Zhang Zhengyu, Yao Xiaolin, Li Ying, Dong Ruiyin, Jin Wen, Li Yunhe
Medical Records Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
Department of urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 311100, China.
BMC Surg. 2025 May 13;25(1):207. doi: 10.1186/s12893-025-02940-7.
This study aimed to examine the consistency of resource consumption (cost homogeneity) and influencing factors of the diagnosis-related group (DRG) "major operations for malignant tumors of the male reproductive system with general complications or comorbidities" (MA13) and offer recommendations for improving the efficacy of the grouping.
This retrospective study analyzed medical records and insurance settlement data of all MA13 patients admitted to a tertiary urology department from January 2021 to December 2024. Combined with semi-structured interviews with urologists, key clinical cost drivers were identified. Multiple linear regression analysis was utilized to assess the significance of these factors and their specific impact on various service costs. We provided recommendations for improving MA13 groupings and evaluated their effectiveness using the coefficient of variation (CV) and t-tests.
The CV for the MA13 group was 0.41. Age and robot-assisted surgery emerged as independent factors due to their statistically dominant effects (P < 0.001) in multivariate regression, whereas comorbidities and insurance type showed limited explanatory power (adjusted R = 0.72). Subgrouping MA13 by age and robotics reduced intra-group heterogeneity (CV: 0.12-0.35 vs. 0.41), enabling equitable reimbursement for advanced surgical techniques while maintaining manageable DRG categories.
Supplementary payments for robot-assisted surgery should be considered to ensure equitable access to advanced technologies while maintaining cost-effectiveness. Stratified validation methods are essential for evaluating grouping effectiveness, which can help improve intra-group consistency and facilitate a more equitable distribution of medical resources.
本研究旨在探讨“男性生殖系统恶性肿瘤伴一般并发症或合并症的大手术”（MA13）诊断相关组（DRG）的资源消耗一致性（成本同质性）及其影响因素，并为提高分组效能提供建议。
本回顾性研究分析了2021年1月至2024年12月期间入住某三级泌尿外科的所有MA13患者的病历和保险结算数据。结合对泌尿外科医生的半结构化访谈，确定关键临床成本驱动因素。采用多元线性回归分析评估这些因素的显著性及其对各项服务成本的具体影响。我们为改进MA13分组提供了建议，并使用变异系数（CV）和t检验评估其有效性。
MA13组的CV为0.41。年龄和机器人辅助手术在多变量回归中具有统计学上的显著效应（P < 0.001），成为独立因素，而合并症和保险类型的解释力有限（调整后R = 0.72）。按年龄和机器人技术对MA13进行亚组划分可降低组内异质性（CV：0.12 - 0.35对0.41），在保持DRG类别可控的同时，使先进手术技术能够获得公平报销。
应考虑对机器人辅助手术进行补充支付，以确保在保持成本效益的同时公平获取先进技术。分层验证方法对于评估分组有效性至关重要，有助于提高组内一致性并促进医疗资源更公平的分配。
