Jud Lukas, Gautschi Nora, Möller Soeren, Möller Klaus, Giesinger Karlmeinrad
Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
Institute of Accounting, Control and Auditing, Chair of Controlling / Performance Management, University of St. Gallen, Tigerbergstrasse 9, 9000, St. Gallen, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5293-5298. doi: 10.1007/s00167-023-07574-x. Epub 2023 Sep 15.
Revision total knee arthroplasty (RTKA) results in high costs with inadequately low reimbursement in different healthcare systems. Therefore, a financial analysis was performed comparing costs and reimbursements of primary total knee arthroplasty (PTKA) versus RTKA using financial and total knee arthroplasty-register data from a large tertiary hospital, the Cantonal Hospital of St. Gallen (KSSG), Switzerland.
All PTKA and RTKA performed between January 2012 and September 2019 at the KSSG were included. Financial and TKA-register data for each case were collected, including detailed cost allocation, reimbursement, patients' insurance status, type and indication for surgery and length of hospital stay. RTKA was further subdivided in one-stage and two-stage RTKA. Direct hospital costs were analyzed and compared to reimbursement in both groups. Cost-coverage ratios were calculated.
730 PTKA and 106 RTKA were included. The RTKA group contained 66 one-stage and 40 two-stage RTKA. Cost-coverage ratio for PTKA and RTKA showed to be 110.9% and 81.3%, respectively. Cost-coverage ratio was lower for two-stage RTKA than for one-stage RTKA with 74.1% and 92.3%, respectively.
RTKA leads to financial deficits especially for tertiary hospitals within the Swiss healthcare system. Restructuring of the reimbursements for PTKA and RTKA should be considered in favor of RTKA. Otherwise, tertiary hospitals will face a growing financial burden with the constantly increasing annual number of RTKA procedures, predominantly performed in this type of hospitals.
III.
全膝关节置换翻修术（RTKA）成本高昂，而在不同医疗体系中报销费用却极低。因此，利用瑞士圣加仑州立医院（KSSG）这家大型三级医院的财务数据和全膝关节置换登记数据，对初次全膝关节置换术（PTKA）与RTKA的成本和报销情况进行了财务分析。
纳入2012年1月至2019年9月期间在KSSG进行的所有PTKA和RTKA病例。收集每个病例的财务和全膝关节置换登记数据，包括详细的成本分配、报销情况、患者保险状况、手术类型和指征以及住院时间。RTKA进一步细分为一期RTKA和二期RTKA。分析并比较两组的直接医院成本与报销情况。计算成本覆盖比。
共纳入730例PTKA和106例RTKA。RTKA组包括66例一期RTKA和40例二期RTKA。PTKA和RTKA的成本覆盖比分别为110.9%和81.3%。二期RTKA的成本覆盖比低于一期RTKA，分别为74.1%和92.3%。
RTKA会导致财务赤字，尤其是在瑞士医疗体系中的三级医院。应考虑对PTKA和RTKA的报销进行调整，以利于RTKA。否则，随着RTKA手术年度数量的不断增加（主要在这类医院进行），三级医院将面临日益沉重的财务负担。
III级。
