title: Australian National Diagnosis Related Groups and Abdominal surgery.
abstract: This study compares the declared splits for abdominal surgery within the Australian National Diagnosis Related Groups (AN-DRG) with age-based strata. Data were derived from two clinical trials involving 2114 adults. The patients tended to be elderly (25% > 71 years) and had significant co-morbidity, that is, 57% with an American Society of Anesthesia (ASA) classification > 1. Adverse events after surgery included pulmonary complications (16%), urinary tract infections (10%), wound infection (6%), and death (4.5%). Only 27% of the patients could be classified into a 'non-complicated' AN-DRG partition; these patients had a median age of 25 years and 88% had either appendicectomy or cholecystectomy. In contrast, analysis of six age-based strata revealed a stepwise increase in the incidence of adverse events after surgery (Friedman ANOVA, P < 0.001). It might therefore be wise to consider the inclusion of age-strata in the abdominal surgery component of the AN-DRG. Failure to do so may result in financial penalties for hospitals that care for patients at high risk of an adverse outcome after abdominal surgery.
authors.affiliation: University Department of Surgery, Royal Perth Hospital, Western Australia.
authors.forename: J C
authors.initials: JC
authors.lastname: Hall
authors.forename: B
authors.initials: B
authors.lastname: Brooks
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001062:Appendectomy; D001315:Australia / Q000453:epidemiology; D002763:Cholecystectomy; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology