Is Administratively Coded Comorbidity and Complication Data in Total Joint Arthroplasty Valid?
Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA, .Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 04/2012; 471(1). DOI: 10.1007/s11999-012-2352-1
BACKGROUND: Administrative claims data are increasingly being used in public reporting of provider performance and health services research. However, the concordance between administrative claims data and the clinical record in lower extremity total joint arthroplasty (TJA) is unknown. QUESTIONS/PURPOSES: We evaluated the concordance between administrative claims and the clinical record for 13 commonly reported comorbidities and complications in patients undergoing TJA. METHODS: We compared 13 administratively coded comorbidities and complications derived from hospital billing records with clinical documentation from a consecutive series of 1350 primary and revision TJAs performed at three high-volume institutions during 2009. RESULTS: Concordance between administrative claims and the clinical record varied across comorbidities and complications. Concordance between diabetes and postoperative myocardial infarction was reflected by a kappa value > 0.80; chronic lung disease, coronary artery disease, and postoperative venous thromboembolic events by kappa values between 0.60 and 0.79; and for congestive heart failure, obesity, prior myocardial infarction, peripheral arterial disease, bleeding complications, history of venous thromboembolism, prosthetic-related complications, and postoperative renal failure by kappa values between 0.40 and 0.59. All comorbidities and complications had a high degree of specificity (> 92%) but lower sensitivity (29%-100%). CONCLUSIONS: The data suggest administratively coded comorbidities and complications correlate reasonably well with the clinical record. However, the specificity of administrative claims is much higher than the sensitivity, indicating that comorbidities and complications coded in the administrative record were accurate but often incomplete. LEVEL OF EVIDENCE: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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ABSTRACT: Study Design. Retrospective national database analysis.Objective. A national population-based database was analyzed to characterize cervical spine procedures performed at teaching and non-teaching hospitals with regards to patient demographics, clinical outcomes/complications, resource utilization and costs.Summary of Background Data. There are mixed reports in the literature regarding the quality and costs of healthcare provided by teaching hospitals in the United States. However, outcomes of cervical spine surgery based upon teaching-status remains largely unknown.Methods. Data from the Nationwide Inpatient Sample was obtained from 2002-2009. Patients undergoing elective anterior or posterior cervical fusion (ACF, PCF), or posterior cervical decompression (PCD; i.e. laminoforaminotomy, laminectomy, laminoplasty) for a diagnosis of cervical myelopathy and/or radiculopathy were identified and separated into two cohorts (teaching and non-teaching hospitals). Patient demographics, co-morbidities, complications, length of hospitalization, costs, and mortality were compared for both groups. Regression analysis was performed to assess independent predictors of mortality.Results. A total of 212,385 cervical procedures were identified from 2002-2009 in the United States, with 54.6% performed at teaching hospitals. More multilevel fusions and posterior approaches were performed in teaching hospitals (p<0.0005). Patients treated in teaching hospitals trended towards male gender, increased costs, and hospitalizations. Overall, procedure-related complications and in-hospital mortality were increased in teaching hospitals. Regression analysis revealed that significant predictors of mortality were age ≥ 65 (O.R. = 3.0) and multiple co-morbidities. Teaching status was not a significant predictor of mortality (p = 0.07).Conclusion. Patients treated in teaching hospitals for cervical spine surgery demonstrated longer hospitalizations, increased costs, and mortality over patients treated in non-teaching hospitals. Incidences of post-operative complications were identified as higher in teaching hospitals. Possible explanations for these findings are an increased complexity of procedures performed at teaching hospitals. Older age and presence of co-morbidities were more significant predictors of in-hospital mortality than teaching-status. Future studies should identify long-term complications and costs beyond an in-patient setting to assess if differences extend beyond the peri-operative period.Spine 02/2013; 38(13). DOI:10.1097/BRS.0b013e31828da26d · 2.30 Impact Factor
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ABSTRACT: Study Design: Retrospective database analysis.Objective: To determine the national incidence, mortality, and risk factors for peri-operative cardiac complications associated with cervical spine surgery in the United States.Summary of Background Data: Peri-operative myocardial infarctions and cardiac failure are leading causes of mortality in non-cardiac surgery. The incidence of these complications has not been reported in cervical spine surgery.Methods: Data from the Nationwide Inpatient Sample was obtained from 2002-2009. Patients undergoing anterior or posterior cervical fusion (ACF, PCF) and posterior cervical decompression (PCD) without fusion for degenerative etiologies were identified. Only elective admissions were included. Incidences of cardiac complications were identified and patient demographics, hospital costs, length of stay (LOS), and mortality were compared for each group. Logistic regression was used to identify independent predictors of cardiac complications.Results: A total of 214,900 elective cervical spine procedures were identified in the United States from 2002-2009. Overall, there were 4.0 cardiac events per 1,000 cases. For individual procedures, the incidence was 11.6 per 1,000 PCFs, 5.2 per 1,000 PCDs, and 3.2 per 1,000 ACFs. Patients with cardiac events were statistically older with greater co-morbidities (p<0.0005). Across all cohorts, LOS increased an additional 4.5 days, hospital costs increased $13,435, and mortality increased from 0.8 to 65.3 deaths per 1,000 cases in the presence of a cardiac event (p<0.0005). Logistic regression analysis demonstrated that independent predictors for cardiac events included age≥65 years, multilevel fusions, acute blood-loss anemia, congestive heart failure, fluid/electrolyte disorders, and pulmonary circulation disorders.Conclusions: Our results demonstrate an overall incidence of 4.0 cardiac events per 1,000 cervical spine surgeries. Older patients with greater co-morbid risk factors, particularly cardiovascular diseases, were at significantly increased risk for cardiac complications. Due to the large impact cardiac events have on healthcare utilization and mortality, we recommend a thorough risk stratification for older patients undergoing elective cervical spine procedures.Spine 03/2013; 38(15). DOI:10.1097/BRS.0b013e318290fdac · 2.30 Impact Factor
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ABSTRACT: Study Design. Retrospective database analysis.Objective. In order to determine rates of gastrointestinal (GI) hemorrhage following lumbar fusions, a population-based database was analyzed to identify incidence, mortality, and risk factors associated with anterior (ALF), posterior (PLF), and simultaneous anterior/posterior (APLF) lumbar procedures.Summary of Background Data. GI hemorrhage following lumbar surgery is a rare complication that can have devastating consequences. Incidences of GI bleeding after lumbar fusion are not well characterized in the current literature.Methods. Data from the Nationwide Inpatient Sample was obtained from 2002-2009. Patients undergoing ALF, PLF, and APLF for degenerative pathologies were identified and the incidence of GI hemorrhage was evaluated. Patient demographics, Charlson Co-morbidity Index (CCI), length of stay (LOS), costs, and mortality were assessed. SPSS v.20 was used to detect statistical differences between groups and perform logistic regression analyses to identify independent predictors of GI bleeding. A p-value of <0.001 denoted significance.Results. A total of 220,522 lumbar fusions were identified in the United States from 2002-2009. Of these, 19,762 were ALFs, 182,801 were PLFs, and 17,959 were APLFs. GI bleeding was noted in ALFs with 1.1 events per 1,000 cases, PLFs with 1.4, and APLFs with 1.7. Patients with GI bleeding demonstrated greater CCI scores, LOS, costs, and mortality (p<0.001). Logistic regression analysis demonstrated independent predictors of GI hemorrhage include advanced age (>65 years), male gender, blood-loss anemia, fluid/electrolyte disorders, metastatic neoplasm, and weight loss (p<0.001).Conclusion. The results of our study demonstrate very low complication rates of GI hemorrhage across ALFs, PLFs, and APLF cohorts. Across all surgical procedures, the presence of GI bleeding complications was associated with greater co-morbidity, LOS, cost, and mortality. We strongly advise physicians to perform stringent peri-operative assessments of risk factors and to provide prompt medical attention in order to minimize the impact of GI bleeding complications.Spine 04/2013; 38(18). DOI:10.1097/BRS.0b013e318298768d · 2.30 Impact Factor
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