Document Detail

Identifying patient preoperative risk factors and postoperative adverse events in administrative databases: results from the Department of Veterans Affairs National Surgical Quality Improvement Program.
MedLine Citation:
PMID:  11893128     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The Department of Veterans Affairs (DVA) National Surgical Quality Improvement Program (NSQIP) employs trained nurse data collectors to prospectively gather preoperative patient characteristics and 30-day postoperative outcomes for most major operations in 123 DVA hospitals to provide risk-adjusted outcomes to centers as quality indicators. It has been suggested that routine hospital discharge abstracts contain the same information and would provide accurate and complete data at much lower cost. STUDY DESIGN: With preoperative risks and 30-day outcomes recorded by trained data collectors as criteria standards, ICD-9-CM hospital discharge diagnosis codes in the Patient Treatment File (PTF) were tested for sensitivity and positive predictive value. ICD-9-CM codes for 61 preoperative patient characteristics and 21 postoperative adverse events were identified. RESULTS: Moderately good ICD-9-CM matches of descriptions were found for 37 NSQIP preoperative patient characteristics (61%); good data were available from other automated sources for another 15 (25%). ICD-9-CM coding was available for only 13 (45%) of the top 29 predictor variables. In only three (23%) was sensitivity and in only four (31%) was positive predictive value greater than 0.500. There were ICD-9-CM matches for all 21 NSQIP postoperative adverse events; multiple matches were appropriate for most. Postoperative occurrence was implied in only 41%; same breadth of clinical description in only 23%. In only four (7%) was sensitivity and only two (4%) was positive predictive value greater than 0.500. CONCLUSION: Sensitivity and positive predictive value of administrative data in comparison to NSQIP data were poor. We cannot recommend substitution of administrative data for NSQIP data methods.
William R Best; Shukri F Khuri; Maureen Phelan; Kwan Hur; William G Henderson; John G Demakis; Jennifer Daley
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  194     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-03-14     Completed Date:  2002-03-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  257-66     Citation Subset:  AIM; IM    
The Hines VA Midwest Center for Health Services and Policy Research, IL 60141, USA.
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MeSH Terms
Bias (Epidemiology)
Data Collection
Databases, Factual / statistics & numerical data*
Hospitals, Veterans / standards*
Medical Records / statistics & numerical data
Patient Discharge / statistics & numerical data*
Postoperative Complications / epidemiology*
Predictive Value of Tests
Quality Indicators, Health Care*
Risk Adjustment
Risk Factors
Sensitivity and Specificity
Severity of Illness Index
Surgical Procedures, Operative / adverse effects*,  mortality
Total Quality Management
United States / epidemiology
United States Department of Veterans Affairs
Comment In:
J Am Coll Surg. 2003 Feb;196(2):337-8; author reply 338-9   [PMID:  12595063 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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