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A Pervasive Problem: Surgical Wound Class Miscoding in Pediatric Laparoscopic Appendectomy
John M Woodward1, Michael LaRock2, Krystle Bittner3
1University at Buffalo Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14215, USA; University at Buffalo Division of Pediatric Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14215, USA.
Insights
Surgical wound classification (SWC) miscoding is common in pediatric appendectomies, affecting over 20% of cases. This rate doubles to 50% for perforated appendicitis, impacting data accuracy.
Area of Science:
- Pediatric Surgery
- Surgical Quality Improvement
- Health Informatics
Background:
- Surgical wound classification (SWC) is crucial for predicting surgical site infections (SSIs), patient outcomes, and hospital quality assessment.
- Accurate SWC is essential for reliable risk adjustment and research in surgical quality.
Purpose of the Study:
- To determine the prevalence of SWC miscoding in pediatric laparoscopic appendectomies using a national database.
- To identify miscoding rates in both non-perforated and perforated acute appendicitis cases.
Main Methods:
- Analysis of data from the NSQIP-P registry (2017-2021) for pediatric laparoscopic appendectomies (CPT: 44970).
- Evaluation of SWC based on ICD-10 codes for acute appendicitis (K35-K37).
- Comparison of coded SWC (1-4) against expected classifications for non-perforated (SWC 3) and perforated (SWC 4) appendicitis.
Main Results:
- A total of 71,374 procedures were analyzed.
- An overall SWC miscoding rate of at least 22.5% was identified.
- The miscoding rate was 28.1% for non-perforated and 49.9% for perforated appendicitis.
Conclusions:
- Pediatric laparoscopic appendectomies exhibit a significant rate of SWC miscoding, exceeding 20% overall.
- The miscoding rate approaches 50% for perforated appendicitis, highlighting a critical data quality issue.
- Improved accuracy in SWC coding is necessary for reliable hospital metrics, risk calculators, and SSI research.
Purpose:
Surgical wound classification (SWC) is one factor contributing to the likelihood of surgical site infection (SSIs). This results in SWC being an important prognostic factor for SSI, post-operative morbidity for patients, and hospital quality assessment and finance. This analysis aimed to investigate the prevalence of SWC miscoding in pediatric laparoscopic appendectomies in a national database.
Methods:
Data were extracted from the NSQIP-P registry (2017-2021) for pediatric laparoscopic appendectomies (CPT: 44970) associated with acute appendicitis diagnoses (ICD-10 codes K35-K37). Frequencies were calculated for all SWC, with clean (SWC 1) and clean/contaminated (SWC 2) considered as miscoded for all acute appendicitis cases given the presence of acute inflammation. Subgroup analysis distinguished between non-perforated (ICD-10 codes K35.30, K35.31, K35.890, K35.891) and perforated appendicitis (ICD-10 codes K35.21, K35.32, K35.33), with the correct wound classifications deemed contaminated (SWC 3) and dirty/infected (SWC 4), respectively.
Results:
Of the 71,374 laparoscopic appendectomies analyzed, a minimum miscoding rate of 22.5 % was identified. Specifically, 28.1 % of the 10,580 non-perforated acute appendicitis subgroup were miscoded and 49.9 % of the 4247 perforated appendicitis subgroup were miscoded.
Conclusion:
There is a concerning misclassification rate of surgical wounds in pediatric laparoscopic appendectomies for acute appendicitis, exceeding 20 %. This rate rises to 50 % in instances of perforated appendicitis. Further investigation and solutions are needed to improve wound class miscoding to ensure the accuracy of data being used for hospital metrics, risk calculators and research related to surgical site infections.
Level Of Evidence (I-V):
Level III.
