Haenle M, Skripitz C, Mittelmeier W, Skripitz R
Orthopädische Klinik und Poliklinik, Universität Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland.
Orthopade. 2012 Jun;41(6):467-76. doi: 10.1007/s00132-012-1939-2.
The treatment of an infected total hip arthroplasty is becoming an increasing economic problem. The additional costs of treatment are insufficiently represented in the diagnosis-related groups (DRG) categories. The aim of this study was to clarify whether the costs can be covered under the German DRG system and to identify the extent of the surplus or negative balance.
A retrospective analysis of the treatment costs of total hip arthroplasty was carried out. Data from all patients treated at the orthopedic clinic of the University Hospital in Rostock were collected from patient records and from the hospital information system and calculation of the personnel and material costs using data from the central pharmacy and control centre of the University of Rostock.
In this study a total of 49 patients were included. The average treatment costs were 29,331.36 EUR per patient for an infected and 6,263.59 EUR for a primarily non-infected total hip arthroplasty. A comparison between the calculated and compensated costs resulted in an average deficit of 12,685.60 EUR per patient and an average surplus of 781.41 EUR per patient in the control group.
An economically viable treatment of infected total hip arthroplasty was not possible mostly due to the increased personnel and material costs but also to the lack of inclusion of the procedures in the DRG system. Further multicenter cost analysis studies and extensive quality assurance measures are necessary with respect to a comprehensive medical standard for a medically meaningful and economically reasonable treatment of periprosthetic infections.
感染性全髋关节置换术的治疗正成为一个日益严重的经济问题。诊断相关分组（DRG）类别中未充分体现治疗的额外成本。本研究的目的是明确德国DRG系统能否涵盖这些成本，并确定盈余或负平衡的程度。
对全髋关节置换术的治疗成本进行回顾性分析。从罗斯托克大学医院骨科诊所治疗的所有患者的病历和医院信息系统中收集数据，并利用罗斯托克大学中央药房和控制中心的数据计算人员和材料成本。
本研究共纳入49例患者。感染性全髋关节置换术患者的平均治疗成本为每人29,331.欧元，初次非感染性全髋关节置换术患者的平均治疗成本为6,263.59欧元。计算成本与补偿成本之间的比较显示，感染组患者平均亏损12,685.60欧元，对照组患者平均盈余781.41欧元。
感染性全髋关节置换术在经济上可行的治疗大多无法实现，这主要是由于人员和材料成本增加，也由于DRG系统未纳入这些手术。关于假体周围感染的有医学意义且经济合理的综合医疗标准，有必要进行进一步的多中心成本分析研究和广泛的质量保证措施。
