Wirtschaftliche Überlegungen zur operativen Therapie der akuten Appendizitis

Abstract

The costs of the operative treatment of acute appendicitis have to be verified under DRG conditions. Laparoscopic and open appendectomies in a 5-year-period were evaluated retrospectively. Analyses of costs of the year 2004 were performed according to the clinical automatic settlement (SAP / R3) in direct comparison to the data of 140 participating hospitals using the same software. In the 5-year-period 775 of 830 (91.8 %) appendectomies were started laparoscopically, in 68 cases the method was converted to the open surgical procedure. Postoperative complications required radiologic interventional treatment or reoperation in 4.2 % of the patients. The arising costs in the own hospital and the 140 associated hospitals were defrayed only for 90 % by the DRG-payment system. The deficit for the DRG codes G 23 Z, G 22 Z and G 07 Z were 212 euro, 296 euro and 455 euro per case. Compensation of costs in clinical routine results from reduction of duration of patients stay (162 euro per day) or avoidance of the laparoscopic procedure. The material costs of laparoscopic appendectomy are 4.3 times higher than the costs of the open conventional procedure (310 euro vs. 71 euro). The clinical costs of appendectomy are not compensated by the DRG-System. The surgeon has to take into account the economic aspects of the intended operative procedure.