[Identification and economic evaluation of anesthesiologic secondary diagnoses on the basis of intraoperative medication]. / Identifikation und ökonomische Bewertung von anästhesiologischen Nebendiagnosen auf Basis von intraoperativen Medikamentengaben.

BACKGROUND: Complications and comorbidities are encodable in the German diagnosis related groups (G-DRG) system and can improve revenues. In this study, secondary diagnoses were identified through drug administrations during anaesthesia and were economically evaluated by regrouping these cases. METHODS: All intraoperative drug administrations from 2008 were extracted from a database. After exclusion of synonyms and procedure-specific drug administrations, all remaining drugs were matched to explicit secondary diagnoses. All cases were regrouped with their newly defined secondary diagnoses by G­DRG grouper software, and changes in cost weight were evaluated. RESULTS: A total of 29 drugs could be assigned to 18 secondary diagnoses. From 22,440 anaesthesia the § 21 data record could be extracted in 1,929 cases and was regrouped with 2,976 secondary diagnoses, according to additional proceeds of 125,330.25 € in 2008 and 103,542.35 € in 2014. Intraoperative secondary diagnoses influence cost weight only in small parts. The average increase in revenue in this study could have been about 50 € per case. From 2008 to 2014 secondary diagnoses were continuously devaluated, although some of them, e. g. afibrinogenemia, have were revaluated. DISCUSSION: Our retrospective method of making a diagnosis and assuming a correct indication of drug administration is inapplicable to daily routine. The anaesthesiologic documentation has to make drug administration and thereby the secondary diagnosis plausible.