TO REVİSE OR NOT TO REVİSE! THAT İS THE QUESTİON

Yıl 2021, , 42 - 49, 05.01.2021

Ferdi Dırvar , Sevda Uzun Dırvar , Ömer Cengiz , Mehmet Ali Talmaç , Timur Yıldırım , Şükrü Sarper Gürsü

https://doi.org/10.18229/kocatepetip.669035

Öz

OBJECTIVE: The aim of this study was to investigate the costs covered by the hospital during the inpatient treatment process of the patients who underwent hip revision arthroplasty surgery in orthopedics and traumatology clinics of a public hospital and compare with the invoiced amount.
MATERIAL AND METHODS: The demographic information and revision reasons of 60 patients who underwent total hip revision arthroplasty operation in a public hospital between 01.01.2016 and 30.09.2017 were determined through Hospital Information Management System records. The patients were categorized under two groups including septic and aseptic. For each patient, the costs of medical consumables, medicine/serum, medical treatment, surgery, anesthesia, imaging services, laboratory procedures, blood and blood products, meal and companion costs, device depreciation expenses, consultation, control examination, preoperative patient preparation stage, surgery, visit and other costs were calculated separately during the inpatient treatment.
RESULTS: The total cost of an average patient was 21,956.00 ₺, while the average amount of invoice was 17,220.00 ₺, with a difference of 4,736.00 ₺. This difference was found to be 9,876.00 ₺ in the septic group and 2.534,00 ₺ in the aseptic group. The bill payment made by the Social Security Institution (SGK) to the institution covers 78.4% of the cost of revision hip arthroplasty. In the septic group, the duration of hospital stay, medical expenditure, medication, treatment, surgery, anesthesia, laboratory, imaging, blood center, consultation, visit, meal cost, total cost and invoice amount were found to be significantly higher than the aseptic group (p< 0.05).
CONCLUSIONS: Regulations by the Social Security Institution are needed to ensure the fiscal sustainability of public hospitals. In addition, following the medical and technical treatment protocols in revision surgery can help reduce the costs.

Anahtar Kelimeler

Hospital Costs, Revision, Joint, Arthroplasty, Hip, Cost Analysis

REVİZE ETMEK VEYA ETMEMEK! İŞTE BÜTÜN MESELE BU

Öz

AMAÇ: Bir kamu hastanesinin ortopedi ve travmatoloji kliniğinde kalça revizyon artroplasti ameliyatı yapılan hastaların yatarak tedavi gördüğü süreçte, kurumca katlanılan maliyetlerinin araştırılması ve fatura edilen miktar ile karşılaştırılması amaçlanmıştır.
GEREÇ VE YÖNTEM: 01.01.2016 ile 30.09.2017 tarihleri arasında bir kamu hastanesinde total kalça revizyon artroplastisi ameliyatı yapılan 60 hastanın demografik bilgileri ve revizyon nedenleri tespit edilmiştir. Hastalar septik ve aseptik olarak iki gruba ayrılmıştır. Hastaların, yatarak tedavi gördüğü sürece katlanılan tıbbi sarf, ilaç/serum, tedavi, ameliyat, anestezi, görüntüleme, laboratuvar, kan ve kan ürünleri, yemek, refakatçı maliyetleri, cihaz amortisman giderleri, konsültasyon, kontrol muayenesi, ameliyat öncesi hasta hazırlık aşaması, vizit ve diğer maliyetleri her bir hasta için ayrı ayrı hesaplanmıştır.
BULGULAR: Bir hastanın toplam maliyeti ortalama 21.956,00 ₺ iken fatura tutarı ortalama 17.220,00 ₺ tespit edilmiş olup arada 4.736,00 ₺ fark bulunmaktadır. Bu fark septik gruptaki hastalarda 9.876,00 ₺, aseptik gruptaki hastalarda 2.534,00 ₺ olarak tespit edilmiştir. SGK'nın kuruma yaptığı fatura ödemesi, revizyon kalça artroplastisi maliyetinin% 78,4'ünü kapsıyor. Septik grupta yatış süresi, tıbbi sarf, ilaç, tedavi, ameliyat, anestezi, laboratuvar, görüntüleme, kan merkezi, konsültasyon, vizit, yemek maliyeti, toplam maliyet ve fatura tutarı aseptik gruptan anlamlı (p< 0.05) olarak daha yüksek bulunmuştur.
SONUÇ: Kamu hastanesinin mali sürdürebilirliğinin sağlanması için SGK tarafından düzenlemelerin yapılmasına ihtiyaç bulunmaktadır. Ayrıca, revizyon cerrahisinde medikal ve teknik protokolleri takip edilmesi maliyetin azalmasına yardımcı olabilir.

Anahtar Kelimeler

Hastane Maliyetleri, Revizyon, Eklem, Artroplasti, Kalça, Maliyet analizi

Kaynakça

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