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Related Experiment Videos

Administrative databases' complication coding in anterior spinal fusion procedures. What does it mean?

T Faciszewski1, L Johnson, C Noren

  • 1Marshfield Clinic, Wisconsin, USA.

Spine
|August 15, 1995
PubMed
Summary

Hospital coding for spinal fusion complications is inaccurate. Studies using this data may be flawed due to underestimation and overestimation of specific complication types.

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Area of Science:

  • Spinal surgery outcomes research
  • Health informatics
  • Medical coding accuracy

Background:

  • Electronic administrative databases are increasingly used for clinical research.
  • Accuracy of ICD-9-CM complication coding in spinal procedures remains unevaluated.
  • Previous studies have not assessed the correlation between coded data and actual clinical outcomes.

Purpose of the Study:

  • To evaluate the accuracy of hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) complication coding.
  • To assess the clinical significance of conclusions drawn from studies using administrative databases for spinal procedures.
  • To compare physician-identified complications with ICD-9-CM coded complications.

Main Methods:

  • Retrospective review of 310 anterior spinal fusion patient records.

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  • Independent review of medical records by a physician and a research technician to identify complications.
  • Comparison of identified complications with hospital-acquired ICD-9-CM coded complications.

    • Main Results:

    • Physician identified 152 complications (32 types); research abstracter identified 175 complications (34 types).
    • Hospital ICD-9-CM coding identified only 105 complications (11 types), with 27% being unspecified.
    • ICD-9-CM coding overestimated cardiac/pulmonary complications and underestimated wound, genitourinary, and gastrointestinal complications.

    Conclusions:

    • Hospital ICD-9-CM complication coding for spinal procedures is inaccurate.
    • Relying on ICD-9-CM codes for spinal procedure complication studies may lead to flawed conclusions.
    • Administrative database accuracy is questionable for detailed clinical outcome research.