Kilian M, Hammerich R, Langelotz C, Raue W, Tsilimparis N, Rau B, Hartmann J
Klinik für Allgemein-, Visceral-, Gefäss- und Thoraxchirurgie, Charité-Universitätsmedizin Berlin, Deutschland.
Chirurg. 2010 Nov;81(11):1005-12. doi: 10.1007/s00104-010-1927-1.
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) offers patients with peritoneal cancer of various origins the chance of a relevant increase in life expectancy. These cases are very complex from a medical viewpoint and very expensive from an economical aspect. An analysis of case cost calculations was performed to find out whether this procedure can on average be carried out cost-effectively by a maximum care university.
All cases from 2008 in which HIPEC was carried out were analyzed. The types of main diagnosis, secondary diagnoses, procedures, times from incision to suture and hospital stay were analyzed. On the basis of the case costs the proceeds and marginal returns were calculated from the diagnosis-related groups (DRGs) and additional remuneration when applicable. The causes of positive and negative marginal returns were explained using the InEK cost matrix.
In 18 patients there were 9 different main diagnoses and 7 different "main procedures" (from a surgical perspective the most resource intensive procedures) and a total of 10 different DRGs were identified in the grouping algorithm. With an average of 2 operations (range 1-7) per patient the summed incision-to-suture time was 423 min (170-962 min). The patients stayed on average 6.4 days (1.3-17.6 days) in intensive care. The average case cost was 21,072€ (range 8,657-55,904€) and the proceeds 20,474€ (6,333-37,497€). Each case had on average a debit balance of 598€ (range from 11,843€ profit balance to 18,407€ debit balance) with an assumed base rate of 2,786€. The causes for positive or negative marginal profits were mostly operating times, incision-to-suture times and duration of intensive care.
The proceeds showed on average a deficit of only 3% compared to the costs. The operating times must be decreased by optimization particularly of the preoperative approach. Interventions should be carried out in one stage only and the intraoperative connecting and waiting times should be reduced in order to reduce the incision-to-suture times.
细胞减灭术联合腹腔热灌注化疗（HIPEC）为各种起源的腹膜癌患者提供了显著提高预期寿命的机会。从医学角度来看，这些病例非常复杂，从经济方面来说成本也非常高昂。进行了病例成本计算分析，以确定一所顶级大学附属医院平均是否能够经济高效地开展该手术。
分析了2008年所有实施HIPEC的病例。对主要诊断类型、次要诊断、手术操作、从切开到缝合的时间以及住院时间进行了分析。根据病例成本，从诊断相关分组（DRG）计算收益和边际收益，并在适用时计算额外报酬。使用InEK成本矩阵解释正边际收益和负边际收益的原因。
18例患者有9种不同的主要诊断和7种不同的“主要手术操作”（从手术角度来看是资源消耗最多的操作），在分组算法中总共确定了10种不同的DRG。每位患者平均进行2次手术（范围为1 - 7次），切开到缝合的总时间为423分钟（170 - 962分钟）。患者在重症监护室平均停留6.4天（1.3 - 17.6天）。平均病例成本为21,072欧元（范围为8,657 - 55,904欧元），收益为20,474欧元（6,333 - 37,497欧元）。假设基础费率为2,786欧元，每个病例平均借方余额为598欧元（范围从11,843欧元的利润余额到18,407欧元的借方余额）。正或负边际利润的原因主要是手术时间、切开到缝合的时间以及重症监护的持续时间。
收益与成本相比平均仅亏损3%。必须通过优化特别是术前方案来减少手术时间。干预应仅在一个阶段进行，并减少术中连接和等待时间，以缩短切开到缝合的时间。
