A Cost–Benefit Analysis of Minimally Invasive Versus Open Vein Harvesting in Cardiac Surgery Based on the German DRG System

Abstract

Background: A cost–benefit analysis of open vein harvesting (OVH) versus endoscopic vein harvesting (EVH) for leg wound complications in intermediate- and high-risk cardiac surgical patients was performed based on the German Diagnosis-Related Groups (G-DRG) in a retrospective cohort.

Methods: The highest Fowler score and EuroSCORE II were utilized as risk variables for leg wound infection. Risk adjustment (1:1) was performed to compare two groups of patients undergoing surgery with OVH or EVH techniques. Total costs, including costs of facilities, additional hospital stays, and personnel expenses based on Institute for the Hospital Remuneration System calculations, were compared with G-DRG reimbursements.

Results: The baseline characteristics of the two groups did not differ significantly. Thirty-four (41.8%) patients developed a wound healing disorder, 28 in the OVH group and 6 in the EVH group (p = 0.037). During the hospital stay, five (7.4%) patients in the OVH group had major leg wound healing disorders. Patients in the OVH group had a marginally longer hospital stay, though without statistical significance (14.3 vs. 11.7 days; p = 0.424). The total cost was 23,223€ for the OVH group compared with 18,627€ for the EVH group (p < 0.001); thus, the cost of the OVH group exceeded that of the EVH group by 4596€ based on G-DRG calculations.

Conclusion: EVH was associated with significant cost savings and fewer leg wound complications in intermediate- or high-risk patients. The G-DRG reimbursement system ended with the statement that case-based flat rates are not viable for hospitals treating vulnerable groups of patients.