[Cost comparison of different graft materials in femoropopliteal bypass: experience with G-DRG].
BACKGROUND
The German DRG classification refrains from medical accuracy of different surgical procedures by concentrating mainly on economic aspects. The process cost calculation of femoropopliteal bypass should as an example illuminate the charge of a surgical procedure under hospital conditions.


METHODS
From 07/03 to 03/04 we analysed out of 71 peripheral arterial reconstructions 10 alloplastic grafts (PBP) and 10 autologous vein grafts (VBP) for femoropopliteal above-knee bypass through the process cost calculation. This required a classification of the procedure in different diagnostic and treatment sections (ward, intensive care, diagnosis, treatment (surgical procedure)).


RESULTS
The average length of hospitalisation with VBP amounted to 12.2 +/- 3.6 (7-19) days, and with PBP to 14.0 +/- 8.0 (8-35) days. The duration of the surgical procedure was almost identical with 118 +/- 26 minutes (VBP) compared to 110 +/- 31 minutes (PBP), but in average 0.4 more assistants participated in VBP. One bleeding caused revision in VBP; one PBP led to extended length of hospitalisation because of wound complication. We diagnosed one asymptomatic bypass occlusion in VBP. The average total costs in VBP amounted to 4 368.10 euro (profit: 4 468.15 euro), in PBP to 5 069.50 euro (profit: 3 802.94 euro).


CONCLUSIONS
The reconstruction of the superficial femoral artery with alloplastic or autologous vein graft is profitable in G-DRG. Although less medical staff in required in PBP the price of the prosthesis weakens the profit. The autologous vein graft shows furthermore a shorter length of hospitalisation. Further investigation into cost-effectiveness regarding long-term follow-up and patency rates could lead to consequences for the German health system.
Klinik für Gefässchirurgie, vaskuläre und endovaskuläre Chirurgie, Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld. th.nowak@klinikum-krefeld.de
T
T
Nowak
H
H
Slusarek
C
C
Schröders
T
T
Steinke
B
B
Luther
D001166:Arteriovenous Shunt, Surgical / Q000191:economics*; D001807:Blood Vessel Prosthesis / Q000191:economics*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups / Q000191:economics*; D005263:Femoral Artery / Q000601:surgery*; D005858:Germany; D006801:Humans; D007511:Ischemia / Q000191:economics / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D007902:Length of Stay / Q000191:economics; D009313:National Health Programs / Q000191:economics*; D010823:Physician Assistants / Q000191:economics; D011138:Polytetrafluoroethylene / Q000191:economics*; D011150:Popliteal Artery / Q000601:surgery*; D014680:Veins / Q000637:transplantation*
D011138:Polytetrafluoroethylene