[Emergency hand surgery in the course of time : Clinical and economic aspects of inpatient and outpatient cases at a university hospital in the last decade].

Abstract

Background: Hand surgery departments nowadays face the challenge of operating profitably, training new specialists, managing increasing case numbers and implementing the required shift towards outpatient care in clinical practice.

Objective: The aim of this study was to describe the demographic and economic indicators of a university hospital and to examine the development of inpatient and outpatient case numbers over the past decade.

Material and methods: A retrospective data analysis was carried out for patients treated for hand injuries in the period from 2013 to 2023. The main diagnoses of cases were identified and descriptively analyzed using the International Classification of Diseases (ICD). In order to demonstrate a correlation, a linear regression model was calculated and a p-value <0.05 was considered significant.

Results: In total, 2918 cases were included over a decade starting in 2013. Out of these 776 cases were treated on an outpatient basis and two thirds of the patients were male. The patients were generally healthy with an average American Society of Anesthesiologists (ASA) status of 1.6 ± 0.6 and with a patient clinical complexity level (PCCL) of 0 in 79% of cases. Patient numbers increased continuously from 161 cases in 2013 to 393 cases in 2022 (p < 0.001). The most common main diagnosis was infectious hand diseases (L02.4-M65.14). This resulted in the most frequently assigned diagnosis-related group (DRG) being I32E (319 cases). For inpatient cases the average incision-to-suture time was 51:51 min and for outpatient cases 26:03 min. The revenue was on average 4372.90 € per inpatient case and 300.77 € per outpatient case. The rate of examinations by the German Medical Service of Health Funds (Medizinischer Dienst) was 19% over the entire observational period.

Conclusion: The increasing case numbers in the outpatient and inpatient sectors indicate a centralization and consolidation of hand surgical expertise in the region. There are significant revenue differences between outpatient and inpatient cases.