Department of Congenital Heart Surgery-Pediatric Heart Surgery, 14929Deutsches Herzzentrum Berlin, Augustenburger Platz, Berlin, Germany.
Department of Anesthesiology, 14929Deutsches Herzzentrum Berlin, Augustenburger Platz, Berlin, Germany.
World J Pediatr Congenit Heart Surg. 2020 Sep;11(5):557-562. doi: 10.1177/2150135120926978.
Duration of mechanical ventilation is an important variable used by German Diagnosis-Related Groups (G-DRG) system to establish cost weight values for reimbursement after congenital heart surgery. Infants are commonly ventilated after open heart surgery. As of year 2015, we strived to achieve early postoperative extubation. This work studies how this approach impacted reimbursement after infant open heart surgery.
Data of infants who underwent surgery on cardiopulmonary bypass (CPB) from 2014 to 2018 were reviewed. Successful early extubation was defined as end of mechanical ventilation within 24 hours postoperatively, without reintubation at a later point. Mean cost weight values (case mix index [CMI]) of achieved DRGs were used for estimation of reimbursement. Evolutions over years of early extubation and of reimbursement were compared.
A total of 521 infants underwent operations on CPB. Of these, 161 (31%) procedures were of higher risk Society of Thoracic Surgery and the European Association for Cardio-Thoracic Surgery (STAT) categories 3 and 4. Early extubation was achieved in 205 (39%) patients. The rate increased from 14% (year 2014) to 57% (year 2018). Case mix index amounted to 8.87 ± 7.00 after early extubation, and 12.37 ± 7.85 after late extubation: value <.0001. It was 8.77 ± 6.09 after early extubation in patients undergoing lower risk STAT categories 1 and 2 operations, and 8.09 ± 2.95 when categories 3 and 4 procedures were performed ( = .18). An overall 14.4% decrease in hospital reimbursement per patient was observed.
Early extubation could be progressively obtained in the majority of infants. This resulted in lower reimbursement. Surgical complexity was disregarded. The current G-DRG system appears to favor longer mechanical ventilation durations after infant open heart surgery.
机械通气时间是德国诊断相关分组（G-DRG）系统用于确定先天性心脏病手术后报销费用权重值的一个重要变量。婴儿在心脏直视手术后通常需要通气。截至 2015 年，我们努力实现术后早期拔管。本研究旨在探讨这种方法对婴儿心脏直视手术后报销的影响。
回顾了 2014 年至 2018 年在体外循环（CPB）下行手术的婴儿患者的数据。早期成功拔管定义为术后 24 小时内停止机械通气，且此后不再进行重新插管。使用达到的诊断相关分组的平均费用权重值（病例组合指数[CMI]）来估计报销。比较了多年来早期拔管和报销的演变。
共有 521 名婴儿接受 CPB 手术。其中，31%的手术为高风险（胸外科协会和欧洲心胸外科协会[STAT]分类 3 和 4）。205 例（39%）患者实现了早期拔管。这一比例从 2014 年的 14%增加到 2018 年的 57%。早期拔管后 CMI 为 8.87±7.00，晚期拔管后为 12.37±7.85：<0.0001。行低风险 STAT 分类 1 和 2 手术的患者早期拔管后 CMI 为 8.77±6.09，行高风险 STAT 分类 3 和 4 手术的患者为 8.09±2.95（=0.18）。观察到每位患者的住院报销费用总体下降了 14.4%。
大多数婴儿可以逐渐实现早期拔管，这导致报销减少。手术的复杂性没有得到考虑。目前的 G-DRG 系统似乎更倾向于婴儿心脏直视手术后延长机械通气时间。
