Kottenberg-Assenmacher Eva, Merguet Peter, Kamler Markus, Peters Jürgen
Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Universitätsklinikum Essen, Essen, Germany.
J Cardiothorac Vasc Anesth. 2009 Apr;23(2):142-6. doi: 10.1053/j.jvca.2008.10.001. Epub 2008 Dec 21.
In the German diagnosis-related group (G-DRG) system, hospital reimbursement for anesthesia is linked to specific surgical procedures, irrespective of case duration. Accordingly, costs of innovative procedures, such as endoscopic cardiac surgery, may be underreimbursed. The authors assessed to what extent anesthesia costs for endoscopic cardiac surgery are reimbursed with the G-DRG system.
Retrospective analysis.
University hospital.
Eighty-four patients were studied undergoing general anesthesia for minimally invasive endoscopic port-access intracardiac surgery (n = 42) or conventional "open" surgery (n = 42) for similar indications.
None.
The authors measured anesthesia staffing time, costs, and reimbursement for endoscopic cardiac surgery and compared results with data from a matched group undergoing conventional surgery. Endoscopic surgery increased anesthesia staffing time per case by 521 minutes (977 minutes +/- 177 v 456 +/- 92, mean +/- standard deviation, p = 0.0001) and costs by approximately 200%. Anesthesia duration increased by 152 minutes (503 minutes +/- 89 v 351 +/- 69, p = 0.0001). In contrast, staffing reimbursement did not increase at the time of the patient's surgery (euro500/case [446-569] v 492 [452-508], p = 0.75, median [interquartile range]) or with the 2007 G-DRG matrix (euro548/case [463-559] v 503 [503-568], p = 0.48). Cost recovery was only 66% +/- 17.4% and 72.7 +/- 38.9 in the 2007 G-DRG matrix, respectively.
It was shown that (1) endoscopic cardiac surgery consumed more anesthesia resources and was underreimbursed both relative to actual costs and to conventional surgery, (2) costs for such anesthesia services were inappropriately reflected in the G-DRG system, and (3) a DRG system's inability to adapt timely to innovative procedures may adversely affect anesthesia departments and medical progress.
在德国诊断相关分组（G-DRG）系统中，医院对麻醉的报销与特定外科手术相关，而与病例持续时间无关。因此，诸如内镜心脏手术等创新手术的费用可能报销不足。作者评估了G-DRG系统对内镜心脏手术麻醉费用的报销程度。
回顾性分析。
大学医院。
对84例因相似适应证接受全身麻醉的患者进行研究，其中42例行微创内镜端口入路心脏手术，42例行传统“开放”手术。
无。
作者测量了内镜心脏手术的麻醉人员配备时间、费用及报销情况，并将结果与一组接受传统手术的匹配组数据进行比较。内镜手术使每例麻醉人员配备时间增加521分钟（977分钟±177比456±92，均值±标准差，p = 0.0001），费用增加约200%。麻醉持续时间增加152分钟（503分钟±89比351±69，p = 0.0001）。相比之下，在患者手术时人员配备报销并未增加（500欧元/例[446 - 569]比492[452 - 508]，p = 0.75，中位数[四分位间距]），在2007年G-DRG矩阵中也未增加（548欧元/例[463 - 559]比503[503 - 568]，p = 0.48）。在2007年G-DRG矩阵中，成本回收率分别仅为66%±17.4%和72.7±38.9。
结果表明，（1）内镜心脏手术消耗了更多的麻醉资源，相对于实际成本和传统手术而言报销不足；（2）此类麻醉服务的费用在G-DRG系统中未得到恰当体现；（3）DRG系统无法及时适应创新手术可能会对麻醉科室和医学进展产生不利影响。
