title: Comparative analysis of the revenues of pylorus-preserving pancreatic head resections and laparoscopic cholecystectomies as prototypic surgical procedures in the German health-care system.
abstract: BACKGROUND
  Although centralization of complex surgical procedures such as pancreaticoduodenectomies is associated with a reduction in morbidity and mortality rates, it is unclear whether such surgeries are adequately represented in the German disease-related group (DRG) system.
  
  
  METHODS
  Out of all patients who underwent pancreatic resections (n = 450) at our institution between January 2008 and November 2011, 76 patients who underwent a pylorus-preserving pancreatic head resection due to pancreatic head adenocarcinoma were selected for analysis. The revenues generated by these surgical procedures were compared with those of 144 patients who had undergone elective laparoscopic cholecystectomies for symptomatic gallstone disease between January 2009 and September 2010 in our hospital.
  
  
  RESULTS
  In patients undergoing pylorus-preserving pancreaticoduodenectomy, revenues per case were 1,585.55 Euros, with an average length of hospital stay (ALOS) of 19.9 days (range 7-55 days) and an average postoperative hospital stay of 16 days; however, if the ALOS was exceeded, expenditures increasingly exceeded returns. Analysis of the cohort of patients with pylorus-preserving pancreaticoduodenectomies demonstrated average revenues per day of 79.27 Euros. In contrast, for laparoscopic cholecystectomy, which was treated with high surgical standardization and stringent case management, the ALOS was only 2.8 days, producing average revenues of 288.80 Euros per day and total revenues of 817.53 Euros per case.
  
  
  CONCLUSIONS
  At university hospitals, cost-effective realization of major pancreatic surgery is difficult, while highly standardized surgeries such as laparoscopic cholecystectomies can be performed at a favorable balance. This may be due to, firstly, an underrepresentation of university hospitals in the German DRG calculation basis and, secondly, to a relatively long preoperative hospital stay as a result of extensive diagnostic measures. We consider this kind of preoperative assessment paramount for an academic pancreatic center and thus argue for an increased reimbursement for these procedures.
authors.affiliation: Department of Surgery, Technische Universität München, Ismaningerstrasse 22, Munich 81675, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Stellwag
authors.forename: Christoph W
authors.initials: CW
authors.lastname: Michalski
authors.forename: Bo
authors.initials: B
authors.lastname: Kong
authors.forename: Mert
authors.initials: M
authors.lastname: Erkan
authors.forename: Carolin
authors.initials: C
authors.lastname: Reiser-Erkan
authors.forename: Carsten
authors.initials: C
authors.lastname: Jäger
authors.forename: Christian
authors.initials: C
authors.lastname: Meinl
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.forename: Jörg
authors.initials: J
authors.lastname: Kleeff
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000379:methods; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000379:methods; D003953:Diagnosis-Related Groups / Q000191:economics*; D017558:Elective Surgical Procedures / Q000191:economics / Q000379:methods; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000191:economics* / Q000379:methods; D011183:Postoperative Complications / Q000191:economics / Q000503:physiopathology; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis