Statistical analysis of the intracranial procedures in Poland in 2008-2009.

BACKGROUND AND PURPOSE: Quantitative and qualitative analysis of neurosurgical procedures provides important data for assessment of the development and trends in the field of neurosurgery. The authors present statistical data on intracranial procedures (IPs) performed in Poland in 2008-2009. MATERIAL AND METHODS: Data on IPs come from reports of the National Health Fund, grouped according to the system of Diagnosis-Related Groups, group A - nervous system diseases. Data concerning the year 2009 include all IPs performed in Poland. Data from the second half of 2008 to 2009 (18 months) come from 35 neurosurgical centers in Poland, divided by provinces. We analyzed the number of IPs, the cost of procedures, duration of hospitalization and deaths. RESULTS: 20 849 IPs were performed in Poland in 2009. The most common procedure was A12 (6807; 32.65%), and the rarest was A04 (96; 0.46%). The annual cost of all IPs was 228 599 956 PLN. Average cost of the procedure ranged from 1578 PLN (A14) to 47 940 PLN (A03). Duration of the hospitalization ranged between 3 days (A14) and 12 days (A12). The highest percentage of deaths was reported for A01 (n = 1050, 19.06%). Reports from 35 neurosurgical centers in the second half of 2008 and 2009 showed the highest number of IPs per 100 000 population in Kujawsko-Pomorskie (93) and the lowest in Wielkopolskie (27) and Podkarpackie (27). The highest number of IPs (1669) was performed in neurosurgical center M1 (Malopolskie), and the lowest (99) in W1 (Wielkopolskie). CONCLUSIONS: A significant disparity in the number of IPs performed in different centers in Poland was observed.

[Anesthesiological co-diagnosis "difficult intubation": effects on the reimbursement situation of a university hospital]. / Anästhesiologische Nebendiagnose "schwierige Intubation" : Auswirkung auf die Erlössituation eines Universitätsklinikums.

OBJECTIVE: Within the German diagnosis related groups (G-DRG) system, the accurate coding of the co-morbidity "failed or difficult intubation (T88.4)" may be relevant with respect to reimbursement. In this study, the impact of this typical anesthesia co-morbidity on revenues of an university hospital was investigated. METHODS: The computerized records of 21,204 anesthesia procedures from the year 2005 were scanned for failed or difficult intubations. The results were checked for accordance with the coding recommendation of the Medical Service of the Health Insurance Funds (MDK) with respect to the co-morbidity T88.4. For all valid cases, the DRG, the diagnosis code and the co-morbidity codes were retrieved from the hospital information system. Subsequently all cases were regrouped with the GetDRG grouper (Fa. GEOS), taking the co-morbidity T88.4 in account. RESULTS: Out of the 21,204 patients, 12,261 were intubated for general anesthesia. A failed or difficult intubation according to the definition of the expert group of social medicine was documented in 276 anesthesia cases (2.3%). In 31 cases the coding of the co-morbidity T88.4 led to an increase in revenue by grouping the case in a different DRG. Using the base rate of the year 2005 (EUR 3,379.66), the surplus in basic points of 17.093 resulted in an additional reimbursement of EUR 57,768.53. CONCLUSION: With this study it was shown that the consequent coding of the co-morbidity T88.4 during anesthesia can lead to increased reimbursement. A prerequisite is the accurate documentation and coding by the attending anesthetist.