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Infectious Surgical Complications are Not Dichotomous: Characterizing Discordance Between Administrative Data and
David A Etzioni1,2, Cynthia L Lessow1,2, Heather D Lucas1
1Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ.
Objective:
To characterize reasons for discordance between administrative data and registry data in the determination of postoperative infectious complications.
Background:
Data regarding the occurrence of postoperative surgical complications are identified through either administrative or registry data. Rates of complications vary significantly between these two types of data; the reasons for this are not well-understood.
Methods:
The occurrence of 30-day inpatient infectious complications (pneumonia, sepsis, surgical site infection, and urinary tract infection) was compared between the NSQIP and administrative mechanisms at 4 academic hospitals between 2012 and 2014. In each situation where the NSQIP and administrative data were discordant regarding the occurrence of a specific complication, a 2-clinician chart abstraction was performed to characterize the reasons for discordance as (i) administrative coding error, (ii) NSQIP coding error, (iii) "question of criteria", where the discordance was the result of differences in criteria, or (iv) "dually incorrect", where both data sources coded the complication incorrectly.
Results:
The cohort included 19,163 patients undergoing surgery in 4 different academic hospitals. Rates of infectious complications varied up to 5-fold between the two data sources. A total of 717 discordant complications were identified. Of these, the greatest portion (43%) was due to "question of criteria," followed by administrative coding error (37%), NSQIP error (15%), and dually incorrect (5%).
Conclusions:
With a goal of improving existing mechanisms for measuring surgical quality, definitions for the occurrence of a postoperative complication need to be developed and applied consistently. Progress toward this goal will enable patients and payers to better take advantage of recent advances in healthcare data transparency.
Insights
Discordance in postoperative infectious complication data between administrative and registry sources is often due to differing criteria, not just coding errors. Standardizing complication definitions is crucial for accurate surgical quality measurement and healthcare transparency.
Area of Science:
- Healthcare quality measurement
- Surgical outcomes research
- Health informatics
Background:
- Administrative and registry data are used to track postoperative surgical complications.
- Significant variations in complication rates exist between these data sources.
- The reasons for these discrepancies remain unclear.
Purpose of the Study:
- To identify and characterize the reasons for discordance between administrative and registry data in identifying postoperative infectious complications.
- To improve the accuracy of surgical quality metrics.
Main Methods:
- Compared 30-day inpatient infectious complications (pneumonia, sepsis, SSI, UTI) between the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and administrative data at 4 academic hospitals (2012-2014).
- Conducted a 2-clinician chart abstraction for discordant cases to categorize reasons: administrative coding error, NSQIP coding error, criteria differences, or dual errors.
- Analyzed 19,163 surgical cases.
Main Results:
- Infectious complication rates varied up to fivefold between data sources.
- Of 717 discordant complications, 43% were due to differing criteria ('question of criteria').
- Administrative coding errors accounted for 37%, NSQIP errors for 15%, and dual errors for 5%.
Conclusions:
- Inconsistent definitions for postoperative complications are a primary driver of data discordance.
- Standardized and consistently applied definitions are necessary to enhance surgical quality measurement.
- Improved data accuracy will support healthcare transparency for patients and payers.
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