Analysis of DRG remuneration of acute fracture procedures versus elective total arthroplasty for the German health care system – Is elective total arthroplasty really more cost-effective?

Elective arthroplasty is considered a cost-effective procedure compared to trauma-related surgical interventions. This study aims to compare remuneration, certain ratios regarding implant costs, operation (OR) time and length of stay (LOS) as well as contribution margins including personnel costs for acute fracture interventions and elective arthroplasty procedures at the hip and shoulder joint in the aG-DRG system. Based on billing data of 212 inpatient treatment cases from a University Orthopaedic Trauma Department reimbursements of nail fixation and hemi-arthroplasty (HA) for proximal femoral fractures versus elective total hip arthroplasty (THA) for osteoarthritis were analysed. Locking plate fixation and reverse total shoulder arthroplasty (rTSA) for proximal humeral fractures were compared to elective rTSA for osteoarthritis. Different ratios of the DRG remuneration in relation to LOS, OR time and implant costs but also personnel costs and contribution margins were calculated. DRG reimbursement was highest for fracture arthroplasty of the shoulder (9.050 EUR, rTSA) and the hip (6.930 EUR, HA). Regarding LOS, DRG reimbursement was highest for elective rTSA (1.641 EUR/day). Nail fixation of proximal femoral fractures showed the highest DRG reimbursement regarding OR time (111 EUR/min) and implant costs (15 EUR/EUR). The contribution margin was highest for fracture rTSA (6.339 EUR) and lowest for elective THA (3.842 EUR). Elective total hip and shoulder arthroplasty is not generally more cost-effective in the aG-DRG system. Acute fracture-related interventions seem economically more advantageous with regard to implant costs and OR time, elective total arthoplasty seems more profitable regarding LOS in the hospital.