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. 2022 Apr 4;19(7):4325.
doi: 10.3390/ijerph19074325.

Profit-Influencing Factors in Orthopedic Surgery: An Analysis of Costs and Reimbursements

Felix Rohrer  1   2 , Aresh Farokhnia  3 , Hubert Nötzli  4   5 , Frederik Haubitz  6 , Tanja Hermann  7 , Brigitta Gahl  8 , Andreas Limacher  8 , Jan Brügger  2   9
Affiliations

Profit-Influencing Factors in Orthopedic Surgery: An Analysis of Costs and Reimbursements

Felix Rohrer et al. Int J Environ Res Public Health. .

Abstract

The aging population and the associated demand for orthopedic surgeries are increasing health costs. Although the Diagnostic Related Groups (DRG) system was introduced to offer incentives for hospitals, concerns remain that reimbursements for older and frail patients do not cover all hospital expenses. We investigated further: (1) Does age influence net financial results in orthopedic surgery? (2) Are there patient or surgical factors that influence results? This retrospective, monocentric study compares costs and reimbursements for orthopedic patients in a tertiary care hospital in Switzerland between 2015 and 2017. The data of 1230 patients were analyzed. Overall, the net results for the hospital were positive, despite 19.5% of patients being treated at a loss. We did not find any correlation between age and profitability (p = 0.61). Patient-related factors associated with financial losses were female sex (p < 0.001) and diabetes (p = 0.013). Patients free of serious comorbidities (p = 0.012) or with a higher cost weight (p < 0.001) were more often profitable. A longer length of stay was associated with higher losses (p < 0.001). This is the first study to address the Swiss DRG reimbursement system in a broad orthopedic population, while also analyzing specific patient and surgical factors. Overall, the reimbursement system is fair, but could better account for certain interventions.

Keywords: Swiss DRG; cost-benefit profitability analysis; costing; finance; net financial result; orthopedic surgery; patient health data; profit.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Correlation between age and net financial results. The red line indicates the fitted values.
Figure 2
Figure 2
Correlation between age and total cost of stay-total cost of stay increased proportionally with age.
Figure 3
Figure 3
Correlation of age and nursing costs-nursing costs increase with age.
Figure 4
Figure 4
Correlation between age and LOS-LOS increases proportionally with age.
Figure 5
Figure 5
Correlation between age and cost weight. Cost weight increases proportionally with age, indicating the increased burden of treatment and comorbidities associated with older patients.
Figure 6
Figure 6
Correlation between age and the age-adjusted Charlston Comorbidity Index. This correlation is logical, as the score adds one point per 10 years after 50 years.
Figure 7
Figure 7
Correlation between total cost of stay and AACCI-cost of stay increases with more comorbidities.
Figure 8
Figure 8
AACCI and net financial results-no statical relevant correlation.
Figure 9
Figure 9
Box plot of cost weight according to surgical site.
Figure 10
Figure 10
Box plot of net financial results according to surgical site.
Figure 11
Figure 11
Relative cost distribution by cost units for main types of surgery.
Figure 12
Figure 12
Costs and reimbursement by type of surgery. Dashed line indicates net financial zero. Dots to the right of the dashed line indicate a positive net financial result. Lines in color are regression lines by surgery site.
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