[Economic Analysis of Treatment Courses for Patients Over the Age of 80 Years at a Surgical Maximum Care Centre].
BACKGROUND
The demographic change in Germany with an aging population and the resulting necessity of adequate surgical care for older patients was lately discussed with concern. One major aspect is the estimated higher treatment costs in the care of the elderly.


METHODS
InEK data from all cases of patients over the age of 80, who were treated and discharged from 2008 to 2012 as inpatients at the Department of General, Visceral, Vascular and Thoracic Surgery at the Charité - Universitätsmedizin Berlin, Campus Mitte, were analysed. Of a total of 13,612 patients 626 patients were over the age of 80. Their lengths of stay, mode of discharge and discharge management as well as costs and reimbursements according to the relevant diagnosis-related groups were analysed.


RESULTS
Cases of elderly patients amounted to a stable 5 % of all cases from 2008 until 2012. Their mean length of stay was 14 (median, 9), range, 1-129 days. 80 % of patients could be regularly discharged, 9 % died, 8 % were transferred to another hospital, 2 % discharged into a nursing home and 1 % into a rehabilitation centre. The elderly patients had a patient clinical complexity level of mean 2.84. Costs per day amounted to a mean 778 (median: 627) €, range: 306-7740 €, total costs to 10,686 (median: 5140) €, range: 368-186,059 €. The mean deficit was 491 (median: 176) € per patient, range: - 30,470-75,144 €. The discharge management was significantly different in comparison to patients under the age of 80 with respect to avoidance of discharge at the weekend.


CONCLUSIONS
Patients over the age of 80 are a relevant group in surgery. They have an increased perioperative risk, but patients should not be denied surgery solely because of their age. The perioperative management of the elderly has to be of maximum standardised quality. From an economic perspective it can be stated that elderly patients currently pose no exceptional financial risk to a surgical department, but contribute relevantly to the turnover, whereby special attention has to be paid to an early structured discharge management.
Klinik für Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Campus Mitte, Charité - Universitätsmedizin Berlin, Deutschland.
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C
Langelotz
Geschäftsbereich Unternehmenscontrolling, Charité - Universitätsmedizin Berlin, Deutschland.
A
A
Bloch
Geschäftsbereich Klinisches Qualitäts- und Risikomanagement, Charité - Universitätsmedizin Berlin, Deutschland.
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R
Hammerich
Kaufmännische Zentrumsleitung CC08, Charité - Universitätsmedizin Berlin, Deutschland.
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A
Köhler
Klinik für Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Campus Mitte, Charité - Universitätsmedizin Berlin, Deutschland.
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J
Pratschke
Klinik für Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Campus Mitte, Charité - Universitätsmedizin Berlin, Deutschland.
M
M
Kilian
D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis / Q000191:economics; D003365:Costs and Cost Analysis / Q000191:economics*; D005260:Female; D005858:Germany; D017722:Hospital Charges / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D009313:National Health Programs / Q000191:economics*; D010360:Patient Transfer / Q000191:economics; D011157:Population Dynamics; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality; D013514:Surgical Procedures, Operative / Q000191:economics*; D013531:Surgicenters / Q000191:economics*