Wachtel Nikolaus, Wiggenhauser Paul S, Ahmad Nura, Giunta Riccardo E, Ehrl Denis
Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München.
Handchir Mikrochir Plast Chir. 2020 Dec;52(6):464-472. doi: 10.1055/a-1230-3914. Epub 2020 Sep 2.
Advances in reconstructive microsurgery have led to significant improvements in the surgical care of complex interdisciplinary cases. At the same time, however, this also increases the resource expenditure of the plastic surgeon involved. This study aimed to analyse the relationship between increase in revenue and resource expenditure in reconstructive microsurgery at a university hospital of maximum care with regard to the treatment of interdisciplinary patients.
In 2018 and 2019, all cases of interdisciplinary cooperation were followed up at one location of a plastic surgery department of a university clinic. The interdisciplinary surgical cases were identified from the collective and evaluated prospectively with regard to inpatient treatment days, surgical resource expenditure and economic development (DRG before and after microsurgical reconstruction).
In 2018 and 2019, a total of 68 free microsurgical flaps were performed in 64 interdisciplinary cases. 62 of these cases met the criteria for interdisciplinary surgical treatment. Considering the contribution of plastic surgery to the economic development and the associated resource expenditure, there is a significant increase in all parameters (p < 0.0001). Thus, the Case Mix Index (CMI) rose by 20.2 %, inpatient treatment days by 79.1 %, the number of surgical interventions by 62.4 %, cumulative incision-suture time by 131.4 % and total surgeon hours by 75.4 %.
Reconstructive microsurgical procedures lead to a significant increase in revenue in interdisciplinary surgical cases. However, a significant increase in resource consumption is observed as well. Moreover, these additional costs are not always adequately reflected in the revenue of the DRG. This especially applies to DRGs with a high initial cost weight. To ensure modern, individual, patient-oriented and guideline-compliant patient care, there is, therefore, an urgent need to adapt the (G-)DRG system to the additional resource consumption. In addition, in the case of interdisciplinary surgical cases, a clear internal cost allocation must be carried out in accordance with the surgical resource expenditure.
重建显微外科的进展已使复杂的多学科病例的手术治疗有了显著改善。然而，与此同时，这也增加了相关整形外科医生的资源消耗。本研究旨在分析一所特级护理大学医院在治疗多学科患者方面，重建显微外科收入增加与资源消耗之间的关系。
2018年和2019年，在一所大学诊所的整形外科某一地点对所有多学科合作病例进行随访。从病例集中识别出多学科手术病例，并对住院治疗天数、手术资源消耗和经济发展情况（显微外科重建前后的疾病诊断相关分组）进行前瞻性评估。
2018年和2019年，在64例多学科病例中总共进行了68例游离显微皮瓣手术。其中62例符合多学科手术治疗标准。考虑到整形外科对经济发展的贡献以及相关的资源消耗，所有参数均有显著增加（p < 0.0001）。因此，病例组合指数（CMI）上升了20.2%，住院治疗天数增加了79.1%，手术干预次数增加了62.4%，累计切开缝合时间增加了131.4%，外科医生总工作时长增加了75.4%。
重建显微外科手术在多学科手术病例中使收入显著增加。然而，资源消耗也有显著增加。此外，这些额外成本在疾病诊断相关分组的收入中并不总是得到充分体现。这尤其适用于初始成本权重较高的疾病诊断相关分组。因此，为确保提供现代、个性化、以患者为导向且符合指南的患者护理，迫切需要使（G-）疾病诊断相关分组系统适应额外的资源消耗。此外，对于多学科手术病例，必须根据手术资源消耗进行明确的内部成本分配。
