[Influence of a spontaneous bacterial peritonitis, nosocomial infections and acute-on-chronic liver failure on treatment revenues in patients with decompensated cirrhosis in Germany]. / Einfluss einer spontan bakteriellen Peritonitis, nosokomialer Infektionen und eines akut auf chronischen Leberversagens auf die Behandlungserlöse bei Patienten mit dekompensierter Leberzirrhose in Deutschland.
Z Gastroenterol
; 58(9): 855-867, 2020 Sep.
Article
em De
| MEDLINE
| ID: mdl-32947631
ABSTRACT
BACKGROUND:
The economic effects of spontaneous bacterial peritonitis (SBP), nosocomial infections (nosInf) and acute-on-chronic liver failure (ACLF) have so far been poorly studied. We analyzed the impact of these complications on treatment revenues in hospitalized patients with decompensated cirrhosis.METHODS:
371 consecutive patients with decompensated liver cirrhosis, who received a paracentesis between 2012 and 2016, were included retrospectively. DRG (diagnosis-related group), "ZE/NUB" (additional charges/new examination/treatment methods), medication costs, length of hospital stay as well as different kinds of specific treatments (e.âg., dialysis) were considered. Exclusion criteria included any kind of malignancy, a history of organ transplantation and/or missing accounting data.RESULTS:
Total treatment costs (DRGâ+âZE/NUB) were higher in those with nosInf (â10,653 vs.ââ5,611, pâ<â0.0001) driven by a longer hospital stay (23âd vs. 12âd, pâ<â0.0001). Of note, revenues per day were not different (â473 vs.ââ488, pâ=â0.98) despite a far more complicated treatment with a more frequent need for dialysis (pâ<â0.0001) and high-complex care (pâ=â0.0002). Similarly, SBP was associated with higher total revenues (â10,307 vs.ââ6,659, pâ<â0.0001). However, the far higher effort for the care of SBP patients resulted in lower daily revenues compared to patients without SBP (â443 vs.ââ499, pâ=â0.18). ACLF increased treatment revenues toââ10,593 vs.â6,369 without ACLF (pâ<â0.0001). While treatment of ACLF was more complicated, revenue per day was not different to no-ACLF patients (â483 vs.ââ480, pâ=â0.29).CONCLUSION:
SBP, nosInf and/or ACLF lead to a significant increase in the effort, revenue and duration in the treatment of patients with cirrhosis. The lower daily revenue, despite a much more complex therapy, might indicate that these complications are not yet sufficiently considered in the German DRG system.
Texto completo:
1
Temas:
ECOS
/
Aspectos_gerais
/
Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Peritonite
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Infecções Bacterianas
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Infecção Hospitalar
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Custos de Cuidados de Saúde
/
Grupos Diagnósticos Relacionados
/
Insuficiência Hepática Crônica Agudizada
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
De
Revista:
Z Gastroenterol
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Alemanha