Economic aspects of interdisciplinary plastic surgery: change in Diagnosis-Related Groups (DRG) due to procedures of reconstructive microsurgery

Abstract

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.