Mishra Vinod, Geiran Odd, Krohg-Sørensen Kirsten, Andresen Sølvi
Health Professional Support Department, Rikshospitalet Radiumhospitalet Medical Center, and Faculty Division Rikshospitalet, University of Oslo, Oslo, Norway.
Scand Cardiovasc J. 2008 Feb;42(1):77-84. doi: 10.1080/14017430701716814.
The main objective of this study was to analyze direct hospital cost and to compare cost with existing DRG reimbursement for open repair of thoracic and thoraco-abdominal aortic disease. STUDY SAMPLE AND METHODOLOGY: Between January 2003 and September 2003, the cost of treatment for 24 surgical procedures on ascending aorta and arch, descending or thoraco-abdominal aortic disease were examined prospectively. Seven patients had urgent or emergency surgeries. Ten had sternotomies for disease of the ascending aorta and aortic arch; two had left thoracotomies and three thoraco-laparotomy incisions with procedures performed on x-corporeal circulation. Nine other patients had more distal thoraco-abdominal aortic operations with a clamp-and-sew technique. Micro-cost analysis was performed on each hospital stay, in addition overhead hospital costs were allocated to each procedure.
The patients were grouped by discharge diagnosis (ICD-10) and surgical procedure performed (NCSP) into Norwegian DRG code. Patient with surgery on ascending aorta & aortic arch were allocated to DRG 108 (n=9) or 483 (tracheostomy, n=1) while patient with surgery on descending or thoraco-abdominal aorta were allocated to DRG 108 (n=3), 110 (n=4), 111 (n=4) or 483 (tracheostomy, n=3). The mean EuroSCORE for patients with proximal aortic disease was 11 (5-18), and the length of stay was 5 days (range 3-8 days), spending 2 days (range 1-7 days) in thoracic intensive care unit. For patients with distal aortic disease the mean Euroscore was 7 (2-14), and the mean length of stay 10 days (range 4-23 days) with a mean 4 days (range 1-13 days) in intensive care unit. Eight patients developed medical problems requiring new surgical procedures or prolonged ICU stay. The average direct hospital cost for proximal aortic surgery was USD 15,877 (USD 1=NOK 7.5) while the respective 100% DRG reimbursement including one patient needing a tracheostomy, was 19 803 USD. For patients with distal aortic disease, average direct hospital cost was 23 005 USD and DRG reimbursement including patients needing a tracheostomy was 31543 USD.
Our results underscore previous findings that these patients are resource intensive. This study shows that Norwegian 100% DRG reimbursement did over-compensate observed total hospital costs in this cohort. Detailed analysis showed that this was due to the higher DRG reimbursement for patients needing prolonged ventilatory support. Thus the actual DRG reimbursement seems to be relevant to the tertiary hospital actual costs when these complicated patients are considered as a group. It remains however unclear whether this reimbursement is sufficient to support the scientific infrastructure for new knowledge and skills needed for the further refinement of treatment.
本研究的主要目的是分析直接住院费用，并将其与现有的用于胸主动脉和胸腹主动脉疾病开放修复的疾病诊断相关分组（DRG）报销费用进行比较。
在2003年1月至2003年9月期间，前瞻性地研究了24例升主动脉和主动脉弓、降主动脉或胸腹主动脉疾病手术治疗的费用。7例患者进行了急诊或紧急手术。10例因升主动脉和主动脉弓疾病行胸骨切开术；2例行左胸切开术，3例行胸腹联合切开术并在体外循环下进行手术。另外9例患者采用钳夹缝合技术进行了更远端的胸腹主动脉手术。对每个住院期间进行微观成本分析，此外还将医院间接费用分摊到每个手术中。
根据出院诊断（国际疾病分类第十版，ICD - 10）和所实施的手术程序（挪威国家手术程序编码，NCSP）将患者分组为挪威DRG编码。升主动脉和主动脉弓手术患者被分配到DRG 108（n = 9）或483（气管切开术，n = 1），而降主动脉或胸腹主动脉手术患者被分配到DRG 108（n = 3）、110（n = 4）、111（n = 4）或483（气管切开术，n = 3）。近端主动脉疾病患者的平均欧洲心脏手术风险评估系统（EuroSCORE）评分为11（5 - 18），住院时间为5天（范围3 - 8天），在胸外科重症监护病房停留2天（范围1 - 7天）。对于远端主动脉疾病患者，平均Euroscore评分为7（2 - 14），平均住院时间为10天（范围4 - 23天），在重症监护病房平均停留4天（范围1 - 13天）。8例患者出现需要新的手术程序或延长重症监护病房停留时间的医疗问题。近端主动脉手术的平均直接住院费用为15,877美元（1美元 = 7.5挪威克朗），而包括1例需要气管切开术患者在内的100% DRG报销费用为19,803美元。对于远端主动脉疾病患者，平均直接住院费用为23,005美元，包括需要气管切开术患者在内的DRG报销费用为31,543美元。
我们的结果强调了先前的发现，即这些患者资源消耗大。本研究表明，挪威100%的DRG报销费用在该队列中对观察到的总住院费用补偿过度。详细分析表明，这是由于对需要延长通气支持的患者给予了更高的DRG报销费用。因此，当将这些复杂患者视为一个群体时，实际的DRG报销费用似乎与三级医院的实际成本相关。然而，尚不清楚这种报销是否足以支持进一步完善治疗所需新知识和技能的科学基础设施。
