Can administrative data be used to compare postoperative complication rates across hospitals?

Patrick S Romano, Benjamin K. Chan, Michael E. Schembri, Julie A. Rainwater

Research output: Contribution to journalArticle

186 Citations (Scopus)

Abstract

BACKGROUND. Several quality assessment systems use administrative data to identify postoperative complications, with uncertain validity. OBJECTIVES. To determine how accurately postoperative complications are reported in administrative data, whether accuracy varies systematically across hospitals, and whether serious complications are more consistently reported. DESIGN. Retrospective cohort. SUBJECTS. Nine hundred ninety-one randomly sampled adults who underwent elective lumbar diskectomies at 30 nonfederal acute care hospitals in California in 1990 to 1991. Hospitals with especially low or high risk-adjusted complication rates, and patients who experienced complications, were over sampled. MEASURES. Postoperative complications were specified by reviewing medical literature and consulting clinical experts; each complication was mapped to ICD-9-CM. Hospital-reported complications were compared with our independent recoding of the same records. RESULTS. The weighted sensitivity, specificity, and positive and negative predictive values for reported complications were 35%, 98%, 82%, and 84%, respectively. The weighted sensitivity was 30% for serious, 40% for minor, and 10% for questionable complications. It varied from 21% among hospitals with fewer complications than expected to 45% among hospitals with more complications than expected. Only reoperation, bacteremia/sepsis, postoperative infection, and deep vein thrombosis were reported with at least 60% sensitivity. Half of the difference in risk-adjusted complication rates between low and high outlier hospitals was attributable to reporting variation. CONCLUSIONS. ICD-9-CM complications were underreported among diskectomy patients, especially at hospitals with low risk-adjusted complication rates. The validity of using coded complications to compare provider performance is questionable, even with careful efforts to identify serious events, although these results must be confirmed using more recent data.

Original languageEnglish (US)
Pages (from-to)856-867
Number of pages12
JournalMedical Care
Volume40
Issue number10
DOIs
StatePublished - Oct 2002

Fingerprint

Diskectomy
International Classification of Diseases
management counsulting
Bacteremia
Reoperation
Venous Thrombosis
Sepsis
expert
Sensitivity and Specificity
event
Infection
performance
literature

Keywords

  • Administrative data
  • Complications
  • Hospital outcomes
  • Performance measurement
  • Quality measurement
  • Quality of care

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Can administrative data be used to compare postoperative complication rates across hospitals? / Romano, Patrick S; Chan, Benjamin K.; Schembri, Michael E.; Rainwater, Julie A.

In: Medical Care, Vol. 40, No. 10, 10.2002, p. 856-867.

Research output: Contribution to journalArticle

Romano, Patrick S ; Chan, Benjamin K. ; Schembri, Michael E. ; Rainwater, Julie A. / Can administrative data be used to compare postoperative complication rates across hospitals?. In: Medical Care. 2002 ; Vol. 40, No. 10. pp. 856-867.
@article{3841990287a748828b2fac5f866df7a9,
title = "Can administrative data be used to compare postoperative complication rates across hospitals?",
abstract = "BACKGROUND. Several quality assessment systems use administrative data to identify postoperative complications, with uncertain validity. OBJECTIVES. To determine how accurately postoperative complications are reported in administrative data, whether accuracy varies systematically across hospitals, and whether serious complications are more consistently reported. DESIGN. Retrospective cohort. SUBJECTS. Nine hundred ninety-one randomly sampled adults who underwent elective lumbar diskectomies at 30 nonfederal acute care hospitals in California in 1990 to 1991. Hospitals with especially low or high risk-adjusted complication rates, and patients who experienced complications, were over sampled. MEASURES. Postoperative complications were specified by reviewing medical literature and consulting clinical experts; each complication was mapped to ICD-9-CM. Hospital-reported complications were compared with our independent recoding of the same records. RESULTS. The weighted sensitivity, specificity, and positive and negative predictive values for reported complications were 35{\%}, 98{\%}, 82{\%}, and 84{\%}, respectively. The weighted sensitivity was 30{\%} for serious, 40{\%} for minor, and 10{\%} for questionable complications. It varied from 21{\%} among hospitals with fewer complications than expected to 45{\%} among hospitals with more complications than expected. Only reoperation, bacteremia/sepsis, postoperative infection, and deep vein thrombosis were reported with at least 60{\%} sensitivity. Half of the difference in risk-adjusted complication rates between low and high outlier hospitals was attributable to reporting variation. CONCLUSIONS. ICD-9-CM complications were underreported among diskectomy patients, especially at hospitals with low risk-adjusted complication rates. The validity of using coded complications to compare provider performance is questionable, even with careful efforts to identify serious events, although these results must be confirmed using more recent data.",
keywords = "Administrative data, Complications, Hospital outcomes, Performance measurement, Quality measurement, Quality of care",
author = "Romano, {Patrick S} and Chan, {Benjamin K.} and Schembri, {Michael E.} and Rainwater, {Julie A.}",
year = "2002",
month = "10",
doi = "10.1097/00005650-200210000-00004",
language = "English (US)",
volume = "40",
pages = "856--867",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Can administrative data be used to compare postoperative complication rates across hospitals?

AU - Romano, Patrick S

AU - Chan, Benjamin K.

AU - Schembri, Michael E.

AU - Rainwater, Julie A.

PY - 2002/10

Y1 - 2002/10

N2 - BACKGROUND. Several quality assessment systems use administrative data to identify postoperative complications, with uncertain validity. OBJECTIVES. To determine how accurately postoperative complications are reported in administrative data, whether accuracy varies systematically across hospitals, and whether serious complications are more consistently reported. DESIGN. Retrospective cohort. SUBJECTS. Nine hundred ninety-one randomly sampled adults who underwent elective lumbar diskectomies at 30 nonfederal acute care hospitals in California in 1990 to 1991. Hospitals with especially low or high risk-adjusted complication rates, and patients who experienced complications, were over sampled. MEASURES. Postoperative complications were specified by reviewing medical literature and consulting clinical experts; each complication was mapped to ICD-9-CM. Hospital-reported complications were compared with our independent recoding of the same records. RESULTS. The weighted sensitivity, specificity, and positive and negative predictive values for reported complications were 35%, 98%, 82%, and 84%, respectively. The weighted sensitivity was 30% for serious, 40% for minor, and 10% for questionable complications. It varied from 21% among hospitals with fewer complications than expected to 45% among hospitals with more complications than expected. Only reoperation, bacteremia/sepsis, postoperative infection, and deep vein thrombosis were reported with at least 60% sensitivity. Half of the difference in risk-adjusted complication rates between low and high outlier hospitals was attributable to reporting variation. CONCLUSIONS. ICD-9-CM complications were underreported among diskectomy patients, especially at hospitals with low risk-adjusted complication rates. The validity of using coded complications to compare provider performance is questionable, even with careful efforts to identify serious events, although these results must be confirmed using more recent data.

AB - BACKGROUND. Several quality assessment systems use administrative data to identify postoperative complications, with uncertain validity. OBJECTIVES. To determine how accurately postoperative complications are reported in administrative data, whether accuracy varies systematically across hospitals, and whether serious complications are more consistently reported. DESIGN. Retrospective cohort. SUBJECTS. Nine hundred ninety-one randomly sampled adults who underwent elective lumbar diskectomies at 30 nonfederal acute care hospitals in California in 1990 to 1991. Hospitals with especially low or high risk-adjusted complication rates, and patients who experienced complications, were over sampled. MEASURES. Postoperative complications were specified by reviewing medical literature and consulting clinical experts; each complication was mapped to ICD-9-CM. Hospital-reported complications were compared with our independent recoding of the same records. RESULTS. The weighted sensitivity, specificity, and positive and negative predictive values for reported complications were 35%, 98%, 82%, and 84%, respectively. The weighted sensitivity was 30% for serious, 40% for minor, and 10% for questionable complications. It varied from 21% among hospitals with fewer complications than expected to 45% among hospitals with more complications than expected. Only reoperation, bacteremia/sepsis, postoperative infection, and deep vein thrombosis were reported with at least 60% sensitivity. Half of the difference in risk-adjusted complication rates between low and high outlier hospitals was attributable to reporting variation. CONCLUSIONS. ICD-9-CM complications were underreported among diskectomy patients, especially at hospitals with low risk-adjusted complication rates. The validity of using coded complications to compare provider performance is questionable, even with careful efforts to identify serious events, although these results must be confirmed using more recent data.

KW - Administrative data

KW - Complications

KW - Hospital outcomes

KW - Performance measurement

KW - Quality measurement

KW - Quality of care

UR - http://www.scopus.com/inward/record.url?scp=0036780449&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036780449&partnerID=8YFLogxK

U2 - 10.1097/00005650-200210000-00004

DO - 10.1097/00005650-200210000-00004

M3 - Article

C2 - 12395020

AN - SCOPUS:0036780449

VL - 40

SP - 856

EP - 867

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 10

ER -