Health economic evaluation of polytrauma treatment in the current aG-DRG system – Results of a Level I Trauma Center

PURPOSE: Resource-intensive polytrauma care is associated with high treatment and readiness costs and poses a financial challenge for hospitals. The aim of this retrospective single-center study of the years 2020 to 2022 was to analyze polytrauma reimbursements and costs. METHODS: Based on billing and clinical data of 201 polytrauma cases from a German University Hospital and Level I Trauma Center, revenues and costs of the eleven MDC 21 A polytrauma DRGs were analyzed. Ratios of the revenue in relation to LOS, ventilation hours, OR time and implant costs as well as personnel costs were calculated. Contribution margins were determined as an upper-bound estimate. RESULTS: DRG reimbursement was highest for the most severely injured patients (50,852 €, DRG W36Z). It was lowest for patients who died within five days (2,214 €, DRG W60Z) or without surgeries (4,056 €, DRG W61B). The contribution margin was also highest for the most severely injured patients (52,775 €, DRG W36Z). Revenues in relation to ICU LOS (3,455 €/day, DRG W36Z) and ventilation time (238 €/hour, DRG W01B) were lowest for the most severe polytraumas. Regarding OR time and implant costs, reimbursement was lowest for injuries of the spine, pelvis and extremities with 62 €/min (DRG W02B) and 5 €/€ (DRG W02A). CONCLUSION: Treatment of polytrauma patients with long ICU stay, extended mechanical ventilation and multiple injuries of the extremities, pelvis and spine is not adequately reflected by the current per-case reimbursement in relation to the resources used (ICU days, ventilation hours, OR time and implant costs).