[Outpatient Surgery in German ENT in Teaching Hospitals--Economic Nonsense?]. / Ambulante Operationen in HNO-Ausbildungskliniken - ökonomischer (Un)sinn?

INTRODUCTION: There is an ever-increasing demand to increase efficiency and decrease costs in health care. This leads to an growing number of outpatient surgeries which are less cost effective. Especially in the setting of university teaching hospitals, this may lead to both an undersupply of qualified physicians, as well as to a worsening of clinical training of residents. In order to quantify a possible undersupply and estimate the expense of teaching residents, the time for medical procedures needs to be quantified and compared between board-certified physicians and residents. This was the aim of the current study. MATERIAL AND METHODS: All outpatient adenotomies of children with or without paracentesis or tympanic drainage insertion performed in 2012 in 2 ENT teaching hospitals were analyzed. The length of the surgical procedure as well as the level of training of the surgeon was analyzed. Operating times of residents in training were analyzed stratified by training level and then compared to operation times of board-certified ENT surgeons. RESULTS: 255 procedures were analyzed. Significant differences of the mean operation time could be identified depending on the level of training of residents compared to board-certified ENT surgeons for all investigated training levels. E. g. 1(st) year residents' surgeries required 2.4 times more time than those of board-certified ENT surgeons. CONCLUSION: Based on an analysis of outpatient ENT-surgical procedures it becomes apparent that due to the extended operating times of residents in training outpatient surgery is by far less cost-effective than by board-certified physicians. To cope with the demand of teaching residents for their clinical training, more resources are necessary in the setting of teaching hospitals.

[Epistaxis and anticoagulation - a medical and economic challenge?]. / Epistaxis bei Antikoagulation - eine klinische und ökonomische Herausforderung?

BACKGROUND: According to recent statistics more and more elderly patients are hospitalized due to epistaxis and need anticoagulation. Aim of the present study was to investigate if it was more complex to treat anticoagulated patients than non-anticoagulated patients, if these patients needed a longer hospital stay and to characterize the study population in terms of the various applied therapeutic methods. METHODS: Retrospective study, collecting clinical data of all in-patients treated between 1.1.2007 to 1.8.2011 at an ENT-Department of an University Clinic due to epistaxis. RESULTS: Of 656 patients 265 were not anticoagulated, 391 were anticoagulated. The mean patients' age increased statistically significant. Patients without anticoagulation were significantly younger than patients with anticoagulation. The duration of the hospitalization differed significantly between the groups, with the longest for patients treated with warfarin (5.4 days). 71 patients underwent surgical treatment of epistaxis (cautery of the sphenopalatine artery or anterior ethmoid artery). CONCLUSION: During the study period an increasing number of more elderly patients needed hospitalization due to epistaxis. The duration of hospitalization differed significantly between the groups, with longer stays for the anticoagulated patients. Currently, treatment of epistaxis patients however is reimbursed independently of the presence of comorbidities or anticoagulation therapy. For the further development of the German DRG System a new split of the epistaxis DRG should be considered.

[Effects of D-DRG system on hospital financing on the example of septorhinoplasty]. / Die Kostenabbildung der Septorhinoplastik im D-DRG System.

INTRODUCTION: Since the introduction of DRGs (diagnosis related groups) 2004, the septorhinoplasty, regardless whether an open or closed approach is chosen or whether orthotopic cartilage or autologous cartilage is required and whether a complex deformity (patients with cleft palate) or post-traumatic deformities are treated in the adult all procedures are valued the same. The aim of the study was to investigate at a center for rhino-surgery the real effort for the different diseases and to assess the necessity of a new split in the DRG for septorhinoplasty. METHODS: Retrospective study of all patients, who were treated from January 2006 to December 2009 at the ENT Clinic of the University of Ulm with a septorhinoplasty/septal perforation closure in terms of duration of surgery and the material consumption. RESULTS: In the years 2006-2009 at the ENT Clinic in Ulm 705 septorhinoplasties were performed, 124 were revision surgeries, 216 with ear cartilage and 35 with rib cartilage. In 66 cases nasal deformities due to cleft palate was treated. The duration of surgery of the different septorhinoplasties differed statistically significant from each other, also the material consumption/material costs. CONCLUSION: A re-organization of the DRG D 37 can be justified with varying surgery time and material consumption for each operation type. A proposal is presented.