Subscribe to RSS
DOI: 10.1055/s-2005-858954
© Georg Thieme Verlag KG Stuttgart · New York
Chronischer Hydrozephalus nach aneurysmatischer Subarachnoidalblutung im Zeitalter von German Diagnose Related Groups (G-DRG)
Chronic Hydrocephalus after Aneurysmatic Subarachnoid Hemorrhage in the Age of German Diagnose Related Groups (G-DRG)Publication History
Publication Date:
10 August 2006 (online)
![](https://www.thieme-connect.de/media/gesqm/200604/lookinside/thumbnails/10.1055-s-2005-858954-1.jpg)
Zusammenfassung
Hintergrund: Das derzeitige DRG-System vergütet eine Folgeoperation nur dann, wenn der Patient 30 Tage nach Entlassung wieder stationär aufgenommen wird. Bei Patienten mit Subarachnoidalblutung ist eine zweite Operation wegen eines chronischen Hydrozephalus nicht selten notwendig. Ziel dieser Studie ist es, die Häufigkeit der Shuntimplantation nach Subarachnoidalblutung (SAB) zu untersuchen und dies in Beziehung zum derzeitigen Entgeltsystem zu setzen. Material und Methoden: Die Krankenakten von insgesamt 274 SAB Patienten (mittleres Alter 49 ± 11 Jahre, männlich zu weiblich 1:1,5) wurden retrospektiv aufgearbeitet. Folgende epidemiologische Faktoren wurden erhoben: Alter, Hunt-&-Hess-Grad, Fisher-Grad im ersten CT, Vasospasmus, akuter und chronischer Hydrozephalus, Zeitpunkt der Shuntanlage. Ergebnisse: Insgesamt benötigten 24,1 % aller Patienten einen Shunt nach SAB. Risikofaktoren waren akuter Hydrozephalus, höherer Hunt-&-Hess- und Fisher-Grad bei Aufnahme sowie Nachblutung. 77,7 % aller Shunts wurden während des stationären Aufenthaltes oder innerhalb von 30 Tagen nach Entlassung oder Verlegung gelegt. Nur 22 % aller Shunts wurden neu vergütet. Schlussfolgerung: Das derzeitige DRG-System sieht keine finanzielle Kompensation für fast 80 % aller Patienten mit chronischem Hydrozephalus nach SAB vor. Hier ist eine Neukalkulation der Vergütung erforderlich.
Abstract
Background: The current German hospital reimbursement system pays only for follow-up operations if the patient was readmitted to the hospital more than 30 days after discharge or transfer. The aim of this study was to test the hypothesis that CSF shunt operations after subarachnoid hemorrhage (SAH) are not adequately reimbursed. Material and Methods: A total of 274 SAH patients’ hospital charts (average age 49 ± 11 years, male:female = 1:1.5) were retrospectively reviewed. The following epidemiological parameters were recorded: age, Hunt & Hess grade, Fisher Grade on admission, vasospasm, acute/chronic hydrocephalus, recurrent bleeding, timing of CSF shunting. Results: A total of 24.1 % of patients required CSF shunting after SAH. Typical risk factors were acute hydrocephalus, higher Hunt & Hess and Fisher Grades and recurrent hemorrhage. Overall, 77.7 % of shunts were placed during the initial hospital stay or within 30 days after discharge or transfer. Only 22 % of shunting procedures were reimbursed. Conclusions: The current German reimbursement system does not compensate for almost 80 % of shunt operations after SAH. A revision of the system is necessary.
Schlüsselwörter
Subarachnoidalblutung - Shunt - DRG
Key words
Subarachnoid hemorrhage - shunt - reimbursement
Literatur
- 1 Clusmann H, Haun D, Schramm J. Implementation of documentation assistance and computerized workplace system: first experiences (Abstract). 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC) 2005 Straßburg; 2005
- 2 Bagley C J. Blood in the cerebrospinal fluid. Resultant functional and organic alterations in the central nervous system. A experimental data. Arch Surg. 1928; 17 18-38
- 3 Foltz E L, Ward A A. Communicating hydrocephalus from subarachnoid bleeding. J Neurosurg. 1956; 13 546-566
- 4 Hunt W E, Hess R M. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968; 28 (1) 14-20
- 5 Fisher C M, Kistler J P, Davis J M. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980; 6 (1) 1-9
- 6 Ohwaki K, Yano E, Nakagomi T. et al . Relationship between shunt-dependent hydrocephalus after subarachnoid haemorrhage and duration of cerebrospinal fluid drainage. Br J Neurosurg. 2004; 18 (2) 130-134
- 7 Dehdashti A R, Rilliet B, Rufenacht D A. et al . Shunt-dependent hydrocephalus after rupture of intracranial aneurysms: a prospective study of the influence of treatment modality. J Neurosurg. 2004; 101 (3) 402-407
- 8 Gruber A, Reinprecht A, Bavinzski G. et al . Chronic shunt-dependent hydrocephalus after early surgical and early endovascular treatment of ruptured intracranial aneurysms. Neurosurgery. 1999; 44 (3) 503-509; discussion 509 - 512
- 9 Pietila T A, Heimberger K C, Palleske H. et al . Influence of aneurysm location on the development of chronic hydrocephalus following SAH. Acta Neurochir (Wien). 1995; 137 (1 - 2) 70-73
- 10 Spallone A, Gagliardi F M. Hydrocephalus following aneurysmal SAH. Zentralbl Neurochir. 1983; 44 (2) 141-150
- 11 Torvik A, Bhatia R, Murthy V S. Transitory block of the arachnoid granulations following subarachnoid haemorrhage. A postmortem study. Acta Neurochir (Wien). 1978; 41 (1 - 3) 137-146
- 12 Massicotte E M, Del B igio MR. Human arachnoid villi response to subarachnoid hemorrhage: possible relationship to chronic hydrocephalus. J Neurosurg. 1999; 91 (1) 80-84
- 13 Kibler R F, Couch R SC, Crompton M R. Hydrocephalus in the adult following spontaneous subarachnoid hemorrhage. Brain. 1961; 84 45-61
- 14 Watanabe K, Miyazaki S, Hara K. et al . Neonatal EEG and computerized tomography. Neuropadiatrie. 1979; 10 (4) 348-360
- 15 Alksne J F, Lovings E T. The role of the arachnoid villus in the removal of red blood cells from the subarachnoid space. An electron microscope study in the dog. J Neurosurg. 1972; 36 (2) 192-200
- 16 Flood C, Akinwunmi J, Lagord C. et al . Transforming growth factor-beta1 in the cerebrospinal fluid of patients with subarachnoid hemorrhage: titers derived from exogenous and endogenous sources. J Cereb Blood Flow Metab. 2001; 21 (2) 157-162
- 17 Logan A, Berry M, Gonzalez A M. et al . Effects of transforming growth factor beta 1 on scar production in the injured central nervous system of the rat. Eur J Neurosci. 1994; 6 (3) 355-363
- 18 Klopfenstein J D, Kim L J, Feiz-Erfan I. et al . Comparison of rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage: a prospective randomized trial. J Neurosurg. 2004; 100 (2) 225-229
- 19 Drake J M, Sainte-Rose C. Shunt complications. Drake JM, Sainte-Rose C The shunt book Malden; Blackwell 1995: 123-192
Dr. med. Matthias Friedrich Oertel
Neurochirurgische Klinik Universitätsklinikum Gießen und Marburg - Standort Gießen
Klinikstrasse 29
35385 Gießen
Email: matthias.oertel@neuro.med.uni-giessen.de