RESUMEN
The perioperative management of colorectal resections is often dominated by traditional procedures and a strong focus on safety. Evidence-based measures such as those established in Fast Track or ERAS programs, are rarely applied in a standardised manner. As part of elective colorectal surgery, many patients therefore continue to routinely receive central venous access, peridural catheters, urinary catheters, drains and/or gastric tubes ("Big Five" of invasiveness). This article presents the currently available evidence on these measures in colorectal surgery. In addition, results relating to the "Big Five" from the author's own centre are presented. This review shows that the "Big Five" of invasiveness are clinically unnecessary or supported by evidence. In addition, they often impair the patient's function.
RESUMEN
BACKGROUND: ERAS (Enhanced Recovery After Surgery) describes a multimodal, interdisciplinary and interprofessional treatment concept that optimizes the postoperative convalescence of the patient through the use of evidence-based measures. GOAL OF THE WORK: The aim of this article is to examine the economic feasibility of the concept in the German DRG system. MATERIAL AND METHODS: Since August 2019, patients have been treated in our clinic according to the later certified ERAS concept. The last 20 patients before ERAS implementation are compared below with 20 patients after ERAS implementation, who were identified using a matched pair analysis. In addition to the comparison of costs and revenues, the clinical outcome of the patients is also presented. RESULTS: The cases of the patients in the pre-ERAS cohort caused median costs of 7432.83. BWR of 3.38 were billable. The resulting DRG revenue for the patients in this group amounted to 11325.78. The proceeds generated in the end amounted to 4575.14. The cases of patients in the ERAS cohort resulted in costs of 5582.96. BWR of 2.84 could be billed. The DRG proceeds for the patients in this group therefore amounted to 10014.18. The profit generated was thus 4993.84. DISCUSSION: The cost reduction generated by ERAS was comparable to the "loss" caused by the BWR decrease. ERAS is therefore also possible to cover costs in the German DRG system.
Asunto(s)
Neoplasias Colorrectales , Grupos Diagnósticos Relacionados , Humanos , Tiempo de InternaciónRESUMEN
PURPOSE: ERAS® (Enhanced Recovery After Surgery) describes a multimodal, interdisciplinary, and interprofessional treatment concept that optimizes the postoperative convalescence of the patient through the use of evidence-based measures. Goal of the work. The aim of this article is to examine the economic feasibility of the ERAS® concept in the German DRG (diagnosis-related groups) system. MATERIAL AND METHODS: Since August 2019, patients have been treated in our clinic according to the later certified ERAS® concept. The last 50 patients before ERAS® implementation are compared below with 50 patients after ERAS® implementation, who were identified using a matched pair analysis. In addition to the comparison of costs and revenues, the clinical outcome of the patients is also presented. RESULTS: The cases of the patients in the pre-ERAS® cohort caused median costs of 7432.83. BWR (valuation ratio) of 3.38 were billable. The resulting DRG revenue for the patients in this group amounted to 11,325.78. The proceeds generated in the end amounted to 4575.14. The cases of patients in the ERAS® cohort resulted in costs of 5582.96. BWR of 2.84 could be billed. The DRG proceeds for the patients in this group therefore amounted to 10,014.18. The profit generated was thus 4993.84. CONCLUSION: The cost reduction generated by ERAS® was more pronounced than the "loss" due to the decrease in BWR. ERAS® is therefore also possible in the German DRG system at absolutely cost-covering levels.
Asunto(s)
Neoplasias Colorrectales , Recuperación Mejorada Después de la Cirugía , Humanos , Costos de la Atención en Salud , Grupos Diagnósticos Relacionados , Tiempo de InternaciónRESUMEN
Modern concepts of perioperative treatment place great value on the active role of the patient. In order to make this possible, intensive patient support is necessary. The position of the ERAS nurse has developed from this necessity. She is the primary contact for the patient before, during and after the operation. The conceptual creation and continuous further development of an ERAS concept may primarily be a medical activity, but the day-to-day work on the patient and filling the concept with life is mainly done by an ERAS nurse. Her main tasks are preoperative patient education, daily patient visits during the inpatient stay, filling in the documentation, ongoing communication with nursing staff and monitoring compliance with the ERAS requirements of all team members involved. It is accordingly important to create the position of an ERAS nurse and to integrate her as a valuable member of the team. In the following article, which is based on our experience as a certified ERAS centre, the job description in detail is presented, including tasks, importance and suggested solutions for common problems.