[Patient selection in tertiary hospitals based on economic data: exemplified by visceral surgery]

With respect to economic aspects it remains questionable if tertiary hospitals should focus on operations with high complexity or if surgery for benign diseases should be performed as well.

Data from the Institute for Reimbursement in hospitals (InEK) were analyzed for esophageal and pancreatic surgery and for appendectomy, cholezystectomy and thyroid surgery.

Operations with a high complexity showed a slightly better revenue-cost relation. Earnings in esophageal and pancreatic surgery varied between 590 EUR and 1,977 EUR, while in operations for benign diseases it ranged from 492 EUR to 1,648 EUR. In patients with a longer hospital stay this advantage diminished. The cost-revenue ratio was much more stable for patients with appendectomy, cholezystectomy or thyroid resection.

For economic reasons tertiary hospitals need to treat not only oncology patients but also patients with benign diseases. The focus on surgery for malignant diseases is economically not recommended because the revenues may be drained by the costs particularly in patients with a longer hospital stay due to complications.