Background With approximately 175,000 procedures per year (IQTIG, reporting year 2024), laparoscopic cholecystectomy is among the most common visceral surgical procedures in Germany. Since 2026, "simple" laparoscopic cholecystectomy (H08M) has been included in the cross-sectoral hybrid diagnosis-related groups (DRG) scheme under & sect; 115f of the German Social Code Book V (SGB V). Objective To critically analyze the hybrid DRG classification with respect to the underlying evidence, coding/grouping logic, real-world care patterns and economic implications, including a model calculation of the expected case distribution. Results The current context factor logic does not consistently distinguish between hybrid and full inpatient DRG by severity: acute cholecystitis without gallstones (K81.0) is defined as a context factor (triggering the inpatient DRG H08C), whereas acute cholecystitis with gallstones (K80.00/K80.01) is not, despite comparable or greater treatment complexity. Based on a model calculation using routine data from the Institute for Quality Assurance and Transparency in the Healthcare System (IQTIG) for 2022-2024, an estimated 93,000-96,000 cases per year (approximate to 60-65% of "simple" laparoscopic cholecystectomies) are likely to be uncomplicated and therefore eligible for the hybrid DRG, while approximately 52,000-55,000 cases per year (approximate to 35-38%) involve acute cholecystitis, for which the classification is inconsistent and in some cases implausible. The actual outpatient share is likely to remain below 1%. Conclusion Hybrid DRG eligibility is not equivalent to suitability for outpatient care. What is required are diagnosis-specific, more precisely defined context factors, a correct and sanction-free coding logic, and adequate reimbursement reflecting standby capacity costs and training obligations.
The S2k guidelines on liver transplantation are the first German language interdisciplinarily developed guidelines on liver transplantation and provide a comprehensive framework for action for the treatment of patients before, during and after transplantation. This article provides a compact overview of selected recommendations from the guidelines that are particularly relevant for the practice. In addition to central aspects of transplantation evaluation, waiting list management and perioperative care, the essential differences to the guidelines of the German Medical Association for management of the waiting list and organ distribution according to Section 16, para. 1, p.1, nos. 2 and 5 of the Transplantation Act are also discussed.
Die elektive roboterassistierte tubuläre Sigmaresektion bei Divertikelkrankheit ist ein etabliertes Verfahren. Daten zu den Einflussgrößen auf die Operationszeit sowie zur individualisierten intrakorporalen Anastomosentechnik fehlen bisher. Die aktuelle Studie soll folgende Fragen beantworten: Welche patientenbezogenen und operativen Faktoren (BMI, CDD-Klassifikation, Flexurmobilisationsstrategie) beeinflussen die Operationszeit? Welche Anastomosentechniken werden angewendet und mit welchen Ergebnissen? Retrospektive Auswertung prospektiv erfasster Daten aller konsekutiven Patienten mit elektiver roboterassistierter Sigmaresektion bei Divertikelkrankheit am Kantonsspital Olten (April 2019 bis Juni 2025). Ausschlusskriterium: Notfallindikation. Primäre Studienparameter: Operationszeit (in Bezug auf BMI, CDD-Klassifikation und Flexurmobilisation) sowie Anastomosentechnik. Statistische Analyse mit GraphPad Prism 11.0.2 (GraphPad Software, LLC [Dotmatics], San Diego, CA, USA), Kruskal-Wallis-Test mit Dunn-Post-hoc-Vergleichen (Bonferroni-Korrektur), Spearman-Rangkorrelation und einfache lineare Regression. Es wurden 116 Patienten (59,5
