To investigate the clinical application value of indocyanine green(ICG) fluorescence-guided thoracoscopic lung lesion resection under the diagnosis related group(DRG) payment system, and to provide reference for the management of new medical technologies in healthcare institutions.

Discharged patients who underwent thoracoscopic segmentectomy and/or wedge resection at Peking Union Medical College Hospital from January 1, 2016 to May 31, 2024 were enrolled. Patients who received ICG fluorescence guidance were assigned to new technology group, while those who did not receive ICG fluorescence guidance were assigned to control group. Operative time, length of stay, cost consumption index, time consumption index, duration of ventilator use, total hospitalization cost, and 10 representative cost items were compared between the two groups. Propensity score matching(PSM) was further used to analyze the changes in these indicators after controlling for confounding factors including age, sex, DRG code, and surgical type.

A total of 7999 patients who met the inclusion and exclusion criteria were enrolled, including 1392 patients(17.4%) in the new technology group and 6607 patients(82.6%) in the control group. Compared with the control group, the new technology group showed significantly shorter operative time and length of stay, and significant reductions in time consumption index, consultation and diagnostic fees, nursing fees, therapeutic medical material fees, bed fees, oxygen therapy fees, antibiotic fees, and albumin product fees, while the cost consumption index, total hospitalization cost, surgical fees, and surgical medical material fees were significantly increased(all P < 0.001). Among EB15(major thoracic surgery without important complications or comorbidities) patients, all indicators except duration of ventilator use, western medicine fees, and duration of invasive mechanical ventilation showed statistically significant differences between the two groups(all P < 0.001). Among patients in EB11(major thoracic surgery with important complications or comorbidities), only albumin product fees were significantly lower in the new technology group than those in the control group(P=0.003), with no statistically significant differences in other indicators(P > 0.05). In patients undergoing wedge resection alone, the new technology group showed significantly shorter operative time and length of hospital stay, as well as significant reductions in time consumption index, consultation and diagnostic fees, nursing fees, therapeutic medical material fees, bed fees, oxygen therapy fees, western medicine fees, antibiotic fees, and albumin product fees, total hospitalization cost and cost consumption index, while surgical medical material fees increased (P < 0.05). After PSM, the operative time in the new technology group was significantly shorter than that in the control group(P=0.022); except for increased western medicine fees, oxygen therapy fees, antibiotic fees, albumin product fees, and therapeutic medical material fees in the new technology group were all significantly lower than those in the control group(all P < 0.05).

ICG fluorescence-guided thoracoscopic lung lesion resection can significantly improve medical efficiency, optimize cost structure, and reduce perioperative supportive resource consumption. However, its clinical benefits vary significantly among patients with different surgical types or different DRG groups, so clinicians are advised to strengthen preoperative precise evaluation.

To analyze the disease group structure and its trends in key departments of large public hospitals using diagnosis related group (DRG) data, explore the key points of intervention and optimization of disease groups in departments, and further promote the rational allocation of department resources.

We retrospectively collected DRG data from two surgical departments in a large public hospital in Beijing from 2017 to 2023. When the case mix index (CMI) of the two surgical departments declined, interventions such as performance appraisal, department education, and hospital publicity were promptly adopted. The changesin CMI values were observed and the trends in disease group weights, time consumption index, cost consumption index, and mortality rate in low-risk groups were analyzed.

After the interventions, in surgical department Ⅰ, the proportion of patients with lower-weight diseases, such as major thyroid surgery (KD1), significantly decreased, while that of patients with higher-weight diseases, such as colorectal malignancy surgery (GB2) and pancreatic malignancy surgery (HB1), significantly increased. In surgical department Ⅱ, the proportion of patients with lower-weight diseases, such as chemotherapy (RE1), decreased markedly, while that of patients with higher-weight diseases, including major surgery for malignancy of kidney, ureter, and bladder (LA1), adrenal gland surgery (KC1), surgery for kidney/ureter/bladder except for major malignancy surgery (LB1), and male genital organ malignancy surgery (MA1), increased significantly. Both surgical departments achieved the goal of increasing their CMI values. In terms of efficiency, cost, and quality indicators, the time consumption index and cost consumption index of the two surgical departments were significantly lower than 1, and the mortality rate in low-risk groups was 0.

Based on actual conditions and development goals, large public hospitals can achieve improvements in CMI values and optimization of disease group structures through reasonable interventions, thereby enhancing medical efficiency and rational utilization of resources.