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The accuracy of hip fracture data entered into the national surgical quality improvement program (NSQIP) database
Violette C Simon1, Nicholas J Tucker1,2, Alla Balabanova1,2
1University of Colorado School of Medicine, Aurora, CO, USA.
Insights
Accuracy of hip fracture Current Procedural Terminology (CPT) codes and complications in the National Surgical Quality Improvement Program (NSQIP) registry is frequently inaccurate. This study highlights the need for validation of NSQIP orthopedic data.
Area of Science:
- Orthopedic surgery
- Surgical quality improvement
- Health informatics
Background:
- Internal validation studies have raised concerns about the accuracy of National Surgical Quality Improvement Program (NSQIP) registry data.
- Accurate data is crucial for quality assessment and improvement initiatives in surgical care.
Purpose of the Study:
- To assess the accuracy of hip fracture Current Procedural Terminology (CPT) codes and 30-day complication data recorded in the NSQIP registry.
- To identify specific procedures and complication types with notable inaccuracies within a single institution.
Main Methods:
- Retrospective review of hip fracture patients within a two-year period at a single institution.
- Analysis of NSQIP data for CPT codes (Perc FNFX, Open FNFX, Plate ITFX, IMN ITFX, HA) and 30-day complications.
- Comparison of NSQIP data against institutional medical records for accuracy assessment.
Main Results:
- 12.8% of hip fracture CPT codes in the NSQIP registry were inaccurate, with significant variation by procedure (e.g., Plate ITFX 76.9% vs. HA 0%).
- 43.9% of identified complications were not documented in the NSQIP data, with high underreporting for renal complications (100%) and UTIs (53.8%).
Conclusions:
- Hip fracture CPT codes and 30-day complication data in the NSQIP registry exhibit frequent inaccuracies.
- Researchers using NSQIP data should consider these limitations, and further validation studies across diverse procedures and institutions are essential.
Purpose:
Internal validation studies of National Surgical Quality Improvement Program (NSQIP) registry data have reported potential inaccuracies. The purpose of this study was to determine the accuracy of hip fracture CPT codes and complications entered into NSQIP for a single participating center.
Methods:
A retrospective study identified patients with a hip fracture CPT code from NSQIP data at a single institution over a two-year period. CPT codes included 27235 (percutaneous fixation of femoral neck fracture (Perc FNFX)), 27236 (open treatment of femoral neck fracture, internal fixation/prosthetic replacement (Open FNFX)), 27244 (open treatment of inter/peri/subtrochanteric femoral fracture with plate (Plate ITFX)), 27245 (treatment of inter/peri/subtrochanteric femoral fracture, with intramedullary implant (IMN ITFX)), and 27125 (hemiarthroplasty (HA)). The institutional medical record was reviewed to determine the accuracy of CPT code and 30-day complication data entered into the registry.
Result:
12.8% (n = 20/156) of patients had an inaccurate CPT code. The proportion of inaccurate CPT codes varied significantly by procedure: Plate ITFX (76.9%), Open FNFX (13.8%), IMN ITFX (7.0%), and HA (0%) (p < 0.0001). A total of 82 complications were identified in 66 patients via the medical record. 43.9% (n = 36/82) of these complications were not documented in the NSQIP data. The proportion of missing complications varied significantly by type: renal (100%), UTI (53.8%), infection (50%), bleeding (30%), death (25%), respiratory (25%), cardiac (0%), stroke (0%), and VTE (0%) (p < 0.0001).
Conclusion:
Hip fracture CPT codes and 30-day complication data entered into the NSQIP registry were frequently inaccurate. Studies incorporating NSQIP data should acknowledge these potential limitations of the registry, and future research to validate NSQIP orthopedic data across procedures and institutions is necessary.
Level Of Evidence:
LEVEL III: Diagnostic study.
