Department of Surgery, Technische Universität München, Ismaningerstrasse 22, Munich 81675, Germany.
Langenbecks Arch Surg. 2013 Aug;398(6):825-31. doi: 10.1007/s00423-013-1091-4. Epub 2013 Jun 19.
Although centralization of complex surgical procedures such as pancreaticoduodenectomies is associated with a reduction in morbidity and mortality rates, it is unclear whether such surgeries are adequately represented in the German disease-related group (DRG) system.
Out of all patients who underwent pancreatic resections (n = 450) at our institution between January 2008 and November 2011, 76 patients who underwent a pylorus-preserving pancreatic head resection due to pancreatic head adenocarcinoma were selected for analysis. The revenues generated by these surgical procedures were compared with those of 144 patients who had undergone elective laparoscopic cholecystectomies for symptomatic gallstone disease between January 2009 and September 2010 in our hospital.
In patients undergoing pylorus-preserving pancreaticoduodenectomy, revenues per case were 1,585.55 Euros, with an average length of hospital stay (ALOS) of 19.9 days (range 7-55 days) and an average postoperative hospital stay of 16 days; however, if the ALOS was exceeded, expenditures increasingly exceeded returns. Analysis of the cohort of patients with pylorus-preserving pancreaticoduodenectomies demonstrated average revenues per day of 79.27 Euros. In contrast, for laparoscopic cholecystectomy, which was treated with high surgical standardization and stringent case management, the ALOS was only 2.8 days, producing average revenues of 288.80 Euros per day and total revenues of 817.53 Euros per case.
At university hospitals, cost-effective realization of major pancreatic surgery is difficult, while highly standardized surgeries such as laparoscopic cholecystectomies can be performed at a favorable balance. This may be due to, firstly, an underrepresentation of university hospitals in the German DRG calculation basis and, secondly, to a relatively long preoperative hospital stay as a result of extensive diagnostic measures. We consider this kind of preoperative assessment paramount for an academic pancreatic center and thus argue for an increased reimbursement for these procedures.
尽管胰腺十二指肠切除术等复杂手术的集中化与发病率和死亡率的降低有关，但尚不清楚德国疾病相关分组（DRG）系统是否充分涵盖了这些手术。
在我们医院 2008 年 1 月至 2011 年 11 月期间进行胰腺切除术的所有患者中，选择了 76 例因胰腺头部腺癌而行保留幽门的胰头切除术的患者进行分析。将这些手术产生的收入与我们医院 2009 年 1 月至 2010 年 9 月期间 144 例行择期腹腔镜胆囊切除术治疗有症状胆囊结石病的患者进行比较。
行保留幽门胰十二指肠切除术的患者，每例手术的收入为 1585.55 欧元，平均住院时间（ALOS）为 19.9 天（范围 7-55 天），平均术后住院时间为 16 天；然而，如果 ALOS 超过规定时间，支出将超过收入。对行保留幽门胰十二指肠切除术患者队列的分析表明，每天的平均收入为 79.27 欧元。相比之下，腹腔镜胆囊切除术具有高度标准化和严格的病例管理，ALOS 仅为 2.8 天，每天的平均收入为 288.80 欧元，每例手术的总收入为 817.53 欧元。
在大学附属医院，实现主要胰腺手术的成本效益是困难的，而像腹腔镜胆囊切除术这样高度标准化的手术可以以有利的平衡来进行。这可能是由于首先大学附属医院在德国 DRG 计算基础中的代表性不足，其次由于广泛的诊断措施导致术前住院时间相对较长。我们认为这种术前评估对于学术胰腺中心至关重要，因此主张增加这些手术的报销。
