Kavaka Vladyslav, Haag Rose, Sarica Louisa, Heinzel Johannes C, Hoffmann Sebastian, Bankamp Lukas, Rieger Ingmar, Illg Claudius, Krauß Sabrina, Rachunek-Medved Katarzyna, Cerny Michael, Steiner Dominik, Lauer Henrik, Kolbenschlag Jonas, Daigeler Adrien, Thiel Johannes Tobias
Klinik für Hand‑, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland.
Sektion für Plastische und Ästhetische Chirurgie, Dr. Lubos Kliniken, Denninger Str. 44, 81679, München, Deutschland.
Chirurgie (Heidelb). 2025 Jun 6. doi: 10.1007/s00104-025-02322-y.
Soft tissue sarcomas are rare heterogeneous tumors that require extensive treatment and should only be treated in specialized sarcoma centers. Surgical R0 resection with negative margins is one of the most important positive predictors of disease-specific survival. Comprehensive healthcare economic analyses of inpatient treatment costs are largely lacking but are essential to ensure sustainable and cost-effective care.
This retrospective single center study analyzed the inpatient costs of 112 sarcoma cases treated at this university tumor center between 2020 and 2022. The statistical analyses were performed to identify variables that influence case underfunding. Additionally, the revenue distribution was examined with respect to the frequency and extent of underfunding using the cost matrix of the Institute for the Remuneration System in Hospitals (InEK).
A negative revenue balance was observed in 66.1% of cases, leading to a total deficit exceeding € 222,000. Significant predictors of underfunding included prolonged operation times, duration of intensive care stay and exceeding the average length of stay. The highest negative revenues were identified in the categories of "infrastructure costs", "medical technical services" and "operating room costs".
The results reveal significant underfunding of surgical sarcoma treatment in a specialized university sarcoma center. Adjustments to diagnosis-related groups (DRG)-based reimbursement are urgently needed to ensure the economic sustainability of care while safeguarding patient safety, academic training and making clinical decisions.
软组织肉瘤是罕见的异质性肿瘤，需要广泛的治疗，且应仅在专业的肉瘤中心进行治疗。手术切缘阴性的R0切除是疾病特异性生存最重要的积极预测因素之一。目前在很大程度上缺乏对住院治疗费用的全面卫生保健经济分析，但这对于确保可持续且具有成本效益的医疗至关重要。
这项回顾性单中心研究分析了2020年至2022年期间在该大学肿瘤中心接受治疗的112例肉瘤患者的住院费用。进行统计分析以确定影响病例资金不足的变量。此外，使用医院薪酬系统研究所（InEK）的成本矩阵，就资金不足的频率和程度对收入分配进行了研究。
66.1%的病例出现收入负平衡，导致总赤字超过22.2万欧元。资金不足的显著预测因素包括手术时间延长、重症监护住院时间和超过平均住院时间。在“基础设施成本”、“医疗技术服务”和“手术室成本”类别中发现了最高的负收入。
结果显示，在一所专业的大学肉瘤中心，肉瘤手术治疗存在显著的资金不足。迫切需要调整基于诊断相关组（DRG）的报销政策，以确保医疗的经济可持续性，同时保障患者安全、学术培训和临床决策。
