Skip to main content
Erschienen in: Surgical Endoscopy 5/2020

18.07.2019

One-stop routing for surgical interventions: a cost-analysis of endoscopic groin repair

verfasst von: Coen van Hessen, Marleen Roos, Geert Frederix, Egbert Jan Verleisdonk, Geert Jan Clevers, Paul Davids, Josephina Burgmans

Erschienen in: Surgical Endoscopy | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

Single-visit (SV) totally extraperitoneal (TEP) inguinal hernia repair is an efficient service without impairment of safety or complication rate. Data on the economic impact of this approach are rare. The aim of this study was to compare the costs between the SV TEP and the regular TEP in an employed healthy population from a hospital and societal point of view.

Methods

Retrospectively collected hospital costs and prospectively collected societal costs were obtained from patients treated between July 2016 and January 2018. Outcome measures consisted of all documented institutional care, productivity loss and medical consumption.

Results

For analysing the hospital costs, a total of 116 SV patients were matched to 116 regular patients. The hospital costs of a mean SV patient were €1148.78 compared to €1242.84 for a regular patient, with a mean difference of €94.06. Prospective analyses of 50 SV patients and 50 regular patients demonstrated higher societal costs for a mean regular patient (€2188.33) compared to a mean SV patient (€1621.44). The mean total cost difference between a SV TEP repair and a regular TEP repair equalled €660.95 corresponding to a 19.3% decrease in costs.

Conclusions

This comprehensive cost-analysis showed that in an employed, healthy population, the SV TEP repair outprices the regular TEP repair, with savings of €660.95 per patient, reflecting a 19.3% decrease in costs. This routing is mainly interesting from a societal point of view as the difference is mainly impacted by a decrease in societal costs.
Literatur
1.
Zurück zum Zitat Weinstein M, Stason W (1977) Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med 296(13):716–721CrossRef Weinstein M, Stason W (1977) Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med 296(13):716–721CrossRef
2.
Zurück zum Zitat Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J, Snow P, Kugler J (2010) Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev 3:CD006632 Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J, Snow P, Kugler J (2010) Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev 3:CD006632
3.
Zurück zum Zitat Yang S, McLaughlin CP, Vaughan RW, Aluise JJ (1992) Factory focus in hospital-owned ambulatory surgery. Int J Serv Ind Manag 3(4):63–75CrossRef Yang S, McLaughlin CP, Vaughan RW, Aluise JJ (1992) Factory focus in hospital-owned ambulatory surgery. Int J Serv Ind Manag 3(4):63–75CrossRef
4.
Zurück zum Zitat Muller MK, Dedes KJ, Dindo D, Steiner S, Hahnloser D, Clavien PA (2009) Impact of clinical pathways in surgery. Langenbecks Arch Surg 394:31–39CrossRef Muller MK, Dedes KJ, Dindo D, Steiner S, Hahnloser D, Clavien PA (2009) Impact of clinical pathways in surgery. Langenbecks Arch Surg 394:31–39CrossRef
5.
Zurück zum Zitat Statline, Centraal Bureau voor statistiek Statline, Centraal Bureau voor statistiek
6.
Zurück zum Zitat Joh HJ, Moon IS, Park HR, Kim NC, Yang S (2003) The effects of the critical pathway for inguinal hernia repair. Yonsei Med J 44:81–88CrossRef Joh HJ, Moon IS, Park HR, Kim NC, Yang S (2003) The effects of the critical pathway for inguinal hernia repair. Yonsei Med J 44:81–88CrossRef
7.
Zurück zum Zitat Uchiyama K, Takifuji K, Tani M, Onishi H, Yamaue H (2002) Effectiveness of the clinical pathway to decrease length of stay and cost for laparoscopic surgery. Surg Endosc 16(11):1594–1597CrossRef Uchiyama K, Takifuji K, Tani M, Onishi H, Yamaue H (2002) Effectiveness of the clinical pathway to decrease length of stay and cost for laparoscopic surgery. Surg Endosc 16(11):1594–1597CrossRef
8.
Zurück zum Zitat Tagge EP, Hebra A, Overdyk F, Burt N, Egbert M, Wilder A, Williams A, Roland P, Othersen HB Jr (1999) One-stop surgery: evolving approach to pediatric outpatient surgery. J Pediatr Surg 34:129–132CrossRef Tagge EP, Hebra A, Overdyk F, Burt N, Egbert M, Wilder A, Williams A, Roland P, Othersen HB Jr (1999) One-stop surgery: evolving approach to pediatric outpatient surgery. J Pediatr Surg 34:129–132CrossRef
9.
Zurück zum Zitat Gilmartin J, Chin H, Leonard P (2009) Pre-admission clinics in day surgery. The ‘one-stop shop’: tools and methods for practice improvement and service development. Prac Dev Health Care 8:239–252CrossRef Gilmartin J, Chin H, Leonard P (2009) Pre-admission clinics in day surgery. The ‘one-stop shop’: tools and methods for practice improvement and service development. Prac Dev Health Care 8:239–252CrossRef
10.
Zurück zum Zitat Kashani S, Muhtaseb M, Robinson F (2005) Analysis of ‘one-stop’ referral system for ophthalmic minor operations by GPs. Br J Gen Pract 55(510):53–54PubMedPubMedCentral Kashani S, Muhtaseb M, Robinson F (2005) Analysis of ‘one-stop’ referral system for ophthalmic minor operations by GPs. Br J Gen Pract 55(510):53–54PubMedPubMedCentral
11.
Zurück zum Zitat Barnett SJ, Frischer JS, Gaskey JA, Ryckman FC, von Allmen D (2011) Pediatric hernia repair: 1-stop shopping. J Pediatr Surg 47(1):213–216CrossRef Barnett SJ, Frischer JS, Gaskey JA, Ryckman FC, von Allmen D (2011) Pediatric hernia repair: 1-stop shopping. J Pediatr Surg 47(1):213–216CrossRef
12.
Zurück zum Zitat Bismil M, Bismil Q, Harding D, Harris P, Lamyman E, Sansby L (2012) Transition to total one-stop wide-awake hand surgery service-audit: a retrospective review. J R Soc Med Sh Rep 3:23PubMed Bismil M, Bismil Q, Harding D, Harris P, Lamyman E, Sansby L (2012) Transition to total one-stop wide-awake hand surgery service-audit: a retrospective review. J R Soc Med Sh Rep 3:23PubMed
13.
Zurück zum Zitat Voorbrood CE, Burgmans JP, Clevers GJ, Davids PH, Verleisdonk EJ, Schouten N, van Dalen T (2015) One-stop endoscopic hernia surgery: efficient and satisfactory. Hernia 19(3):395–400CrossRef Voorbrood CE, Burgmans JP, Clevers GJ, Davids PH, Verleisdonk EJ, Schouten N, van Dalen T (2015) One-stop endoscopic hernia surgery: efficient and satisfactory. Hernia 19(3):395–400CrossRef
14.
Zurück zum Zitat Sinha R, Sharma N, Dhobal D, Joshi M (2006) Laparoscopic Total extraperitoneal repair versus anterior preperitoneal repair for inguinal hernia. Hernia 10(2):187–191CrossRef Sinha R, Sharma N, Dhobal D, Joshi M (2006) Laparoscopic Total extraperitoneal repair versus anterior preperitoneal repair for inguinal hernia. Hernia 10(2):187–191CrossRef
15.
Zurück zum Zitat Tan SS (2009) Microcosting in economic evaluations: issues of accuracy, feasibility, consistency and genera-lisability. Instituut Beleid en Management Gezondheidszorg (iBMG), 1st edn. Erasmus Universiteit Rotterdam, Rotterdam Tan SS (2009) Microcosting in economic evaluations: issues of accuracy, feasibility, consistency and genera-lisability. Instituut Beleid en Management Gezondheidszorg (iBMG), 1st edn. Erasmus Universiteit Rotterdam, Rotterdam
16.
Zurück zum Zitat Hakkaart-van Roijen L, Van der Linden N, Bouwmans CAM, Kanters T, Tan SS (2015) Dutch manual for costing: methods and reference prices for economic evaluations in healthcare. Institute for Medical Technology Assessment (IMTA) Rotterdam Hakkaart-van Roijen L, Van der Linden N, Bouwmans CAM, Kanters T, Tan SS (2015) Dutch manual for costing: methods and reference prices for economic evaluations in healthcare. Institute for Medical Technology Assessment (IMTA) Rotterdam
17.
Zurück zum Zitat Eklund A, Carlsson P, Rosenblad A, Montgomery A, Bergkvist L, Rudberg C (2010) Long-term cost-minimization analysis comparing laparoscopic with open (Lichtenstein) inguinal hernia repair. Br J Surg 97:765–771CrossRef Eklund A, Carlsson P, Rosenblad A, Montgomery A, Bergkvist L, Rudberg C (2010) Long-term cost-minimization analysis comparing laparoscopic with open (Lichtenstein) inguinal hernia repair. Br J Surg 97:765–771CrossRef
19.
Zurück zum Zitat Putnis S, Merville-Tugg R, Atkinson S (2004) ‘One-stop’ inguinal hernia surgery—day-case referral, diagnosis and treatment. Ann R Coll Surg Engl 86:425–427CrossRef Putnis S, Merville-Tugg R, Atkinson S (2004) ‘One-stop’ inguinal hernia surgery—day-case referral, diagnosis and treatment. Ann R Coll Surg Engl 86:425–427CrossRef
20.
Zurück zum Zitat Olson JK, Deming LA, King DR, Rager TM, Gartner S, Huibregtse N, Moss RL, Besner GE (2017) Single visit surgery for pediatric ambulatory surgical procedures: a satisfaction and cost analysis. J Pediatr Surg S0022–3468(17):30643–30647 Olson JK, Deming LA, King DR, Rager TM, Gartner S, Huibregtse N, Moss RL, Besner GE (2017) Single visit surgery for pediatric ambulatory surgical procedures: a satisfaction and cost analysis. J Pediatr Surg S0022–3468(17):30643–30647
21.
Zurück zum Zitat Krabbe-Alkemade YJFM, Groot TL, Lindeboom M (2017) Competition in the Dutch hospital sector: an analysis of health care volume and cost. Eur J Health Econ 18(2):139–153CrossRef Krabbe-Alkemade YJFM, Groot TL, Lindeboom M (2017) Competition in the Dutch hospital sector: an analysis of health care volume and cost. Eur J Health Econ 18(2):139–153CrossRef
22.
Zurück zum Zitat Vollrath ME (ed) (2006) Handbook of personality and health. Wiley, New York Vollrath ME (ed) (2006) Handbook of personality and health. Wiley, New York
24.
Zurück zum Zitat Steptoe A (1993) The significance of personal control in health and disease. In: Steptoe A, Appels A (eds) Stress, personal control and health. Wiley, Chichester, pp 309–318 Steptoe A (1993) The significance of personal control in health and disease. In: Steptoe A, Appels A (eds) Stress, personal control and health. Wiley, Chichester, pp 309–318
25.
Zurück zum Zitat Scharloo M, Kaptein AA (1997) Measurement of illness perceptions in patients with chronic somatic illness: a review. In: Petrie KJ, Weinman J (eds) Perceptions of health and illness: current research applications. Harwood, London, pp 103–135 Scharloo M, Kaptein AA (1997) Measurement of illness perceptions in patients with chronic somatic illness: a review. In: Petrie KJ, Weinman J (eds) Perceptions of health and illness: current research applications. Harwood, London, pp 103–135
26.
Zurück zum Zitat Isaksson K (1989) Unemployment, mental health and the psychological functions of work in male welfare clients in Stockholm. Scand J Soc Med 17(2):165–169CrossRef Isaksson K (1989) Unemployment, mental health and the psychological functions of work in male welfare clients in Stockholm. Scand J Soc Med 17(2):165–169CrossRef
Metadaten
Titel
One-stop routing for surgical interventions: a cost-analysis of endoscopic groin repair
verfasst von
Coen van Hessen
Marleen Roos
Geert Frederix
Egbert Jan Verleisdonk
Geert Jan Clevers
Paul Davids
Josephina Burgmans
Publikationsdatum
18.07.2019
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 5/2020
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06971-z

Weitere Artikel der Ausgabe 5/2020

Surgical Endoscopy 5/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.