title: [Comparison of pedicle and free tissue transfers in the German DRG system].
abstract: Diagnosis-Related Groups (DRGs) are a patient classification system grouping related types of patients to the resources they have consumed. In this analysis, we compared pedicle and free flaps in plastic and reconstructive surgery in the actual German DRG system. After grouping common flaps while systematically modifying the diagnosis, the operative procedure(s), and the receptor site, reimbursement and thresholds of length of stay were identified. The mean value of the average length of stay was higher in free flaps as compared to pedicle flaps (15 vs. 9 days) and the mean reimbursement in free flaps was almost twice as high as in pedicle flaps (8 936 € vs. 4 582 €). Regarding the diagnosis, third-grade open fractures in pedicle flaps and full-thickness burns in free flaps are in the vanguard of reimbursement. Higher DRG conformity is generally found with free flaps. Different possibilities in coding the procedures and the strong dependence on the underlying diagnosis lead to variations of remuneration and length of stay, which are not explainable and sometimes even seem paradoxical. Furthermore, mixed calculation creates DRGs that lose the ability to describe the real effort.
authors.affiliation: Klinik für Plastische , Hand-, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls Universität, Berufsgenossenschaftliche Unfallklinik Tübingen. oliver.lotter@freenet.de
authors.forename: O
authors.initials: O
authors.lastname: Lotter
authors.forename: S
authors.initials: S
authors.lastname: Stahl
authors.forename: C
authors.initials: C
authors.lastname: Hohenstein
authors.forename: H-E
authors.initials: HE
authors.lastname: Schaller
authors.forename: P
authors.initials: P
authors.lastname: Jaminet
mesh_terms: D003365:Costs and Cost Analysis; D039702:Current Procedural Terminology; D003953:Diagnosis-Related Groups / Q000191:economics*; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D058752:Free Tissue Flaps / Q000191:economics*; D005858:Germany; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D038801:International Classification of Diseases; D007902:Length of Stay / Q000191:economics; D008297:Male; D016462:Mammaplasty / Q000191:economics; D008866:Microsurgery / Q000191:economics; D009313:National Health Programs / Q000191:economics*; D019651:Plastic Surgery Procedures / Q000191:economics*; D013524:Surgical Flaps / Q000191:economics*; D014947:Wounds and Injuries / Q000191:economics / Q000601:surgery