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International Journal for Quality in Health Care 16:51-57 (2004)
© International Society for Quality in Health Care and Oxford University Press 2004; all rights reserved

Exploring the impact of complications on length of stay in major surgery diagnosis-related groups

Julián Librero1, Manuel Marín1,2, Salvador Peiró1,2 and Alberto Verdaguer Munujos3

1 Fundación Instituto de Investigación en Servicios de Salud, Valencia,
2 Escuela Valenciana de Estudios para la Salud, Valencia,
3 Hospital de Mataró, Barcelona, Spain

Study objective. To analyze, in terms of the length of stay (LOS), the use of resources by patients classified under surgical diagnosis-related groups (DRGs) with complication and/or comorbidity (DRGCCs), divided into subgroups where complications were and were not detected, and to explore the repercussions on hospital reimbursement.

Design. The Complication Screening Program© (CSP) was used to divide the patients in 14 DRGCCs into subgroups with and without complications, and to compare the LOS between the subgroups and with the equivalent DRG without CC. The ratios between the LOS and the relative weight of the DRGs for reimbursement were also compared.

Setting. The population hospitalized for major surgery between 1995 and 1999 in the Hospital of Mataró, Catalonia, Spain.

Participants. Patients (4227) hospitalized for major surgery.

Main results. The percentage of complications identified by the CSP ranged from 17.5% to 52.4%. The LOS of the DRGCCs was almost twice as long as in the DRGs without CC; 2.48 times greater if the DRGCC was flagged by the CSP and 70% greater if it was not. On average, the DRGCCs selected were reimbursed at a rate 93% higher than their counterpart DRGs without CC. In 11 of the 14 DRG pairs with or without CC, the reimbursement ratio was lower than the LOS ratio.

Conclusions. DRGCCs can be classified into clearly differentiated groups based on the presence or absence of CSP-flagged complications. CSP-flagged complications produce an increase in LOS greater than the increase in the relative weights for reimbursement.

Keywords: administrative data, diagnosis-related-groups, hospital complications, length of stay, quality of care

Accepted for publication October 9, 2003.


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