TO REVİSE OR NOT TO REVİSE! THAT İS THE QUESTİON

Yıl 2021, Cilt: 22 Sayı: 1, 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

• 1. Pivec R, Johnson A, Mears S, Mont M. Hip arthroplasty. The Lancet. 2012;380(9855):1768-77.
• 2. Kurtz S. Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030. The Journal of Bone and Joint Surgery (American). 2007;89(4):780-5.
• 3. Barrack R. Economics of Revision Total Hip Arthroplasty. Clin Orthop Relat Res.1995; &NA(319):209-14.
• 4. Crowe J, Sculco T, Kahn B. Revision Total Hip Arthroplasty. Clin Orthop Relat Res. 2003;413:175-82.
• 5. 04.02.2018 Değişiklik Tebliği İşlenmiş Güncel 2013 SUT, http://www.sgk.gov.tr/wps/portal/sgk/tr/kurumsal/merkez-teskilati/ana_hizmet_birimleri/gss_genel_mudurlugu/anasayfa_duyurular/degisiklik_tebligi_islenmis_guncel_sut_08022018 accessed 11.09.2019.
• 6. Sağlık Bakanlığı Finansal Analiz Daire Başkanlığı. Maliyet Analizi Çalışmalarında Gider Belirleme Tabloları, Mart 2014 (Revize Ocak-2015), https://khgm.saglik.gov.tr/Dosyalar/5796ea7a9ecf44aa832b697631f7bc56.pdf. accessed 11.09.2019.
• 7. Mut S, Ağırbaş İ. Cost Analisis in Hospitals: Implementation in a Second Line Public Hospital Providing Services in Ankara. Mehmet Akif Ersoy Üniversitesi Sosyal Bilimler Enstitüsü Dergisi. 2017; 9(18):202-17.
• 8. Bradley B, Troy D, Edgar, L, Richard B, William R. Age and Laboratory Costs for Hospitalized Medical Patients. Arch Pathol Lab Med. 2003;127:169-77.
• 9. Al- Fozan H, Dufort J, Kaplow M, Valenti D, Tulandi T. Cost analysis of myomectomy, hysterectomy, and uterine artery embolization. Am J Obstet Gynecol.. 2002;187(5):1401-4.
• 10. Yigit C, Peker S, Cankul İ, Kostik Z, Alkan M, Ozer M, et al. A study on the analysis of the average inpatient cost at GATA training hospital. Gülhane Tıp Dergisi 2003;45(3):233-43.
• 11. Klouche S, Sariali E, Mamoudy P. Total hip arthroplasty revision due to infection: A cost analysis approach. Orthopaedics & Traumatology: Surgery & Research. 2010;96(2):124-32.
• 12. Haenle M, Skripitz C, Mittelmeier W, Skripitz R. Economic impact of infected total hip arthroplasty in the German diagnosis-related groups system. Orthopäde. 2012;41(6):467-76.
• 13. Vanhegan I, Malik A, Jayakumar P, Ul Islam S, Haddad F. A financial analysis of revision hip arthroplasty. J Bone Joint Surg Br. 2012;94-B(5):619-23.
• 14. Jones A, Williams T, Paringe V, White S. The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study. Injury. 2016;47(2):428-31.
• 15. Weber M, Renkawitz T, Voellner F, Craiovan B, Greimel F, Worlicek M et al. Revision Surgery in Total Joint Replacement Is Cost-Intensive. Biomed Res Int. 2018;2018:1-8.
• 16. Haenle M, Skripitz C, Mittelmeier W, Skripitz R. Economic Impact of Infected Total Knee Arthroplasty. The Scientific World Journal. 2012;2012:1-6.
• 17. Vanhegan I, Malik A, Jayakumar P, Ul Islam S, Haddad F. A financial analysis of revision hip arthroplasty. J Bone Joint Surg Br. 2012;94-B(5):619-23.
• 18. Kühn K. Economic Aspects. Management of Periprosthetic Joint Infection. 2018;5-24.
• 19. Lenguerrand E, Whitehouse M, Beswick A, Kunutsor S, Burston B, Porter M et al. Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study. The Lancet Infectious Diseases. 2018;18(9):1004-14.
• 20. Kong L, Cao J, Zhang Y, Ding W, Shen Y. Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J. 2016;14(3):529-36.
• 21. Triantafyllopoulos G, Stundner O, Memtsoudis S, Poultsides L. Patient, Surgery, and Hospital Related Risk Factors for Surgical Site Infections following Total Hip Arthroplasty. ScientificWorldJournal. 2015;2015:1-9.
• 22. Husted H, Otte K, Kristensen B, Ørsnes T, Kehlet H. Readmissions after fast-track hip and knee arthroplasty. Arch Orthop Trauma Surg. 2010;130(9):1185-91.
• 23. Malik A, Jain N, Scharschmidt T, Li M, Glassman A, Khan S. Does Surgeon Volume Affect Outcomes Following Primary Total Hip Arthroplasty? A Systematic Review. J Arthroplasty. 2018;33(10):3329-42.
• 24. Liodakis E, Bergeron S, Zukor D, Huk O, Epure L, Antoniou J. Perioperative Complications and Length of Stay After Revision Total Hip and Knee Arthroplasties: An Analysis of the NSQIP Database. J Arthroplasty. 2015;30(11):1868-71.
• 25. Assmann G, Kasch R, Maher C, Hofer A, Barz T, Merk H et al. Comparison of Health Care Costs Between Aseptic and Two Stage Septic Hip Revision. J Arthroplasty. 2014;29(10):1925-31.
• 26. Lee J, Han S. Patient Blood Management in Hip Replacement Arthroplasty. Hip Pelvis. 2015;27(4):201.
• 27. Villatte G, Engels E, Erivan R, Mulliez A, Caumon N, Boisgard S et al. Effect of local anaesthetic wound infiltration on acute pain and bleeding after primary total hip arthroplasty: the EDIPO randomised controlled study. Int Orthop. 2016;40(11):2255-60.
• 28. Reina N, Fennema P, Hourlier H. The impact of mild peri-operative hypothermia on the effectiveness of tranexamic acid in total hip arthroplasty. Int Orthop. 2017;41(1):55-60.
• 29. Sucher M, Giordani M, Figoni A, Nedopil A. Peri-operative blood-loss after total hip arthroplasty can be significantly reduced with topical application of epsilon-aminocaproic acid. Int Orthop. 2016;40(10):2019-23.
• 30. Scardino M, Martorelli F, D’Amato T, Fenocchio G, Simili V, Grappiolo G et al. Use of a fibrin sealant within a blood-saving protocol in patients undergoing revision hip arthroplasty: effects on post-operative blood transfusion and healthcare-related cost analysis. Int Orthop. 2019;43(12):2707-14.