[Complications and costs in primary knee replacement surgery in an endoprosthetics centre : Influence of state of training].
BACKGROUND
This work examines the hypothesis that in endoprosthesis implantation there are differences between experienced primary and senior caregivers (S-Op) and less experienced follow-up assistants (T-Op) with respect to process-relevant parameters. The main hypothesis is that compared to S‑Op, T‑Op cause significantly longer surgery times and thus additional operating theatre costs. As sub-hypotheses, differences in various perioperative (p-o) parameters between T‑Op and S‑Op were examined.


METHODS
The status of the operator (senior and/or senior main operator [S-Op]) and/or postoperative CRP, perioperative blood loss, the amount of transfused erythrocyte concentrates, patient age, gender, ASA risk classification (American Society of Anesthesiologists), duration of surgery and blood transfusion, duration of inpatient stay, as well as the rates of early revision surgery and complications were recorded. A comparison of patients who had been operated by an S‑Op and those who had been operated by a T‑Op was made for all parameters.


RESULTS
Significant differences were found with respect to the duration of surgery, the duration of the hospital stay, and CRP on the third p‑o day. The T‑Op required an average of 11 min more than the S‑Op. CRP was significantly higher in the T‑Op group only on the third p‑o day, by 18 mg/l. In contrast, in the T‑Op group, a blood loss of 181 ml was lower than in the S‑Op group. This corresponded to a reduction of 0.26 transfused erythrocyte concentrates. There were no significant differences in complication rates between S‑Op and T‑Op.


CONCLUSIONS
In the setting of a certified endoprosthetics centre, the comparison of T‑Op with S‑Op showed that the use of the former with at a non-increased complication rate led to a significant extension of the operating time. This leads to additional training costs in the amount of an estimated 3% of the current DRG remuneration. These additional costs are not represented adequately in the current remuneration system.
Klinik für Orthopädie, Campus Eisenberg, Friedrich-Schiller Universität Jena, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland. c.windisch@krankenhaus-eisenberg.de.
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Windisch
Klinik für Orthopädie, Campus Eisenberg, Friedrich-Schiller Universität Jena, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland.
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Brodt
Klinik für Orthopädie, Campus Eisenberg, Friedrich-Schiller Universität Jena, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland.
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Röhner
Klinik für Orthopädie, Campus Eisenberg, Friedrich-Schiller Universität Jena, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland.
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Matziolis
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000191:economics*; D004502:Education, Medical, Continuing / Q000191:economics*; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D000072161:Orthopedic Surgeons / Q000191:economics* / Q000193:education; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D016896:Treatment Outcome
Disease Cost; Hospitaly stay; Surgery; Surgical time; Total Knee Replacement