RESUMO
BACKGROUND: This work examines the hypothesis that in endoprosthesis implantation there are differences between experienced primary and senior caregivers (S-Op) and less experienced follow-up assistants (T-Op) with respect to process-relevant parameters. The main hypothesis is that compared to SOp, TOp cause significantly longer surgery times and thus additional operating theatre costs. As sub-hypotheses, differences in various perioperative (p-o) parameters between TOp and SOp were examined. MATERIALS AND METHODS: The status of the operator (senior and/or senior main operator [S-Op]) and/or postoperative CRP, perioperative blood loss, the amount of transfused erythrocyte concentrates, patient age, gender, ASA risk classification (American Society of Anesthesiologists), duration of surgery and blood transfusion, duration of inpatient stay, as well as the rates of early revision surgery and complications were recorded. A comparison of patients who had been operated by an SOp and those who had been operated by a TOp was made for all parameters. RESULTS: Significant differences were found with respect to the duration of surgery, the duration of the hospital stay, and CRP on the third po day. The TOp required an average of 11 min more than the SOp. CRP was significantly higher in the TOp group only on the third po day, by 18 mg/l. In contrast, in the TOp group, a blood loss of 181 ml was lower than in the SOp group. This corresponded to a reduction of 0.26 transfused erythrocyte concentrates. There were no significant differences in complication rates between SOp and TOp. DISCUSSION: In the setting of a certified endoprosthetics centre, the comparison of TOp with SOp showed that the use of the former with at a non-increased complication rate led to a significant extension of the operating time. This leads to additional training costs in the amount of an estimated 3% of the current DRG remuneration. These additional costs are not represented adequately in the current remuneration system.