Zusammenfassung
Hintergrund: Das derzeitige DRG-System vergütet eine Folgeoperation nur dann, wenn der Patient
30 Tage nach Entlassung wieder stationär aufgenommen wird. Bei Patienten mit Subarachnoidalblutung
ist eine zweite Operation wegen eines chronischen Hydrozephalus nicht selten notwendig.
Ziel dieser Studie ist es, die Häufigkeit der Shuntimplantation nach Subarachnoidalblutung
(SAB) zu untersuchen und dies in Beziehung zum derzeitigen Entgeltsystem zu setzen.
Material und Methoden: Die Krankenakten von insgesamt 274 SAB Patienten (mittleres Alter 49 ± 11 Jahre,
männlich zu weiblich 1:1,5) wurden retrospektiv aufgearbeitet. Folgende epidemiologische
Faktoren wurden erhoben: Alter, Hunt-&-Hess-Grad, Fisher-Grad im ersten CT, Vasospasmus,
akuter und chronischer Hydrozephalus, Zeitpunkt der Shuntanlage. Ergebnisse: Insgesamt benötigten 24,1 % aller Patienten einen Shunt nach SAB. Risikofaktoren
waren akuter Hydrozephalus, höherer Hunt-&-Hess- und Fisher-Grad bei Aufnahme sowie
Nachblutung. 77,7 % aller Shunts wurden während des stationären Aufenthaltes oder
innerhalb von 30 Tagen nach Entlassung oder Verlegung gelegt. Nur 22 % aller Shunts
wurden neu vergütet. Schlussfolgerung: Das derzeitige DRG-System sieht keine finanzielle Kompensation für fast 80 % aller
Patienten mit chronischem Hydrozephalus nach SAB vor. Hier ist eine Neukalkulation
der Vergütung erforderlich.
Abstract
Background: The current German hospital reimbursement system pays only for follow-up operations
if the patient was readmitted to the hospital more than 30 days after discharge or
transfer. The aim of this study was to test the hypothesis that CSF shunt operations
after subarachnoid hemorrhage (SAH) are not adequately reimbursed. Material and Methods: A total of 274 SAH patients’ hospital charts (average age 49 ± 11 years, male:female
= 1:1.5) were retrospectively reviewed. The following epidemiological parameters were
recorded: age, Hunt & Hess grade, Fisher Grade on admission, vasospasm, acute/chronic
hydrocephalus, recurrent bleeding, timing of CSF shunting. Results: A total of 24.1 % of patients required CSF shunting after SAH. Typical risk factors
were acute hydrocephalus, higher Hunt & Hess and Fisher Grades and recurrent hemorrhage.
Overall, 77.7 % of shunts were placed during the initial hospital stay or within 30
days after discharge or transfer. Only 22 % of shunting procedures were reimbursed.
Conclusions: The current German reimbursement system does not compensate for almost 80 % of shunt
operations after SAH. A revision of the system is necessary.
Schlüsselwörter
Subarachnoidalblutung - Shunt - DRG
Key words
Subarachnoid hemorrhage - shunt - reimbursement
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Dr. med. Matthias Friedrich Oertel
Neurochirurgische Klinik Universitätsklinikum Gießen und Marburg - Standort Gießen
Klinikstrasse 29
35385 Gießen
eMail: matthias.oertel@neuro.med.uni-giessen.de