RESUMO
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.
Assuntos
Neoplasias Colorretais , Grupos Diagnósticos Relacionados , Humanos , Tempo de InternaçãoRESUMO
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.
Assuntos
Neoplasias Colorretais , Recuperação Pós-Cirúrgica Melhorada , Humanos , Custos de Cuidados de Saúde , Grupos Diagnósticos Relacionados , Tempo de InternaçãoRESUMO
A set of bifunctional oxidase-peroxidases has been prepared by fusing four distinct oxidases to a peroxidase. Although such fusion enzymes have not been observed in nature, they could be expressed and purified in good yields. Characterization revealed that the artificial enzymes retained the capability to bind the two required cofactors and were catalytically active as oxidase and peroxidase. Peroxidase fusions of alditol oxidase and chitooligosaccharide oxidase could be used for the selective detection of xylitol and cellobiose with a detection limit in the low-micromolar range. The peroxidase fusions of eugenol oxidase and 5-hydroxymethylfurfural oxidase could be used for dioxygen-driven, one-pot, two-step cascade reactions to convert vanillyl alcohol into divanillin and eugenol into lignin oligomers. The designed oxidase-peroxidase fusions represent attractive biocatalysts that allow efficient biocatalytic cascade oxidations that only require molecular oxygen as an oxidant.
