Factors Influencing Inpatient Costs for Patients Undergoing Surgery for Intrauterine Lesions under DRG Payment

Objective To analyze the factors affecting the cost of hospitalization for patients and provide insights using the intrauterine lesion surgery group (DRG code NE19) as an example.

Methods This study was a retrospective cross-sectional study, with data from the first page of medical records of patients enrolled under NE19 at a comprehensive tertiary hospital in Beijing from March 15, 2022 to November 30, 2023. Influence factor selection and multifactorial linear regression analysis were conducted with hospitalization cost as the dependent variable, and patient's basic information, treatment information and key concern factors as independent variables. The profit and loss of medical records containing key factors and differences in indicators of hospitalization cost structure were analyzed in the context of clinical practice.

Results A total of 2213 valid medical records (all female patients) were included, with patients predominantly young and middle-aged women under 45 years of age (72.12%), and with 931 day surgery medical records (42.07%). The diagnosis records included 334(15.09%) multiple uterine leiomyomas, and 246(11.12%) pelvic adhesions. A total of 150(6.78%) medical records involved ovary- and tubal-related surgeries or manipulations, with 160(7.23%) main operations being laparoscopic hysterectomy of diseased uterine lesions and 38(1.72%) mechanical rotational excision of abnormal uterine tissue using transhysteroscopy. Linear regression analysis showed that whether or not ovarian and tubal surgical operations were involved (βi=0.30), whether or not the main operation was laparoscopic hysterectomy for uterine lesions (βi=0.30), and whether or not transhysteroscopic mechanical rotational excision of abnormal uterine tissue was used (βi=0.20) had a greater impact on hospitalization costs. In the analysis of the focal factors, the percentage of patients who experienced a deficit was higher for surgical operations involving the ovaries and fallopian tubes, whether the primary operation was laparoscopic hysterotomy for uterine lesions, multiple uterine leiomyosarcomas, and pelvic adhesions (all P < 0.05), and "whether or not transhysteroscopic mechanical rotational excision of abnormal uterine tissues was used" and "whether it was a day surgery" had a significant effect on several structural indicators of hospitalization costs (all P < 0.05).

Conclusions The NE19 group of hospitals in the study had a high loss rate, and factors such as the severity of the patient's condition and the use of new technologies affected hospitalization costs, suggesting that there is room for further optimization of the existing grouping scheme. Tiered payment standards can be set up for different tiers of healthcare institutions, and a sound and optimized exclusion mechanism can be used to promote the development of new technologies. The internal management of hospitals should encourage the development of daytime surgery to improve the efficiency of medical services.