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Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care

Background: Medical progress is increasingly enabling more and more stationary treatment to be provided in the outpatient sector. This development should be welcomed, as healthcare costs have been rising for years. The design of efficient processes and a needs-based infrastructure enable further sav...

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Autores principales: Enodien, Bassey, Moser, Dominik, Kessler, Florian, Taha-Mehlitz, Stephanie, Frey, Daniel M., Taha, Anas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9566150/
https://www.ncbi.nlm.nih.gov/pubmed/36231718
http://dx.doi.org/10.3390/ijerph191912410
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author Enodien, Bassey
Moser, Dominik
Kessler, Florian
Taha-Mehlitz, Stephanie
Frey, Daniel M.
Taha, Anas
author_facet Enodien, Bassey
Moser, Dominik
Kessler, Florian
Taha-Mehlitz, Stephanie
Frey, Daniel M.
Taha, Anas
author_sort Enodien, Bassey
collection PubMed
description Background: Medical progress is increasingly enabling more and more stationary treatment to be provided in the outpatient sector. This development should be welcomed, as healthcare costs have been rising for years. The design of efficient processes and a needs-based infrastructure enable further savings. According to international recommendations (EHS/IEHS), outpatient treatment of unilateral inguinal hernias is recommended. Method: Data from patients in GZO Hospital Wetzikon/Zurich between 2019 and 2021 for unilateral inguinal hernia repair was included in this study (n = 234). Any over- or under-coverage correlated with one of the three treatment groups: stationary, partially stationary and patients treated in outpatients clinic. Complications and 30-day readmissions were also monitored. Results: Final revenue for all patients is −95.36 CHF. For stationary treatments, the mean shifts down to −575.01 CHF, for partially stationary treatments the mean shifts up to −24.73 CHF, and for patients in outpatient clinic final revenue is 793.12 CHF. This result is also consistent with the operation times, which are lowest in the outpatient clinic with a mean of 36 min, significantly longer in the partially stationary setting with 58 min, and longest in the stationary setting with 76 min. The same applies to the anesthesia times and the relevant care times by the nurses as the most important cost factors in addition to the supply and allocation costs. Conclusions: We show that cost-effective elective unilateral inguinal hernia care in the outpatient clinic with profit (mean 793.12 CHF) is possible. Stationary unilateral hernia care (mean −575.01 CHF) is loss-making. Crucial factors for cost efficiency are optimized processes in the operating room (anesthesia, surgical technique and quality, operating time), as well as optimized care processes with minimal preoperative services and care times for the patient. However, at the same time, these optimizations pose a challenge to surgical and anesthesiology training and structures with high levels of preoperative and Postoperative services and pay-as-you-go costs. The complication rate is 0.91% lower than in a comparable study. The readmission within 30 days post-operation results with a positive deviation of −3.53% (stationary) and with a negative deviation of +2.29% (outpatient clinic) compared to a comparative study.
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spelling pubmed-95661502022-10-15 Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care Enodien, Bassey Moser, Dominik Kessler, Florian Taha-Mehlitz, Stephanie Frey, Daniel M. Taha, Anas Int J Environ Res Public Health Article Background: Medical progress is increasingly enabling more and more stationary treatment to be provided in the outpatient sector. This development should be welcomed, as healthcare costs have been rising for years. The design of efficient processes and a needs-based infrastructure enable further savings. According to international recommendations (EHS/IEHS), outpatient treatment of unilateral inguinal hernias is recommended. Method: Data from patients in GZO Hospital Wetzikon/Zurich between 2019 and 2021 for unilateral inguinal hernia repair was included in this study (n = 234). Any over- or under-coverage correlated with one of the three treatment groups: stationary, partially stationary and patients treated in outpatients clinic. Complications and 30-day readmissions were also monitored. Results: Final revenue for all patients is −95.36 CHF. For stationary treatments, the mean shifts down to −575.01 CHF, for partially stationary treatments the mean shifts up to −24.73 CHF, and for patients in outpatient clinic final revenue is 793.12 CHF. This result is also consistent with the operation times, which are lowest in the outpatient clinic with a mean of 36 min, significantly longer in the partially stationary setting with 58 min, and longest in the stationary setting with 76 min. The same applies to the anesthesia times and the relevant care times by the nurses as the most important cost factors in addition to the supply and allocation costs. Conclusions: We show that cost-effective elective unilateral inguinal hernia care in the outpatient clinic with profit (mean 793.12 CHF) is possible. Stationary unilateral hernia care (mean −575.01 CHF) is loss-making. Crucial factors for cost efficiency are optimized processes in the operating room (anesthesia, surgical technique and quality, operating time), as well as optimized care processes with minimal preoperative services and care times for the patient. However, at the same time, these optimizations pose a challenge to surgical and anesthesiology training and structures with high levels of preoperative and Postoperative services and pay-as-you-go costs. The complication rate is 0.91% lower than in a comparable study. The readmission within 30 days post-operation results with a positive deviation of −3.53% (stationary) and with a negative deviation of +2.29% (outpatient clinic) compared to a comparative study. MDPI 2022-09-29 /pmc/articles/PMC9566150/ /pubmed/36231718 http://dx.doi.org/10.3390/ijerph191912410 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Enodien, Bassey
Moser, Dominik
Kessler, Florian
Taha-Mehlitz, Stephanie
Frey, Daniel M.
Taha, Anas
Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care
title Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care
title_full Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care
title_fullStr Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care
title_full_unstemmed Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care
title_short Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care
title_sort cost and quality comparison of hernia surgery in stationary, day-patient and outpatient care
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9566150/
https://www.ncbi.nlm.nih.gov/pubmed/36231718
http://dx.doi.org/10.3390/ijerph191912410
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