Cost-Revenue Analysis of Aortic Surgery in the German DRG System

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All articles of this category (opens in new window) Background: Aortic surgery is frequently associated with high costs for hospital management, particularly in complex or emergency interventions. Current DRG-based reimbursement often fails to adequately cover the actual costs of high-value prostheses and intensive care requirements. This study quantifies the cost-revenue gap in aortic surgical procedures to provide evidence-based data for healthcare policy discussions and hospital financial planning. Methods: We conducted a retrospective single-center analysis of 510 consecutive patients undergoing aortic surgery between 2020 and 2022. Exclusion criteria were infective endocarditis, iatrogenic dissection, re-operations, age < 18 years, and in-hospital mortality. Patients were stratified according to urgency (elective vs. acute dissection). Prosthesis expenditure, ICU stay, and length of stay were obtained from the hospital documentation system and compared with DRG reimbursement to identify payment gaps. DRG distributions were analyzed with special focus on complex and most frequent classifications (F05Z, F03A). Results: Of 510 patients, 394 (77%) underwent elective and 116 (23%) acute dissection procedures. Elective cases were predominantly grouped in DRG F05Z (procedures requiring CPB under deep hypothermia, 44%), while aortic dissections were more likely grouped into DRG F05Z and F03A (heart valve surgery with CPB and complicating factors, both 19%). Mean DRG reimbursement was €31,161 ± 11,297 for elective and €38,237 ± 19,289 for acute cases ( p < 0.001). Prosthesis reimbursement covered only 1,713€ ± 554 (31.8% of actual costs) in elective and €1,645€ ± 642 (24% of actual costs) in acute cases. Median hospital stay was 16 (IQR: 13–20) days for elective and 17.5 (IQR: 13.25–22) days for acute cases ( p = 0.21), exceeding DRG-defined lengths of 14 (IQR: 14–16) and 16 (IQR: 14–23) days, respectively (both p < 0.001). ICU stay was significantly longer in acute cases, with a median of 5 (IQR: 3–10.75) vs. 3 (IQR: 2–5) days ( p < 0.001). Conclusion: Aortic surgery shows substantial reimbursement gaps in the German DRG system. Differentiated DRGs based on procedural complexity and prosthesis requirements appear necessary to ensure adequate reimbursement and maintain sustainable aortic surgical programs. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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