gms | German Medical Science

Objectives: The aging population and the associated demand for orthopaedic surgeries are significant drivers of rising health care costs. Although the Diagnostic Related Groups (DRG) system was introduced to offer incentives for hospitals, concerns remain that reimbursements for older and frail patients do not always cover all hospital expenses. To investigate further we asked: 1) Does age influence net financial results in orthopaedic surgery? 2) Are there other patient or surgically related factors that influence the bottom line?

Methods: This retrospective, monocentric study compares costs and reimbursements for orthopaedic patients in a tertiary care hospital in Swtizerland between 2015 and 2017. The primary aim was to study the effect of patient age on net financial result. The secondary aim was to assess which patient and surgical factors, or cost points influence net financial results.

Results and conclusion: Data of 1230 patients were analysed. Overall, the net results for the hospital was positive (profit), despite 19.5% of patients being treated at a loss. We did not find any correlation between age and profitability (p = 0.61). Patient-related factors associated with financial losses were female sex (p < 0.001) and diabetes (p = 0.013). Patients free of serious comorbidities (p = 0.012) were associated with profitable interventions. Patients with a higher cost weight were also associated with profitable interventions (p < 0.001). Spine surgery (p=0.015) and revision knee arthroplasties (p<0.001) were the main source of financial losses. In contrast, primary hip and knee surgeries (p<0.001) were more profitable. Longer length of stay (LOS) was also associated with higher losses (p<0.001).

This is the first study to address the Swiss DRG reimbursement system in a broad orthopaedic population, while also analysing specific patient and surgical factors. Overall, the reimbursement system is fair, but could better account for certain specific interventions.