Utility of a combined current procedural terminology and International Classification of Diseases, Ninth Revision, Clinical Modification code algorithm in classifying cervical spine surgery for degenerative changes.
ABSTRACT Retrospective study.
To evaluate the sensitivity and specificity of a combined Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) algorithm in defining cervical spine surgery in comparison to patient operative reports in the medical record.
Epidemiological studies of spine surgery often use ICD-9-CM billing codes in administrative databases to study trends and outcome of surgery. However, ICD-9-CM codes do not clearly identify specific surgical factors that may be related to outcome, such as instrumentation or number of levels treated. Previous studies have not investigated the sensitivity and specificity of a combined CPT and ICD-9-CM code algorithm for defining cervical spine surgical procedures.
We performed a retrospective study comparing the sensitivity and specificity of a combined CPT and ICD-9-CM code algorithm to the operative note, the gold standard, in a single academic center. We also compared the accuracy of our combined algorithm with our published ICD-9-CM-only algorithm.
The combined algorithm has high sensitivity and specificity for defining cervical spine surgery, specific surgical procedures such as discectomy and fusion, and surgical approach. Compared to the ICD-9-CM-only algorithm, the combined algorithm significantly improves identification of discectomy, laminectomy, and fusion procedures and allows identification of specific procedures such as laminaplasty and instrumentation with high sensitivity and specificity. Identification of reoperations has low sensitivity and specificity, but identification of number of levels instrumented, fused, and decompressed has high specificity.
The use of our combined CPT and ICD-9-CM algorithm to identify cervical spine surgery was highly sensitive and specific. For categories such as surgical approach, accuracy of our combined algorithm was similar to that of our ICD-9-CM-only algorithm. However, the combined algorithm improves sensitivity, and allows identification of procedures not defined by ICD-9-CM procedure codes, and number of levels instrumented and decompressed. The combined algorithm better defines cervical spine surgery and specific factors that may impact outcome and cost.
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ABSTRACT: Study Design. Retrospective cohortObjective. A national population-based database was queried to investigate the incidence of sentinel events in cervical spine surgery as well as the associated perioperative outcomes.Summary of Background Data. Sentinel events in cervical spine surgery are potentially catastrophic complications. The incidence and perioperative outcomes associated with sentinel events in cervical spine surgery have not been well characterized.Methods. The Nationwide Inpatient Sample was queried from 2002-2011. Patients who underwent elective cervical spinal surgery were identified. Sentinel events including esophageal perforation, vascular injury, nerve injury, retention of foreign objects, and wrong-site surgery were identified. Patient demographics, comorbidities (CCI), surgical procedures, length of stay (LOS), total hospital costs, and postoperative outcomes were assessed. The risk for in-hospital mortality associated with each complication was calculated utilizing a 95% confidence interval (CI). Statistical analysis was performed with SPSS v.20 and a p-value of ≤0.001 denoted significance.Results. A total of 251,318 cervical spine procedures were identified between 2002-2011 of which 123 patients (0.5 per 1,000 cases) incurred sentinel events. Circumferential cervical fusion (APCF) demonstrated an increased risk of vascular injury (OR 4.5, CI 1.8-11.2), while cervical total disc replacement (C-TDR) was associated with an increased risk of esophageal perforation (OR 10.9, CI 1.4-85.2) and nerve injury (OR 36.4, CI 1.5-892.3). Posterior cervical fusions (PCF) were associated with an increased risk of wrong-site surgery (OR 3.9, CI 1.5-10.5). The sentinel event cohort incurred a longer hospitalization, greater costs, mortality, and greater incidence of postoperative complications.Conclusion. This database analysis demonstrates that sentinel events are associated with a significant increase in hospital resource utilization and worsened perioperative outcomes. The type of cervical spine procedure and the number of fusion levels significantly impact the risk of sentinel events. Further research is warranted to understand the etiology of sentinel events in cervical spine surgery and to implement protocols to mitigate the associated risk factors.Spine 01/2014; · 2.45 Impact Factor
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ABSTRACT: Study Design. Retrospective analysis of Medicare claims linked to a multi-center clinical trial.Objective. The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenosis, and degenerative spondylolisthesis. We compared the surgical indication derived from Medicare claims to that provided by SPORT surgeons, the "gold standard".Summary of Background Data. Administrative data are frequently used to report procedure rates, surgical safety outcomes, and costs in the management of spinal surgery. However, the accuracy of using diagnosis codes to classify patients by surgical indication has not been examined.Methods. Medicare claims were link to beneficiaries enrolled in SPORT. The sensitivity and specificity of three claims-based approaches to group patients based on surgical indications were examined: 1) using the first listed diagnosis; 2) using all diagnoses independently; and 3) using a diagnosis hierarchy based on the support for fusion surgery.Results. Medicare claims were obtained from 376 SPORT participants, including 21 with disc herniation, 183 with spinal stenosis, and 172 with degenerative spondylolisthesis. The hierarchical coding algorithm was the most accurate approach for classifying patients by surgical indication, with sensitivities of 76.2%, 88.1%, and 84.3% for disc herniation, spinal stenosis, and degenerative spondylolisthesis cohorts, respectively. The specificity was 98.3% for disc herniation, 83.2% for spinal stenosis, and 90.7% for degenerative spondylolisthesis. Misclassifications were primarily due to codes attributing more complex pathology to the case.Conclusion. Standardized approaches for using claims data to accurately group patients by surgical indications has widespread interest. We found that a hierarchical coding approach correctly classified over 90% of spine patients into their respective SPORT cohorts. Therefore, claims data appears to be a reasonably valid approach to classifying patients by surgical indication.Spine 02/2014; · 2.45 Impact Factor
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ABSTRACT: There is wide regional variability in the volume of procedures performed for similar surgical patients throughout the USA. The purpose of this study was to investigate the association of spinal fusion operations with several socioeconomic factors. We performed a retrospective cohort study involving patients who underwent any neurosurgical procedure from 2005 to 2010 and were registered in National Inpatient Sample (NIS). A sub-cohort of patients undergoing spinal operations was also created. Regression techniques were used to investigate the association of the average intensity of neurosurgical care (defined as the average number of neurosurgical procedures per capita) with the average rate of fusions. In the study period, there were 707,951 patients undergoing spinal procedures, who were registered in NIS. There were significant disparities in the fusion rate among different states (ANOVA, P < 0.0001), which ranged from 0.41 in Maine, where non-fusion surgeries were very predominant, to 0.62 in Virginia, where fusion was the main treatment modality used. In a multivariate analysis, the intensity of neurosurgical care was associated with an increased fusion rate. A similar effect was observed for coverage by private insurance, higher income, urban hospitals, large hospital size, African American patients, and patients with less comorbidities. Hospital location in the northeast was associated with a lower rate in comparison to the midwest, and south. Coverage by Medicaid was associated with lower fusion rate. We observed significant disparities in the integration of fusion operations in spine surgery practices in the USA. Increased intensity of neurosurgical care was associated with a higher fusion rate.European Spine Journal 02/2014; · 2.47 Impact Factor