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Ökonomische Aspekte der onkologischen Ösophaguschirurgie

Zentralisierung ist essenziell

Economic aspects of oncological esophageal surgery

Centralization is essential

  • Chirurgie und Ökonomie
  • Published:
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Zusammenfassung

Die Inzidenz des Ösophaguskarzinoms ist in Deutschland in den letzten Jahren steigend. Ziel der vorliegenden Arbeit ist die Diskussion der ökonomischen Aspekte der onkologischen Ösophaguschirurgie im deutschen DRG-System mit Fokus auf den Zusammenhang zwischen Mindestmengengrenzen und Ergebnisqualität sowie Kosten. Die Marge der DRG G03A ist gering und wird schnell aufgezehrt, wenn Komplikationen den postoperativen Verlauf bestimmen. Eine aktuelle Analyse der deutschen Krankenhausabrechnungsdaten konnte einen signifikanten Unterschied der Klinikletalität zwischen Kliniken mit und ohne Erreichen der Mindestmengen der Ösophagektomie belegen. US-amerikanische Daten zeigen, dass neben patientenrelevanten Parametern das Fallvolumen des Chirurgen relevant für die Kosten der Behandlung ist. Derartige kostenbezogene Analysen liegen in Deutschland derzeit nicht vor. Zukünftig erstrebenswert ist die wissenschaftliche Validierung belastbarer Mindestmengengrenzen für die onkologische Ösophagusresektion.

Abstract

The incidence of esophageal carcinoma has increased in recent years in Germany. The aim of this article is a discussion of the economic aspects of oncological esophageal surgery within the German diagnosis-related groups (DRG) system focusing on the association between minimum caseload requirements and outcome quality as well as costs. The margins for the DRG classification G03A are low and quickly exhausted if complications determine the postoperative course. A current study using nationwide German hospital discharge data proved a significant difference in hospital mortality between clinics with and without achieving the minimum caseload requirements for esophagectomy. Data from the USA clearly showed that besides patient-relevant parameters, the caseload of a surgeon is relevant for the cost of treatment. Such cost-related analyses do not exist in Germany at present. Scientific validation of reliable minimum caseload numbers for oncological esophagectomy is desirable in the future.

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Authors and Affiliations

  1. Medizincontrolling, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland

    N. von Dercks

  2. Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland

    I. Gockel & M. Mehdorn

  3. Klinik für Allgemein- und Viszeralchirurgie, Sana Klinikum Offenbach GmbH, Offenbach, Deutschland

    D. Lorenz

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  1. N. von Dercks
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  4. D. Lorenz
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Correspondence to I. Gockel.

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Interessenkonflikt

N. von Dercks, I. Gockel, M. Mehdorn und D. Lorenz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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von Dercks, N., Gockel, I., Mehdorn, M. et al. Ökonomische Aspekte der onkologischen Ösophaguschirurgie. Chirurg 88, 62–69 (2017). https://doi.org/10.1007/s00104-016-0326-7

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  • DOI: https://doi.org/10.1007/s00104-016-0326-7

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