Exploring the impact of complications on length of stay in major surgery diagnosis-related groups.
OBJECTIVE
To analyze, in terms of the length of stay (LOS), the use of resources by patients classified under surgical diagnosis-related groups (DRGs) with complication and/or comorbidity (DRGCCs), divided into subgroups where complications were and were not detected, and to explore the repercussions on hospital reimbursement.


METHODS
The Complication Screening Program(Copyright ) (CSP) was used to divide the patients in 14 DRGCCs into subgroups with and without complications, and to compare the LOS between the subgroups and with the equivalent DRG without CC. The ratios between the LOS and the relative weight of the DRGs for reimbursement were also compared.


METHODS
The population hospitalized for major surgery between 1995 and 1999 in the Hospital of Mataró, Catalonia, Spain.


METHODS
Patients (4227) hospitalized for major surgery.


RESULTS
The percentage of complications identified by the CSP ranged from 17.5% to 52.4%. The LOS of the DRGCCs was almost twice as long as in the DRGs without CC; 2.48 times greater if the DRGCC was flagged by the CSP and 70% greater if it was not. On average, the DRGCCs selected were reimbursed at a rate 93% higher than their counterpart DRGs without CC. In 11 of the 14 DRG pairs with or without CC, the reimbursement ratio was lower than the LOS ratio.


CONCLUSIONS
DRGCCs can be classified into clearly differentiated groups based on the presence or absence of CSP-flagged complications. CSP-flagged complications produce an increase in LOS greater than the increase in the relative weights for reimbursement.
Librero
Julián
J
Fundación Instituto de Investigación en Servicios de Salud, San Vicente 112, 3, 46007 Valencia, Spain.
Marín
Manuel
M
Peiró
Salvador
S
Munujos
Alberto Verdaguer
AV
D015897:Comorbidity; D003953:Diagnosis-Related Groups; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000191:economics*; D012051:Reimbursement Mechanisms; D013030:Spain; D013514:Surgical Procedures, Operative / Q000191:economics*