Elektive Versorgung von Leistenhernien in der universitären Chirurgie – eine ökonomische Herausforderung

Abstract

Elective and emergency inguinal hernia surgery is acentral task for general and abdominal surgeons. As astandard procedure it is regarded as having a relatively low income in the German diagnosis-related groups (DRG) system. This can lead to an economic imbalance, especially in acost-intensive environment of auniversity hospital. The aim of this analysis was to investigate the influence of clinical factors on costs and the contribution margin as well as the overall economic evaluation of elective inguinal hernia surgery at auniversity hospital. All patients undergoing elective inguinal hernia surgery at two locations of the Charité University Medicine Berlin in 2014 and 2015 were included in the analysis. The influence of clinical, patient and surgical factors on the economic outcome of the cases was evaluated. Atotal of 419 patients were included, mostly after a Lichtenstein operation (44.9%) and laparoscopic transabdominal preperitoneal (TAPP) surgery (53.9%). The greatest impact on the economic outcome was the occurrence of postoperative complications. Also, apatient clinical complexity level (PCCL) value of >1, more than 8 encoded secondary diagnoses and aduration of hospital stay of less than 2days had asignificantly negative impact on the contribution margin. Overall, elective inguinal hernia surgery led to anegative contribution margin of € 651 per case. Elective inguinal hernia surgery in the environment of auniversity hospital has a high financial deficit; however, since acomplete discontinuation of this treatment is not an alternative multifactorial approaches are required to improve the economic outcome.