[(section sign) 115 b SGB V threatens outpatient treatment for inguinal hernia. Analysis of outcome and economics].
BACKGROUND
Current German legislation ( (section sign) 115 b SGB V) allows groin hernia inpatient treatment only under particular circumstances. That allows the operative technique of first choice for outpatient groin hernia repair to be determined by basic market principles. The aim of this paper was to study the feasibility of outpatient minimally invasive hernia surgery with regard to complication rates, patient satisfaction, and economic considerations.


METHODS
For 1 year, a total of 571 patients with inguinal hernias (131 male, eight female, mean age 46 years, all ASA I) were treated at two surgical centers. Twenty-four percent (139/571) underwent outpatient total extraperitoneal repair (TEP). Complication rates were recorded. Patient satisfaction with the procedure was evaluated by a standard questionnaire. Cost calculations were compared with revenues according to the EBM2000plus.


RESULTS
Of the patients, 96.4% were discharged on the day of operation without subsequent rehospitalization, 84% had no fears of complications at home, 54% went back to work in less than 14 days, and 88.7% were willing to undergo TEP a second time if necessary. Calculated average total cost of euro 709 exceeded the revenue of euro 565 by 20%.


CONCLUSIONS
For a carefully selected group, outpatient TEP is patient-friendly and safe. Despite these advantages, it still remains economically unattractive to hospital management because of the 20% cover shortage. Improvements in the current legislation are urgently desired.
Weyhe
D
D
Chirurgische Klinik St.-Josef-Hospital, Ruhr-Universität Bochum, Gudrunstrasse 56, 44791 Bochum. d.weyhe@klinikum-bochum.de
Winnemöller
C
C
Hellwig
A
A
Meurer
K
K
Plugge
H
H
Kasoly
K
K
Laubenthal
H
H
Bauer
K-H
KH
Uhl
W
W
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006552:Hernia, Inguinal / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D010343:Patient Admission / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012086:Reoperation