Abstract
Background: Hospital costs are expected to correlate with clinical complexity. Do costs for congenital heart surgery correlate with Aristotle complexity scores? Methods: 442 inpatient stays in 2008 were evaluated. Aristotle scores and levels were determined. Costs were estimated according to the German Institute for Hospital Reimbursement system. Pearson and Spearman r correlation coefficients and corresponding goodness-of-fit regression coefficients r2
were calculated. Results: Mean basic and comprehensive Aristotle scores were 7.60 ± 2.74 and 9.23 ± 2.94 points, respectively. Mean expenses per hospital stay amounted to 29 369 ± 30 823 Euros. Aristotle basic and comprehensive scores and levels were positively correlated with hospital costs. With a Spearman r of 1 and related r2
of 0.9436, scores of the 6 Aristotle comprehensive levels correlated best. Mean hospital reimbursement was 26 412 ± 17 962 Euros. Compensation was higher than expenses for patients in comprehensive levels 1 to 3, but much lower for those in levels 4 to 6. Conclusions: Aristotle comprehensive complexity scores were highly correlated with hospital costs. The Aristotle score could be used as a scale to establish the correct reimbursement after congenital heart surgery.
Key words
cardiovascular surgery - heart defects - congenital - risk scores - health economy
References
-
1
Lacour-Gayet F, Clarke D, Jacobs J The Aristotle Committee et al.
The Aristotle score: a complexity-adjusted method to evaluate surgical results.
Eur J Cardiothorac Surg.
2004;
25
911-924
-
2
Jacobs J P, Lacour-Gayet F G, Jacobs M L et al.
Initial application in the STS congenital database of complexity adjustment to evaluate surgical case mix and results.
Ann Thorac Surg.
2005;
79
1635-1649
-
3
O'Brien S M, Jacobs J P, Clarke D R, Maruszewski B et al.
Accuracy of the Aristotle basic complexity score for classifying the mortality and morbidity potential of congenital heart surgery operations.
Ann Thorac Surg.
2007;
84
2027-2037
-
4
Clarke D R, Lacour-Gayet F, Jacobs J P et al.
The assessment of complexity in congenital cardiac surgery based on objective data.
Cardiol Young.
2008;
18 (Suppl. 2)
169-176
-
5
Heinrichs J, Sinzobahamvya N, Arenz C et al.
Surgical management of congenital heart disease: evaluation according to Aristotle score.
Eur J Cardiothorac Surg.
2010;
37
210-217
-
6
Jenkins K J, Gauvreau K, Newburger J W, Spray T L, Moller J H, Iezzoni L I.
Consensus-based method for risk adjustment for surgery for congenital heart disease.
J Thorac Cardiovasc Surg.
2002;
123
110-118
-
7
O'Brien S M, Clarke D R, Jacobs J P et al.
An empirically based tool for analyzing mortality associated with congenital heart surgery.
J Thorac Cardiovasc Surg.
2009;
138
1139-1153
-
8
Munoz E, Josephson J, Tenenbaum N, Goldstein J, Shears A M, Wise L.
Diagnosis-related groups, costs, and outcome for patients in the intensive care unit.
Heart Lung.
1989;
18
627-633
-
9
Antioch K M, Walsh M K.
The risk-adjusted vision beyond case mix (DRG) funding in Australia. International lessons in high complexity and capitation.
Eur J Health Econ.
2004;
5
95-109
-
10
Benavidez O J, Connor J A, Gauvreau K, Jenkins K J.
The contribution of complications to high resource utilization during congenital heart surgery admissions.
Congenit Heart Dis.
2007;
2
319-326
Dr. Nicodème Sinzobahamvya
Pediatric Cardio-Thoracic Surgery
Deutsches Kinderherzzentrum Sankt Augustin
Arnold-Janssen-Strasse 29
53757 Sankt Augustin
Germany
Phone: +49 22 41 24 96 01
Fax: +49 22 41 24 96 02
Email: n.sinzobahamvya@asklepios.com
