Kostenanalyse des Fast-Track-Konzeptes bei elektiver Kolonchirurgie

TY - JOUR

T1 - Kostenanalyse des Fast-Track-Konzeptes bei elektiver Kolonchirurgie

AU - Jurowich, C F

AU - Reibetanz, J

AU - Krajinovic, K

AU - Larena-Avellaneda, A

AU - Isbert, C

AU - Oberender, P

AU - Germer, C T

AU - von Rahden, B H A

N1 - © Georg Thieme Verlag Stuttgart ˙ New York.

PY - 2011/6

Y1 - 2011/6

N2 - INTRODUCTION: Fast track (FT) is a modern concept to enhance postoperative recovery after elective surgery. It has been approved during the last years. Beside its medical benefits, fast-track (FT) concepts may provide an economic incentive, although a cost-benefit analysis in the daily clinical routine has not yet been realised. In addition to this an elevated consumption of resources is postulated.PATIENTS AND METHODS: In 2007 we prospectively studied the implementation of the FT concept for elective colonic surgery in the daily clinical routine at the Department of General Surgery of Nuremberg Hospital. In a representative subgroup of patients studied, we performed a cost-cost analysis by comparing these patients to a retrospectively analysed group that had been treated in a conventional traditional manner in 2002.RESULTS: 369  patients were included and treated according to the FT concept. Discharge criteria were met at the 4(th) postoperative day in median (SD 3.9  days, minimum  1, maxiumum 29  days). The rate of general postoperative complications was 24.4 % (16 % minor complications) for all patients and 6.6 % in the group of patients who were discharged within 9 postoperative days or less (n=182). With respect to the main FT items, implementation of the FT concept was considered as effective. Cost-cost analyses showed a cost reduction of 32 % in favour of patients treated with the FT concept.CONCLUSION: This study clearly shows the clinical and economic benefits of the FT concept considering health services research. Therefore further clinical implementation of the FT concept seems beneficial, not only in the view of medical aspects, but also for economic reasons.

AB - INTRODUCTION: Fast track (FT) is a modern concept to enhance postoperative recovery after elective surgery. It has been approved during the last years. Beside its medical benefits, fast-track (FT) concepts may provide an economic incentive, although a cost-benefit analysis in the daily clinical routine has not yet been realised. In addition to this an elevated consumption of resources is postulated.PATIENTS AND METHODS: In 2007 we prospectively studied the implementation of the FT concept for elective colonic surgery in the daily clinical routine at the Department of General Surgery of Nuremberg Hospital. In a representative subgroup of patients studied, we performed a cost-cost analysis by comparing these patients to a retrospectively analysed group that had been treated in a conventional traditional manner in 2002.RESULTS: 369  patients were included and treated according to the FT concept. Discharge criteria were met at the 4(th) postoperative day in median (SD 3.9  days, minimum  1, maxiumum 29  days). The rate of general postoperative complications was 24.4 % (16 % minor complications) for all patients and 6.6 % in the group of patients who were discharged within 9 postoperative days or less (n=182). With respect to the main FT items, implementation of the FT concept was considered as effective. Cost-cost analyses showed a cost reduction of 32 % in favour of patients treated with the FT concept.CONCLUSION: This study clearly shows the clinical and economic benefits of the FT concept considering health services research. Therefore further clinical implementation of the FT concept seems beneficial, not only in the view of medical aspects, but also for economic reasons.

KW - Aged

KW - Colectomy/economics

KW - Colonic Diseases/economics

KW - Colorectal Neoplasms/economics

KW - Cost Savings/economics

KW - Cost-Benefit Analysis/economics

KW - Female

KW - Germany

KW - Humans

KW - Intensive Care Units/economics

KW - Length of Stay/economics

KW - Male

KW - Middle Aged

KW - National Health Programs/economics

KW - Outcome and Process Assessment, Health Care

KW - Postoperative Complications/economics

KW - Prospective Studies

KW - Rectal Diseases/economics

KW - Rectum/surgery

U2 - 10.1055/s-0029-1224745

DO - 10.1055/s-0029-1224745

M3 - SCORING: Zeitschriftenaufsatz

C2 - 20607651

VL - 136

SP - 256

EP - 263

JO - ZBL CHIR

JF - ZBL CHIR

SN - 0044-409X

IS - 3

ER -