Impact of the Nursing Personnel Strengthening Act on minimally invasive surgery exemplified by right-sided hemicolectomy from an economic perspective

• Published in: Chirurg Vol. 93; no. 5; pp. 490 - 498
• Main Authors: Winkels, Raphael, Schad, Stefan, Schöffski, Oliver, Seelig, Matthias H
• Format: Journal Article
• Language: German
• Published: Germany 01-05-2022
• Subjects: Colectomy; Humans; Length of Stay; Minimally Invasive Surgical Procedures - methods; Nurses; Retrospective Studies; Colon cancer; Nursing case rate; Postoperative hospitalization; Diagnosis-related groups; Refinancing
• ISSN: 1433-0385
• DOI: 10.1007/s00104-021-01523-5

In the past, a reduced length of postoperative hospital stay was considered a sufficient trade-off to refinance the additional costs associated with minimally invasive surgery; however, with the implementation of the Nursing Personnel Strengthening Act and disincorporation of nursing costs, this argumentation needs to be fundamentally reevaluated.
Using right-sided hemicolectomy as an example, a retrospective case analysis was conducted. Cost reductions associated with the length of hospital stay were compared before and after the introduction of the revised German diagnosis-related groups (aG-DRG) and offset against the increased material and personnel costs.
Among the analyzed cases, the utilization of minimally invasive surgical techniques led to a substantial cost reduction per case compared to conventional surgical treatment. After the introduction of the aG-DRGs the financial benefits of a shortened hospital stay are greatly diminished and cannot be used to refinance the expenses necessary to perform minimally invasive surgery. From a strictly economical perspective, there is a strong incentive to only perform open surgical procedures.
Disincorporation of nursing costs has destabilized the fragile concept of indirect refinancing of advanced operative techniques by the financial incentives associated with a shorter hospital stay. In order to comply with statutory regulations to implicate a performance-based funding, there is an urgent necessity to adjust the grouping algorithms for minimally invasive surgical procedures to the corresponding flat rates.