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Starosta DA, Gräf M. [Change in the age spectrum in strabismus surgery]. DIE OPHTHALMOLOGIE 2024; 121:123-128. [PMID: 37962589 DOI: 10.1007/s00347-023-01955-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The proportion of children undergoing strabismus surgery in the total volume of eye muscle operations appears to have decreased. To verify this we analyzed the age of patients who underwent extraocular muscle (EOM) surgery. METHODS The data of patients who underwent EOM surgery at the University Eye Hospital Giessen between 1991 and 2019 were reviewed and the numbers of operations in decadal age groups were compared to the German population in the respective period. In addition, the types of strabismus which led to surgery were evaluated. The data pool comprised > 25,000 surgeries involving > 60,000 muscles. RESULTS In comparison to 1991, in 2019 the proportion of children aged ≤ 10 years decreased from 50.2% to 31.8%, corresponding to a relative decrease of more than one third. The proportion of patients aged > 50 years increased from 6.5% to 22.5%, i.e., by a factor > 3, while the population ≤ 10 years in 2019 was 13% smaller than in 1991 and the population aged > 50 years increased by 37%. The major reason for the decreasing proportion of children was a 53% reduction in surgery for esotropia. We found no apparent changes in the 2nd-5th decades of life. DISCUSSION AND CONCLUSION The lower proportion of children undergoing EOM surgery appears to indicate an improvement in vision screening during the past 4 decades. The increasing proportion of older patients may result from better information on potential treatment and increased incidence of acquired strabismus with corresponding complaints. The demographic shift played a secondary role. Due to the population structure in Germany, a further increase in the demand for EOM surgery is to be expected.
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Affiliation(s)
- Daniela A Starosta
- Klinik und Poliklinik für Augenheilkunde, Standort Gießen, Universitätsklinikum Gießen und Marburg GmbH, Friedrichstr. 18, 35385, Gießen, Deutschland.
- Universitätsaugenspital Basel, Mittlere Str. 91, 4031, Basel, Schweiz.
| | - Michael Gräf
- Klinik und Poliklinik für Augenheilkunde, Standort Gießen, Universitätsklinikum Gießen und Marburg GmbH, Friedrichstr. 18, 35385, Gießen, Deutschland
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Heydweiller AC, König TT, Yavuz ST, Schwind M, Oetzmann von Sochaczewski C, Rohleder S. [Influencing factors on operating times for metal bar removal after Nuss repair]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:796-803. [PMID: 37353682 PMCID: PMC10447265 DOI: 10.1007/s00104-023-01914-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Metal bar removal after the Nuss repair procedure is prone to be cancelled in cases of operating time shortages due it being suitable to be postponed without harming patients. Consequently, planning operation times as exactly as possible could be one solution. OBJECTIVE Statistical modelling of operation times of metal bar removal after Nuss repair using the prespecified independent predictors of age, sex, intraoperative complications, and number of implanted metal bars. MATERIAL AND METHODS We included all patients whose operation notes included an operation time, which was modelled via linear regression and subject to internal validation via bootstrap. Exploratory analyses also consisted of the surgeon's experience, the number of stabilizers, the body mass index, and preceding re-do surgery for bar dislocation. RESULTS We included 265 patients (14% ♀) with a median age of 19 years (interquartile range 17-20 years), of whom 81% had 1 and 17% had 2 metal bars removed. The prespecified regression model was statistically significant (likelihood ratio 56; df = 5; P < 0.001) and had a bias corrected R2 of 0.148. Patient age influenced operation times by 2.1min per year of life (95% confidence interval 1.3-2.9min; P < 0.001) and 16min per explanted metal bar (95% confidence interval: 10-22min; P < 0.001). CONCLUSION The patient-specific factors of age and the number of explanted metal bars influenced the operation times and can be included into scheduling operation times.
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Affiliation(s)
- Andreas C Heydweiller
- Sektion Kinderchirurgie der Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Tatjana T König
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - S Tolga Yavuz
- Klinik für Allgemeine Pädiatrie, Universitätsklinik Bonn, Bonn, Deutschland
| | - Martin Schwind
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Christina Oetzmann von Sochaczewski
- Sektion Kinderchirurgie der Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland.
- Sektion Kinderchirurgie, Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Stephan Rohleder
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz, Mainz, Deutschland
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Framme C, Kuiper T, Lobbes W, Gottschling J, Scheinichen D, Hufendiek K, Palmaers T, Tode J, Volkmann I, Lammert F. [Economics of operating room use at a university eye hospital]. DIE OPHTHALMOLOGIE 2023; 120:7-19. [PMID: 35925355 DOI: 10.1007/s00347-022-01689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/08/2022] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND In ophthalmologic surgery, there are usually short operation times and thus many changes between the individual operations, which are not subject to remuneration. As in maximum care hospitals consecutive different operations with different durations are often performed, emergency operations have to be inserted and further training of colleagues is practiced, it is particularly important to generate the shortest possible transfer times in order to have both sufficient operation time and to be able to treat as many cases as possible. The aim of this work is to evaluate the efficiency of the surgical performance of a university eye hospital. MATERIAL AND METHOD The surgeries performed in 2021 at the MHH Eye Clinic were evaluated with respect to the spectrum, number, surgery duration, transfer times and process times. In terms of personnel, each operating room was staffed with one assistant anesthesiologist, one nurse anesthetist, two operating room nurses, one surgeon, and 20% senior anesthesiologist supervision. Based on a theoretical concept, which provides an increased staffing ratio while maintaining the same infrastructure, it was calculated how many more surgeries could be performed if the transfer time was halved and whether the additional financial expense could be compensated. RESULTS With a total of n = 2712 surgeries performed during regular duty hours (244 working days) in 2 operating rooms (average daily n = 11.1; weekly n = 53.6 and monthly n = 237.1), the average surgery duration was 37 min and the transition time 43 min. This means that the operating rooms were used for surgery for 51% of the total operating time. Main procedures were vitrectomy with n = 1350 and cataract surgery with n = 1308. The new personnel concept provided one additional operating room nurse per operating room and one additional anesthesiologist for both operating rooms. The additional costs for this personnel expenditure were calculated at approx. 300,000 € per year. The halving of the transfer time from 43 min to about 21 min through possible overlapping induction and parallel work, which was not possible until now, results in an additional operation time of about 100 min per operating room, so that at least 4 additional operations can be planned and performed. In this way, with stringent implementation and the same spatial structures with stable fixed costs, n = 976 more operations could be performed, which, minus the personnel costs, the additional material costs for surgery and anesthesia of 557,042 € and the inpatient hotel costs of 600,663 €, with an average length of stay of 2.8 days, would result in an additional revenue of about 2.4 times the additional personnel costs at the current flat rate of 3739.40 € and an average case mix index of the MHH Eye Hospital of 0.649 (total revenue: 2,155,449 €; profit margin II: 701,389 €) for the considered surgical patient collective in 2021. CONCLUSION An increase of the personnel expenditure in the operating room for surgical subjects such as ophthalmology with shorter interventions and many changes is economically worthwhile also for a large hospital in order to enable and optimize overlapping transfers of anesthesia and surgical care. This should therefore also be considered separately, contrary to standardized staffing of the overall hospital, in order to use existing resources with their fixed costs as optimally as possible.
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Affiliation(s)
- C Framme
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland.
| | - T Kuiper
- Stabsstelle OP-Management, Ressort Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - W Lobbes
- Stabsstelle OP-Management, Ressort Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - J Gottschling
- Stabsstelle Klinische Leistungsentwicklung, Ressort Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - D Scheinichen
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - K Hufendiek
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - T Palmaers
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - J Tode
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - I Volkmann
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - F Lammert
- Vorstandsmitglied für das Ressort Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
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Yang L, Min Y, Jia Z, Wang Y, Zhang R, Sun B. Medical expenditure for strabismus: a hospital-based retrospective survey. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:27. [PMID: 35752832 PMCID: PMC9233768 DOI: 10.1186/s12962-022-00363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background and aims The misconception of the purpose of strabismus treatment has, on the one hand, affected the motivation of strabismus patients to seek care and, on the other hand, has resulted in strabismus not being covered by health insurance, both of which interact to limit the motivation of strabismus patients and also impose a financial burden on strabismus patients. Previous studies on the cost of strabismus had only addressed the cost utility and functional and psychosocial benefits of strabismus surgery. The aim of this study was to estimate the direct medical expenditure incurred for strabismus surgery and analyze the trend for the period 2014–2019 using the data collected by local eye hospitals in northeast China. Methods This study was based on 6-year strabismus medical expenditure data collected from the eye hospital of the first affiliated hospital of Harbin medical university, covering 3596 strabismus patients who had strabismus surgery. All medical expenditure data were adjusted to 2014 using China’s annual consumer price index to remove the effects of inflation. Results The average direct medical expenditure for strabismus cares (in 2014) was 5309.6 CNY (US$870.4), and the annual growth rates from 2015 to 2019 (compared with the previous year) were 9.3, 7.7, 21.7, 14.5, and 4.3%, respectively. Surgical expenses accounted for the highest proportion (33.1%) of the total medical expenses followed by examinations expenses (19.7%) and medical consumables expenses (18.7%). The regression coefficient for general anaesthesia was 1804.5 and age was less than 0. Conclusion The average direct medical expenditure for strabismus increases year by year, and the growth rate is rapid. Anesthesia was the most important factor increasing medical cost, and age was negatively correlated with cost.
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Affiliation(s)
- Lei Yang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yiduo Min
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhiyan Jia
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Yupeng Wang
- Department of Biostatistics, Harbin Medical University, Harbin, Heilongjiang, China
| | - Rihui Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Bitong Sun
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Framme C, Dittberner M, Rohwer-Mensching K, Gottschling J, Buley P, Hufendiek K, Hufendiek K, Junker B, Tode J, Lammert F, Volkmann I. [Performance and cost calculation for a university ophthalmological outpatient clinic]. Ophthalmologe 2022; 119:46-54. [PMID: 34802069 PMCID: PMC8605894 DOI: 10.1007/s00347-021-01529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND Outpatient procedures at a university hospital are generally considered to be unprofitable. In the present publication we evaluate the turnover and costs of the university eye outpatient department of the Hannover Medical School (MHH) in terms of a cost unit accounting as well as providing a summary of the workload. MATERIAL AND METHOD Given the data of the hospital information system (IS-H/i.s.h.med from SAP) and a proprietary software (TimeElement), all patient contacts in the year 2019 were evaluated. The latter software is applied in a standardized manner to record the patient flow of our outpatient service in real time electronically. The total costs consist of personnel, material and room costs including infrastructure of the MHH and are compared to the flat-rate revenues according to the university outpatient contract (HSA) as well as further revenues from internal referral services, self-pay patients, outpatient surgery and cooperation contracts for intravitreal injections (IVOM). RESULTS With an average full-time equivalent (FTE) headcount of 10.63 assistant physicians, 3.6 specialist physicians, and 21 nonphysicians (plus 4 Federal Volunteer Service, BUFDI) in our policlinic, we have determined € 2,927,022 in personnel costs, including overheads, for the entire year. Including infrastructure (€ 524,942), material and equipment costs with overheads and internal cost allocation of € 258.657, the total costs in 2019 resulted in € 3,710,621. In contrast, the total income in 2019 was € 3,524,737 generated through the abovementioned patient segments, resulting in a deficit of € -185,884 (5%). Our data provide evidence that regular outpatient revenues are insufficient and are mainly balanced by outpatient surgery, IVOMs and self-pay patients. In total, there were 19,453 patient contacts during regular office hours (with 17,305 billable cases). At n = 9943, the majority of the contacts were HSA visits; however, only 82% of the cases could effectively be charged due to multiple visits per quarter. The median total patient attendance was 3.21 h (mean 3.38 h). On average, 78 patient contacts were counted per working day. The analysis with TimeElement unveiled a median of n = 2 physician contacts per patient (mean n = 1.91). The median duration per interaction with a physician was 17.98 min (mean 23.23 min). For diagnostics, we counted a median of n = 2 interactions per patient (mean n = 2.31), with an entire interaction lasting a median of 18.30 min (mean 22.60 min). In total n = 37,363 individual diagnostic procedures were recorded in 2019, with SD-OCT being the primary procedure at n = 10,888. CONCLUSION The cost/turnover calculation showed a marginal financial loss through our ophthalmological outpatient department. Thus, the costs of a university eye outpatient department in Lower Saxony do not seem to be sufficiently covered by direct outpatient revenues. Maintaining quarterly flat rates for all cases of the outpatient department would require a fee of about € 214 in our setting to remain cost neutral. Currently, the lower flat rates in the HSA area are compensated by other areas. Obviously, the high content-related workload in our setting requires a high personnel expenditure with a considerable personnel cost contribution of nearly 80%.
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Affiliation(s)
- C Framme
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland.
| | - M Dittberner
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
- TimeElement, Stampfenbachstr. 52/56, 8092, Zürich, Schweiz
| | - K Rohwer-Mensching
- Zentrum für Informationsmanagement (ZIMT), Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - J Gottschling
- Stabsstelle Klinische Leistungsentwicklung des Vorstands für Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - P Buley
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - K Hufendiek
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - K Hufendiek
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - B Junker
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - J Tode
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - F Lammert
- Vorstand für Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - I Volkmann
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
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[Influence of COVID-19 shutdown on the workload of a university eye clinic]. Ophthalmologe 2021; 118:659-669. [PMID: 33881590 PMCID: PMC8059426 DOI: 10.1007/s00347-021-01374-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/09/2021] [Accepted: 03/15/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The outbreak of the novel coronavirus disease 2019 (COVID-19) has led to a significant reduction in the number of patients treated in elective medicine in hospitals in spring 2020. Up until now, there are no corresponding data for university policlinics. MATERIAL AND METHODS With the help of the data of the clinic's electronic medical record system (IS-H/i.s.h.med from SAP, Cerner Corporation, North Kansas City, MO, United States of America and SAP SE, Walldorf, Germany) and the time recording and management software TimeElement (Hannover Medical School, Hannover, Germany), which was codeveloped at our clinic, all patient contacts of the COVID-19 shutdown were evaluated over a period of approximately 7 weeks from 18 March 2020 to 8 May 2020 and compared with the same period in 2019. In addition, quarterly revenues for the first and second quarters of 2019 and 2020 were put into perspective via SAP. RESULTS During the COVID-19 period the total number of patient contacts was reduced by 59.5% compared to the previous year. The number of lockdown period cases decreased by 74.8% compared to the same period in 2019. In particular, the university outpatient/self-paying sector recorded the largest number of lost patient contacts with a reduction to 17.2% of the 2019 baseline. The reduced patient contacts and case numbers resulted in a significant financial loss of at least € 218,000. Via TimeElement there was a 69.4% decrease in all special diagnostic services, with visual field examinations in particular also reduced by 75.3%. Optical coherence tomography (OCT) measurements recorded a decrease of 60.3%. Patient tracking revealed a reduction of average patient attendance times by approximately 23% (COVID 19: 145.8 ± 88.8 min versus 189.6 ± 97.2 min in 2019). DISCUSSION The COVID-19 shutdown caused the work performance of our policlinic to drop to only about 40% of patient contacts and that of functional diagnostic examinations to only about 30%, compared to the performance in 2019; however, the reduction in the number of patients also led to a significant reduction in the time patients were present at the clinic compared to the regular workload. The associated financial losses are considerable and obviously not compensated by legally regulated compensation payments as in the inpatient sector.
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