Immunonutrition and Postoperative Complications under G-DRG's A Comparison of Complication Costs with their Actual G-DRG-Based Reimbursement Rates of Patients Undergoing Major Gastrointestinal Surgery with and without the Perioperative Use of Immunonutrition

Background: Aim of this studywas to evaluate the economic impact of immunonutrition given perioperatively in patients undergoing major gastrointestinal surgery under G-DRG conditions. Material and methods: Basis of this evaluation were clinical and economical data from two prospective, randomised, double-blind, placebo controlled multi centre studies published by Senkal et al. in the years 1995 and 1998. Direct resource use for diagnosis and therapy of the postoperative complications during hospital stay were assessed and valued with actual (year 2002) hospital purchasing prices or by using the DKG-NT tariff. Indirect costs (e.g. for work absenteeism) were not included. The complication costs were compared with the actual G-DRG based reimbursement rates and differences between immune and control nutrition were evaluated. Results: 69 of 308 patients developed postoperative complications, 27 out of 155 patients in the immunonutrition group and in 42 out of 153 patients in the control group (p = 0.012). The average cost including nutrition per patient treated for treating complications were 563 vs. 979 Euro (sic) ( immunonutrition vs. control). A considerably better cost effectiveness of 681 (sic) was calculated for the immunonutrition group compared to 1350 (sic) in the control group. The total complication related costs per group amounted to 67,438 (sic) in the immunonutrition group vs. 147,076 (sic) in the control group, with nutrition included 87,212 vs. 149,837 (sic). Complication reimbursement based on G-DRG was calculated to be 178,084 (sic) in the immunonutrition group and 277,259 (sic) in the control group. For each patient with postoperative complication(s) a reimbursement surplus of 3366 (sic) remained in the immunonutrition group and of 3034 (sic) in the control group. Conclusion: Based on the present economic evaluation, the use of immunonutrition can be recommended also under G- DRG conditions. Even with higher nutritional costs the perioperative use of immunonutrition results in an additional surplus of 332 (sic) per patient with postoperative complication(s) compared to control.