Raakow J, Aydin M, Kilian M, Köhler A, Werner S, Pratschke J, Fikatas P
Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Charité Campus Mitte, Charité Campus Virchow, Charitéplatz 1, 10117, Berlin, Deutschland.
Abteilung für Allgemein- und Viszeralchirurgie, Evangelische Elisabeth Klinik, Lützowstr. 26, 10785, Berlin, Deutschland.
Chirurg. 2019 Dec;90(12):1011-1018. doi: 10.1007/s00104-019-1008-z.
Elective and emergency inguinal hernia surgery is a central task for general and abdominal surgeons. As a standard procedure it is regarded as having a relatively low income in the German diagnosis-related groups (DRG) system. This can lead to an economic imbalance, especially in a cost-intensive environment of a university hospital. The aim of this analysis was to investigate the influence of clinical factors on costs and the contribution margin as well as the overall economic evaluation of elective inguinal hernia surgery at a university hospital.
All patients undergoing elective inguinal hernia surgery at two locations of the Charité University Medicine Berlin in 2014 and 2015 were included in the analysis. The influence of clinical, patient and surgical factors on the economic outcome of the cases was evaluated.
A total of 419 patients were included, mostly after a Lichtenstein operation (44.9%) and laparoscopic transabdominal preperitoneal (TAPP) surgery (53.9%). The greatest impact on the economic outcome was the occurrence of postoperative complications. Also, a patient clinical complexity level (PCCL) value of >1, more than 8 encoded secondary diagnoses and a duration of hospital stay of less than 2 days had a significantly negative impact on the contribution margin. Overall, elective inguinal hernia surgery led to a negative contribution margin of € 651 per case.
Elective inguinal hernia surgery in the environment of a university hospital has a high financial deficit; however, since a complete discontinuation of this treatment is not an alternative multifactorial approaches are required to improve the economic outcome.
择期和急诊腹股沟疝手术是普通外科和腹部外科医生的核心任务。作为一种标准手术，在德国诊断相关分组（DRG）系统中，其收入相对较低。这可能导致经济失衡，尤其是在大学医院这种成本密集型环境中。本分析的目的是研究临床因素对成本和边际贡献的影响，以及对大学医院择期腹股沟疝手术的整体经济评估。
纳入2014年和2015年在柏林夏里特大学医学中心两个地点接受择期腹股沟疝手术的所有患者。评估临床、患者和手术因素对病例经济结果的影响。
共纳入419例患者，多数接受了利chtenstein手术（44.9%）和腹腔镜经腹腹膜前（TAPP）手术（53.9%）。对经济结果影响最大的是术后并发症的发生。此外，患者临床复杂程度水平（PCCL）值>1、编码的二级诊断超过8项以及住院时间少于2天对边际贡献有显著负面影响。总体而言，择期腹股沟疝手术导致每例病例的边际贡献为负651欧元。
在大学医院环境中，择期腹股沟疝手术存在高额财务赤字；然而，由于完全停止这种治疗并非可行之策，因此需要采取多因素方法来改善经济结果。
