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Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care

Author

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  • Bassey Enodien

    (Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
    These authors contributed equally to this work.)

  • Dominik Moser

    (Operations Management, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
    Department of Health Care Management, Technical University of Berlin, 10623 Berlin, Germany
    Department of Economics and Technology, Swiss Distance University of Applied Sciences (FFHS), 8005 Zurich, Switzerland
    School of Medicine, University of St. Gallen, 9000 St. Gallen, Switzerland)

  • Florian Kessler

    (Department of Anesthesiology, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland)

  • Stephanie Taha-Mehlitz

    (Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4058 Basel, Switzerland)

  • Daniel M. Frey

    (Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
    Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
    These authors contributed equally to this work.)

  • Anas Taha

    (Department of Surgery, GZO Hospital Wetzikon/Zurich, 8620 Wetzikon, Switzerland
    Department of Biomedical Engineering, Faculty of Medicine, University of Basel, 4123 Allschwil, Switzerland
    These authors contributed equally to this work.)

Abstract

Background: Medical progress is increasingly enabling more and more stationary treatment to be provided in the outpatient sector. This development should be welcomed, as healthcare costs have been rising for years. The design of efficient processes and a needs-based infrastructure enable further savings. According to international recommendations (EHS/IEHS), outpatient treatment of unilateral inguinal hernias is recommended. Method: Data from patients in GZO Hospital Wetzikon/Zurich between 2019 and 2021 for unilateral inguinal hernia repair was included in this study ( n = 234). Any over- or under-coverage correlated with one of the three treatment groups: stationary, partially stationary and patients treated in outpatients clinic. Complications and 30-day readmissions were also monitored. Results: Final revenue for all patients is −95.36 CHF. For stationary treatments, the mean shifts down to −575.01 CHF, for partially stationary treatments the mean shifts up to −24.73 CHF, and for patients in outpatient clinic final revenue is 793.12 CHF. This result is also consistent with the operation times, which are lowest in the outpatient clinic with a mean of 36 min, significantly longer in the partially stationary setting with 58 min, and longest in the stationary setting with 76 min. The same applies to the anesthesia times and the relevant care times by the nurses as the most important cost factors in addition to the supply and allocation costs. Conclusions: We show that cost-effective elective unilateral inguinal hernia care in the outpatient clinic with profit (mean 793.12 CHF) is possible. Stationary unilateral hernia care (mean −575.01 CHF) is loss-making. Crucial factors for cost efficiency are optimized processes in the operating room (anesthesia, surgical technique and quality, operating time), as well as optimized care processes with minimal preoperative services and care times for the patient. However, at the same time, these optimizations pose a challenge to surgical and anesthesiology training and structures with high levels of preoperative and Postoperative services and pay-as-you-go costs. The complication rate is 0.91% lower than in a comparable study. The readmission within 30 days post-operation results with a positive deviation of −3.53% (stationary) and with a negative deviation of +2.29% (outpatient clinic) compared to a comparative study.

Suggested Citation

  • Bassey Enodien & Dominik Moser & Florian Kessler & Stephanie Taha-Mehlitz & Daniel M. Frey & Anas Taha, 2022. "Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care," IJERPH, MDPI, vol. 19(19), pages 1-20, September.
  • Handle: RePEc:gam:jijerp:v:19:y:2022:i:19:p:12410-:d:929089
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    References listed on IDEAS

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