[Optimisation of the efficiency and cost structure of LVA operations at a university hospital]

The increasing number of lymphatic surgery procedures in recent years has led to an increased economic relevance of plastic surgery departments. The high time variance associated with microsurgical LVA procedures makes surgical planning more challenging and hampers optimal capacity utilisation. In addition, there is currently no data on the adequate representation of the surgical costs in the InEK (Institute for the Hospital Remuneration System) matrices of the DRGs to be billed.By analysing a total of 69 patient cases with LVA surgery, the influence of patient-specific and independent parameters as well as the choice of anaesthesia on the incision-suture time was investigated. After breaking down the surgical costs using cost object accounting, the revenue generated was calculated depending on the DRG. A cost-effectiveness analysis of LVA surgeries and benchmarking with other clinics was then performed.Patient-independent parameters such as the surgeon's experience and the number of anastomoses have a significant influence on the duration of the surgery, whereas patient-specific factors such as comorbidities are of minor importance. Regarding the surgical costs incurred in relation to the amounts calculated by InEK, there was a large discrepancy in the reimbursement amounts depending on the DRG billed, with some of the costs found to be inadequately covered. The training costs for LVA operations exceeded €200.The choice of the DRG to be billed has a decisive influence on the economic viability of LVA operations in the German healthcare system. In addition, inclusion or modulation of patient-independent parameters can optimise surgical planning, resulting in a more efficient use of operating room capacity and improved cost-effectiveness. Training costs are not adequately reflected in LVA surgeries.