By extrapolating these findings CDAD not only harms patients but generates a yearly cost burden of 464 million € for the German healthcare system including a loss of 197 million € for German hospitals. To the authors' opinion sufficient measures against CDAD should include pre hospital risk reduction programs, introduction of effective therapeutic and hygienic strategies in hospitals as well as improvements in documentation for these cases to support further developments of the German DRG system.

Background Surgical site infections (SSI) present a substantial burden to patients and healthcare systems. This study aimed to elucidate the prevalence of SSIs in German hospitals and to quantify their clinical and economic burden based on German hospital reimbursement data (G-DRG). Methods This retrospective, cross-sectional study used a 2010–2016 G-DRG dataset to determine the prevalence of SSIs in hospital, using ICD-10-GM codes, after surgical procedures. The captured economic and clinical outcomes were used to quantify and compare resource use, reimbursement and clinical parameters for patients who had or did not have an SSI. Findings Of the 4,830,083 patients from 79 hospitals, 221,113 were eligible. The overall SSI prevalence for the study period was 4.9%. After propensity-score matching, procedure type, immunosuppression and BMI ≥30 were found to significantly affect the risk of SSI (p<0.001). Mortality and length of stay (LOS) were significantly higher in patients who had an SSI (mortality: 9.3% compared with 4.5% [p<0.001]; LOS (median [interquartile range, IQR]): 28 [27] days compared with 12 [8] days [p<0.001]). Case costs were significantly higher for the SSI group (median [IQR]) €19,008 [25,162] compared with € 9,040 [7,376] [p<0.001]). A median underfunding of SSI was identified at €1,534 per patient. Interpretation The dataset offers robust information about the “real-world” clinical and economic burden of SSI in hospitals in Germany. The significantly increased mortality of patients with SSI, and their underfunding, calls for a maximization of efforts to prevent SSI through the use of evidence-based SSI-reduction care bundles.

In the German hospital reimbursement system (G-DRG) endoscopic procedures are listed in cost center 8. For reimbursement between hospital departments and external providers outdated or incomplete catalogues (e. g. DKG-NT, GOÄ) have remained in use. We have assessed the cost for endoscopic procedures in the G-DRG-system. To assess the cost of endoscopic procedures 74 hospitals, annual providers of cost-data to the Institute for the Hospital Remuneration System (InEK) made their data (2011 - 2015; § 21 KHEntgG) available to the German-Society-of-Gastroenterology (DGVS) in anonymized form (4873 809 case-data-sets). Using cases with exactly one endoscopic procedure (n = 274 186) average costs over 5 years were calculated for 46 endoscopic procedure-tiers. Robust mean endoscopy costs ranged from 230.56 € for gastroscopy (144 666 cases), 276.23 € (n = 32 294) for a simple colonoscopy, to 844.07 € (n = 10 150) for ERCP with papillotomy and plastic stent insertion and 1602.37 € (n = 967) for ERCP with a self-expanding metal stent. Higher costs, specifically for complex procedures, were identified for University Hospitals. For the first time this catalogue for endoscopic procedure-tiers, based on § 21 KHEntgG data-sets from 74 InEK-calculating hospitals, permits a realistic assessment of endoscopy costs in German hospitals. The higher costs in university hospitals are likely due to referral bias for complex cases and emergency interventions. For 46 endoscopic procedure-tiers an objective cost-allocation within the G-DRG system is now possible. By international comparison the costs of endoscopic procedures in Germany are low, due to either greater efficiency, lower personnel allocation or incomplete documentation of the real expenses.

Zusammenfassung Hintergrund: In der Abrechnungssystematik der Deutschen Krankenh?user (G-DRG-System) sind endoskopische Leistungen weder vollst?ndig noch kostengerecht abgebildet. Hauptursache ist eine Zuordnung der Personalkosten aufgrund veralteter Leistungskataloge sowie das Fehlen einer verpflichtenden Zeiterfassung der Personalbindung. Methodik: Zur Erstellung eines zeitgem??en Leistungskatalogs wurden der DGVS von 50 Kalkulationskrankenh?usern des Instituts f?r das Entgeltsystem im Krankenhaus (InEK) die kompletten gastroenterologischen Kostendatens?tze (2011???2013; ??21,4 KHEntgG) anonymisiert ?berlassen (2499?900 Falldatens?tze) und aus diesen alle Operationen und Prozedurenschl?ssel (OPS) endoskopischer Leistungen in Leistungsgruppen (z.?B. Koloskopie mit Biopsie/Koloskopie mit Stenteinlage)?klassifiziert. Eine Expertengruppe ordnete die Leistungsgruppen nach Fallschwere und wies ihnen gesch?tzte Personalbindungszeiten zu. Von Juni bis November 2014 wurde der Leistungskatalog an 119 Krankenh?usern mittels exakter Personalzeiterfassung in der Endoskopie validiert (38?288 Prozeduren). Ergebnisse: Dieses 3-stufige Vorgehen hat, in enger Abstimmung mit dem InEK, die Erstellung eines zeitgem??en Leistungskatalogs mit 97 Einzelleistungsgruppen erm?glicht, der ?ber 99?% aller durchgef?hrten endoskopischen Prozeduren abdeckt und diese anhand der gemessenen ?rztlichen Personalbindung gewichtet. W?hrend in der?Vergangenheit eine diagnostische Koloskopie im?Vergleich zur ?sophagogastroduodenoskopie (Standardwert 1,0) ein Relativgewicht von 1,13 aufwies, wird der Personalaufwand im Leistungskatalog sachgerechter mit 2,16 abgebildet. Bei der diagnostischen ERCP ?ndert sich das Relativgewicht von 1,7 auf 3,62. Leistungen mit hoher Personalbindung, die bisher nicht erfasst wurden, werden jetzt sachgerecht abgebildet (z.?B. ESD im Magen 16,74). Diskussion: Der neue, in Zusammenarbeit von ?ber hundert Krankenh?usern validierte Leistungskatalog bildet endoskopische Prozeduren in der Gastroenterologie nahezu vollst?ndig ab und weist diesen validierte Relativkostengewichte zu. Der Einsatz des Leistungskatalogs wird vom InEK als Ersatz f?r veraltete GO?-, DKG-NT- und Hauskataloge empfohlen und wird, bis zum fl?chendeckenden Einsatz der Zeiterfassung in der Endoskopie, wesentlich zu einer sachgerechteren Zuordnung der Kosten im deutschen DRG-System beitragen.

This novel service catalogue for GI-endoscopy almost completely covers all endoscopic procedures performed in German hospitals and assigns relative personnel-cost values based on actual physician time logs. It is to be included in the national coding recommendation and should replace all prior inventories for cost distribution. The catalogue will contribute to a more objective cost allocation and hospital reimbursement - at least until time tracking for endoscopy becomes mandatory.