomy…………………………………………………………………….. 10-1
10.2 Mastoidectomy …………………………………………………………………….. 10-3
10.3 Myringotomy and Tube Placement………………………………………….. 10-5
10.4 Septoplasty………………………………………………………………………….. 10-7
10.5 Tonsillectomy ………………………………………………………………………. 10-9
10.6 Tracheostomy…………………………………………………………………….. 10-13
10.7 Combined Otorhinolaryngologic Surgical Procedures ………………. 10-17
©2013 Elsevier Business Intelligence x #A628
Germany, Surgical Procedure Volumes Table of Contents
Exhibit 10-1: Germany, Adenoidectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 10-4
Exhibit 10-2: Germany, Mastoidectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………… 10-6
Exhibit 10-3: Germany, Myringotomy and Tube Placement,
Procedure Volumes Forecast, 2011-2018 ………………………………… 10-8
Exhibit 10-4: Germany, Septoplasty, Procedure Volumes Forcast,
2011-2018 …………………………………………………………………………. 10-10
Exhibit 10-5: Germany, Tonsillectomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………. 10-14
Exhibit 10-6: Germany, Tracheostomy, Procedure Volumes Forecast,
2011-2018 …………………………………………………………………………. 10-18
Exhibit 10-7: Germany and Europe, Otorhinolaryngologic Surgery,
Procedure Volumes Forecast, 2011-2018 ………………………………. 10-20
11. UROLOGIC SURGICAL PROCEDURES………………………………………….. 11-1
11.1 Benign Prostatic Hyperplasia …………………………………………………. 11-1
11.2 Kidney Stone Obstruction………………………………………………………. 11-5
11.3 Urinary Incontinence……………………………………………………………. 11-11
Exhibit 11-1: Germany, Benign Prostatic Hyperplasia Treatment,
Procedure Volumes Forecast, 2011-2018 ………………………………… 11-6
Exhibit 11-2: Germany, Kidney Stone Removal,
Procedure Volumes Forecast, 2011-2018 ………………………………. 11-12
Exhibit 11-3: Germany, Urinary Incontinence Treatment,
Procedure Volumes Forecast, 2011-2018 ………………………………. 11-18