Mastectomies for malignancy: A DRG‐based hospital utilization analysis

Abstract

The study identified hospital utilization patterns by diagnosis-related group (DRG) produced by mastectomies for malignancy in Sacramento, California, and Syracuse, New York, for the years 1981-1984. A total of 3,449 discharges were included. Total and subtotal mastectomy discharges per capita increased in both areas. The proportion of mastectomy discharges attributed to total mastectomies increased in Sacramento and decreased in Syracuse. Mean stays for mastectomy DRGs declined by 13.72 to 56.38%. In 1984 mean stays ranged from 4.79 to 7.49 days for total mastectomies and 1.88 to 5.44 days for subtotal mastectomies. A major problem identified by the study was the lack of DRG sensitivity to differences in types of procedures. Under DRGs, radical and simple mastectomies are combined in one type of category, while subtotal mastectomies, quadrant resections, and breast biopsies are combined in another.

Challenges and Adverse Outcomes of Implementing Reimbursement Mechanisms Based on the Diagnosis-Related Group Classification System: A systematic review

“…Of these, the majority (n = 28; 77.8%) were published in 1990 or before. [15][16][17][18][19][20][21]23,24,[27][28][29]31,34,35,[37][38][39][40][41][42][43][44][45][46]48,49 Most studies (n = 31; 86.1%) were set in the USA. [15][16][17][18][19][20][21][22][23][24][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]…”

“…A total of 29 studies (80.6%) were quantitative in nature. [14][15][16][17]19,[21][22][23][24][26][27][28]31,32,[34][35][36][37][38][39][40][42][43][44][45][46][47][48][49] In addition, there were three qualitative (8.3%) and four mixed-method (11.1%) studies. 18,20,25,29,30,33,41 In terms of quality assessment, qualitative, quantitative and mixedmethod studies received scores of >70%, >80% and >85%, respectively; however, quantitative studies were generally higher in quality compared to qualitative and mixed-method studies [ Table 1].…”

“…upgrading or upcoding patients). [25][26][27][28]31,32,37,42,47 Personnel-related challenges were also reported by eight studies (22%); of these, one of the most important was a lack of familiarity among physicians with the DRG classification system and misconceptions regarding the objectives of the mechanism. 25,29,30,33,34,41,42,48,49 No leadership challenges were reported by any of the studies.…”

Evaluation of a short‐stay program for patients undergoing mastectomy

“…Comparing all total mastectomy vs. segmental mastectomy operations regardless of whether a node dissection was performed further exemplifies the trend toward breast-sparing surgery (Table 11). The increased use of breast-sparing procedures has been documented recently based on frequency of various DRG utilization analysis [ 3 ] . Despite criticism that subtotal mastectomy and radiation is a more expensive form of treatment than total mastectomy [4], factors including immediate psychological benefits to the patient, lack of need for reconstruction, and equivalent curative efficacy must also be considered.…”

“…The type of operation, drains used (number and type), perioperative and postoperative complications, day of drain(s) removal, pathological evaluation of resected specimen, pathological stage (TNM), and summary of associated medical conditions were recorded for all patients. The medical conditions (neurologic, pulmonary, cardiac, vascular, gastrointestinal, rheumatoid, muscular, metabolic, and social) were graded none (0), minimal (l), moderate-good control ( 2 ) , and severe-poor control (3). A value was calculated for each patient by adding the individual values.…”