Schulz Torsten, Kirsten Toralf, Nuwayhid Rima, Langer Stefan, von der Höh Sandra, von Dercks Nikolaus
Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland.
Medizininformatikzentrum - Abteilung Medical Data Science, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.
Unfallchirurgie (Heidelb). 2024 Dec;127(12):878-887. doi: 10.1007/s00113-024-01498-y. Epub 2024 Nov 17.
Hand surgery departments nowadays face the challenge of operating profitably, training new specialists, managing increasing case numbers and implementing the required shift towards outpatient care in clinical practice.
The aim of this study was to describe the demographic and economic indicators of a university hospital and to examine the development of inpatient and outpatient case numbers over the past decade.
A retrospective data analysis was carried out for patients treated for hand injuries in the period from 2013 to 2023. The main diagnoses of cases were identified and descriptively analyzed using the International Classification of Diseases (ICD). In order to demonstrate a correlation, a linear regression model was calculated and a p-value <0.05 was considered significant.
In total, 2918 cases were included over a decade starting in 2013. Out of these 776 cases were treated on an outpatient basis and two thirds of the patients were male. The patients were generally healthy with an average American Society of Anesthesiologists (ASA) status of 1.6 ± 0.6 and with a patient clinical complexity level (PCCL) of 0 in 79% of cases. Patient numbers increased continuously from 161 cases in 2013 to 393 cases in 2022 (p < 0.001). The most common main diagnosis was infectious hand diseases (L02.4-M65.14). This resulted in the most frequently assigned diagnosis-related group (DRG) being I32E (319 cases). For inpatient cases the average incision-to-suture time was 51:51 min and for outpatient cases 26:03 min. The revenue was on average 4372.90 € per inpatient case and 300.77 € per outpatient case. The rate of examinations by the German Medical Service of Health Funds (Medizinischer Dienst) was 19% over the entire observational period.
The increasing case numbers in the outpatient and inpatient sectors indicate a centralization and consolidation of hand surgical expertise in the region. There are significant revenue differences between outpatient and inpatient cases.
如今，手外科面临着诸多挑战，包括实现盈利运营、培训新专家、应对不断增加的病例数量以及在临床实践中实现向门诊护理的必要转变。
本研究旨在描述一家大学医院的人口统计学和经济指标，并考察过去十年中住院和门诊病例数量的发展情况。
对2013年至2023年期间因手部损伤接受治疗的患者进行回顾性数据分析。使用国际疾病分类（ICD）确定病例的主要诊断并进行描述性分析。为了证明相关性，计算了线性回归模型，p值<0.05被认为具有统计学意义。
从2013年开始的十年间，共纳入2918例病例。其中776例为门诊治疗，三分之二的患者为男性。患者总体健康，美国麻醉医师协会（ASA）平均状态为1.6±0.6，79%的病例患者临床复杂程度水平（PCCL）为0。患者数量从2013年的161例持续增加到2022年的393例（p<0.001）。最常见的主要诊断是手部感染性疾病（L02.4-M65.14）。这导致最常分配的诊断相关组（DRG）为I32E（319例）。住院病例的平均切开至缝合时间为51:51分钟，门诊病例为26:03分钟。住院病例平均收入为4372.90欧元/例，门诊病例为300.77欧元/例。在整个观察期内，德国健康基金医疗服务机构（Medizinischer Dienst）的检查率为19%。
门诊和住院部门病例数量的增加表明该地区手外科专业知识的集中和整合。门诊和住院病例之间存在显著的收入差异。
