Invited Commentary

Invited Commentary

The authors have made use of the Aristotle score. Complexity adjustment does more than merely help to evaluate surgical results [1]. The authors have shown that complexity scores correlated with hospital costs. They took this further and found that, at least according to the current German diagnosis-related groups (DRG), in their institution highly complex procedures were not adequately reimbursed. These findings emphasize once again the importance of thorough quality assurance. The German Society of Thoracic and Cardiovascular Surgery (GSTCVS) has published a paper on this issue [2]. However, even to date not all German institutions perform adequate quality assurance, and they are therefore not only insufficiently transparent but also fail to produce such detailed case-mix data. What if funding of congenital heart surgery in highly complex cases remains inadequate? Will this lead to changes in practice, i.e. abstaining from treating very sick and potentially “expensive” patients in specialized institutions? The two manuscripts could help to establish a task force within the GSTCVS to collect complexity adjusted data from a number of high-volume and low-volume institutions. This would provide information from other German states, different hospital administrations and their cost management. Ideally, nationwide complexity and risk stratification would help the German authorities such as the InEk to adapt risk-adjusted compensation.

References

• 1 Jacobs J P, Jacobs M L, Lacour-Gayet F G et al. Stratification of complexity improves the utility and accuracy of outcomes analysis in a multi-institutional congenital heart surgery database: application of the risk adjustment in congenital heart surgery (RACHS-1) and Aristotle systems in the Society of Thoracic Surgeons (STS) congenital heart surgery database.  Pediatr Cardiol. 2009;  30 1117-1130
• 2 DGTHG . Struktur chirurgischer Einheiten zur Behandlung angeborener Herzfehler.  Thorac Cardiov Surg. 2006;  54 73-77