Geiger E V, Laurer H L, Jakob H, Frank J M, Marzi I
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/M., Deutschland.
Unfallchirurg. 2013 Jun;116(6):517-23. doi: 10.1007/s00113-011-2114-7.
Complex procedures in knee surgery, such as anterior cruciate ligament (ACL) reconstruction with the double bundle technique are not specially recognized within the German diagnosis-related groups (G-DRG) system. Hence, the goal of the present study was to perform a cost unit calculation and evaluate how ACL reconstruction in single versus double bundle techniques is remunerated.
In 30 patients ACL reconstruction was performed with the single bundle technique (group A) and in 21 an anatomic double bundle reconstruction (group B) was performed. All costs including those for human resources, implants and materials, as well as general costs for administration and facilities were calculated.
All cases entered one DRG category, the I30Z "complex procedures at the knee joint". Thus, the revenue in 2008 was 2,996.65 euro per case and in 2009 3,120.35 euro per case. Calculating all costs, the profit contributions in 2008 and 2009 were 592,42 euro and 716,12 euro, respectively for group A. However, in group B the profit contributions were 314,68 euro and 438,38 euro, respectively.
Performing the double bundle technique for ACL reconstruction in a university hospital setting, significant cost reductions are needed to achieve the revenue generated by the single bundle technique. Additional changes of the relative weighting in the DRG are also necessary.
膝关节手术中的复杂手术，如采用双束技术进行前交叉韧带（ACL）重建，在德国诊断相关分组（G-DRG）系统中未得到特别认可。因此，本研究的目的是进行成本单位计算，并评估单束与双束技术的ACL重建的支付情况。
30例患者采用单束技术进行ACL重建（A组），21例采用解剖双束重建（B组）。计算了所有成本，包括人力资源、植入物和材料成本，以及管理和设施的一般成本。
所有病例均归入一个DRG类别，即I30Z“膝关节复杂手术”。因此，2008年每例收入为2996.65欧元，2009年每例收入为3120.35欧元。计算所有成本后，A组2008年和2009年的利润贡献分别为592.42欧元和716.12欧元。然而，B组的利润贡献分别为314.68欧元和438.38欧元。
在大学医院环境中采用双束技术进行ACL重建，需要大幅降低成本才能达到单束技术产生的收入。DRG中的相对权重也需要进行额外调整。
