{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T23:28:11Z","timestamp":1786577291389,"version":"build-2736575974"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Handchir Mikrochir Plast Chir"],"abstract":"Zusammenfassung<\/jats:title>\n Die autologe Brustrekonstruktion mittels Deep Inferior Epigastric\n Perforator(DIEP)-Lappenplastik gilt aufgrund der Schonung der\n Rektusmuskulatur, nat\u00fcrlicher \u00c4sthetik und hoher Patientinnenzufriedenheit\n als etabliertes Standardverfahren. Gleichzeitig ist sie ressourcenintensiv.\n Fallbezogene gesundheits\u00f6konomische Daten zur Wirtschaftlichkeit im\n deutschen DRG-System sind bislang begrenzt.<\/jats:p>\n Retrospektive monozentrische Fallkostenanalyse von 18 Patientinnen, die 2023\n eine einseitige DIEP-Lappenplastik ohne perioperative Komplikationen und\n ohne DRG-relevante Nebendiagnosen erhielten. Erfasst wurden direkt\n zuordenbare medizinische Kosten der pr\u00e4operativen, perioperativen und\n nachstation\u00e4ren Phase. Die Erl\u00f6sanalyse erfolgte anhand der aG-DRG J01Z\n unter separater Ber\u00fccksichtigung des Pflegeentgelts. Erg\u00e4nzend wurden f\u00fcnf\n Experteninterviews qualitativ ausgewertet.<\/jats:p>\n Die mittleren direkten Gesamtkosten betrugen 9829,07 \u20ac pro Patientin. Der\n gr\u00f6\u00dfte Kostenanteil entfiel auf die perioperative Phase, insbesondere auf\n den Operationsabschnitt mit 5792,27 \u20ac. Dem mittleren DRG-Erl\u00f6s von 14\u2009017,05\n \u20ac stand bei Betrachtung direkter Kosten ein positiver Deckungsbeitrag von\n 4192,65 \u20ac gegen\u00fcber. Unter Annahme indirekter Kosten von bis zu 50% stiegen\n die Gesamtkosten auf 14\u2009738,94 \u20ac, wodurch bei alleiniger DRG-Verg\u00fctung ein\n Defizit von 721,89 \u20ac resultierte. Erst durch das zus\u00e4tzliche Pflegeentgelt\n von 1606,85 \u20ac ergab sich ein geringer positiver Gesamtsaldo von 884,97 \u20ac pro\n Fall.<\/jats:p>\n Die einseitige DIEP-Lappenplastik kann unter den genannten Bedingungen im\n Sinne eines selektionierten Best-Case-Szenarios im deutschen DRG-System\n knapp kostendeckend sein. Die wirtschaftliche Tragf\u00e4higkeit bleibt jedoch\n fragil und wird wesentlich durch indirekte Kosten, Pflegeentgelt,\n Prozessstandardisierung und strukturelle Vorhalteleistungen beeinflusst.\n K\u00fcnftige Verg\u00fctungsmodelle sollten Prozesskomplexit\u00e4t, Zentrumsstrukturen\n und patientenbezogene Langzeitergebnisse st\u00e4rker ber\u00fccksichtigen.<\/jats:p>","DOI":"10.1055\/a-2924-3028","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T23:02:32Z","timestamp":1786575752000},"source":"Crossref","is-referenced-by-count":0,"title":["Zwischen klinischem Goldstandard und \u00f6konomischer Herausforderung:\n Fallkostenanalyse zur Wirtschaftlichkeit der autologen\n Brustrekonstruktion"],"prefix":"10.1055","author":[{"given":"Vadym","family":"Burchak","sequence":"first","affiliation":[{"name":"Klinikum N\u00fcrnberg, Paracelsus Medizinische Universit\u00e4t\n M\u00fcnchen, BY, Germany","place":["Nuremberg"],"department":["Klinik f\u00fcr Plastische, Wiederherstellende und Handchirurgie, Zentrum f\u00fcr\n Schwerbrandverletzte"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Bauer","sequence":"first","affiliation":[{"name":"Allensbach Hochschule, BW, Germany","place":["Konstanz"],"department":["Wirtschaftsp\u00e4dagogik"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9394-8412","authenticated-orcid":false,"given":"Denis","family":"Ehrl","sequence":"additional","affiliation":[{"name":"Klinikum N\u00fcrnberg, Paracelsus Medizinische Universit\u00e4t\n M\u00fcnchen, BY, Germany","place":["Nuremberg"],"department":["Klinik f\u00fcr Plastische, Wiederherstellende und Handchirurgie, Zentrum f\u00fcr\n Schwerbrandverletzte"]},{"name":"Klinikum der Universit\u00e4t M\u00fcnchen,\n Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, BY, Germany","place":["Nuremberg"],"department":["Abteilung f\u00fcr Hand-, Plastische und \u00c4sthetische Chirurgie"]},{"name":"Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, BY, Germany","place":["Munich"],"department":["Ludwig-Maximilians-Universit\u00e4t"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konrad","family":"Karcz","sequence":"additional","affiliation":[{"name":"Klinikum N\u00fcrnberg, Paracelsus Medizinische Universit\u00e4t\n M\u00fcnchen, BY, Germany","place":["Nuremberg"],"department":["Klinik f\u00fcr Plastische, Wiederherstellende und Handchirurgie, Zentrum f\u00fcr\n Schwerbrandverletzte"]},{"name":"Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, BY, Germany","place":["Munich"],"department":["Ludwig-Maximilians-Universit\u00e4t"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3746-7838","authenticated-orcid":false,"given":"Nikolaus","family":"Wachtel","sequence":"additional","affiliation":[{"name":"Klinikum der Universit\u00e4t M\u00fcnchen,\n Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, BY, Germany","place":["Nuremberg"],"department":["Abteilung f\u00fcr Hand-, Plastische und \u00c4sthetische Chirurgie"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Nuernberger","sequence":"additional","affiliation":[{"name":"Klinikum N\u00fcrnberg, Paracelsus Medizinische Universit\u00e4t\n M\u00fcnchen, BY, Germany","place":["Nuremberg"],"department":["Klinik f\u00fcr Plastische, Wiederherstellende und Handchirurgie, Zentrum f\u00fcr\n Schwerbrandverletzte"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3614-9600","authenticated-orcid":false,"given":"Moritz","family":"Billner","sequence":"additional","affiliation":[{"name":"Klinikum N\u00fcrnberg, Paracelsus Medizinische Universit\u00e4t\n M\u00fcnchen, BY, Germany","place":["Nuremberg"],"department":["Klinik f\u00fcr Plastische, Wiederherstellende und Handchirurgie, Zentrum f\u00fcr\n 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