Rampado Sabrina, Geron Andrea, Pirozzolo Giovanni, Ganss Angelica, Pizzolato Elisa, Bardini Romeo
Department of Surgical Oncology and Gastroenterology, General Surgery, School of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
Updates Surg. 2017 Sep;69(3):375-381. doi: 10.1007/s13304-017-0453-9. Epub 2017 Apr 25.
Repair of an incisional hernia (IH) generates costs on several levels and domains of society. The aim of this study was to make a complete cost analysis of incisional hernia repair (IHR) with synthetic and biological mesh and to compare it with financial reimbursement. Patients were grouped into three levels to determine the complexity of their care, and hence, the costs involved. Group 1 included patients without comorbidities, who underwent a "standard" incisional hernia repair (SIHR), with synthetic mesh. Group 2 included patients with comorbidities, who underwent the same surgical procedure. Group 3 included all patients who underwent a "complex" IHR (CIHR) with biological mesh. Total costs were divided into direct (including preoperative and operative phases) and indirect costs (medications and working days loss). Reimbursement was calculated according to Diagnosis-Related Group (DRG). From 2012 to 2014, 76 patients underwent prosthetic IHR: group 1 (35 pts); group 2 (30 pts); and group 3 (11 pts). The direct costs of preoperative and operative phases for groups 1 and 2 were €5544.25 and €5020.65, respectively, and €16,397.17 in group 3. The total reimbursement in the three groups was €68,292.37 for group 1, €80,014.14 for group 2, and €72,173.79 for group 3, with a total loss of €124,658.43, €69,675.36, and €100,620.04, respectively. All DRGs underestimate the costs related to IHR and CIHR, thus resulting in an important economic loss for the hospital. The cost analysis shows that patient-related risk factors do not alter the overall costs. To provide a correct "cost-based" reimbursement, different DRGs should be created for different types of hernias and prostheses.
切口疝（IH）修复在社会的多个层面和领域都会产生费用。本研究的目的是对使用合成材料和生物材料补片进行的切口疝修补术（IHR）进行全面成本分析，并将其与财务报销情况进行比较。患者被分为三个级别以确定其护理的复杂性，进而确定所涉及的成本。第1组包括无合并症的患者，他们接受了使用合成补片的“标准”切口疝修补术（SIHR）。第2组包括有合并症的患者，他们接受了相同的手术。第3组包括所有接受使用生物补片的“复杂”IHR（CIHR）的患者。总成本分为直接成本（包括术前和手术阶段）和间接成本（药物和工作日损失）。报销是根据诊断相关分组（DRG）计算的。2012年至2014年，76例患者接受了人工材料IHR：第1组（35例）；第2组（30例）；第3组（11例）。第1组和第2组术前和手术阶段的直接成本分别为5544.25欧元和5020.65欧元，第3组为16397.17欧元。三组的总报销金额分别为：第1组68292.37欧元，第2组80014.14欧元，第3组72173.79欧元，分别亏损124658.43欧元、69675.36欧元和100620.04欧元。所有DRG均低估了与IHR和CIHR相关的成本，从而给医院带来了重大经济损失。成本分析表明，与患者相关的风险因素不会改变总体成本。为了提供正确的“基于成本”的报销，应针对不同类型的疝气和补片创建不同的DRG。
