Infectious Surgical Complications are Not Dichotomous
| Autor: | Elizabeth B. Habermann, Robert R. Cima, Amit Merchea, Nabil Wasif, Yu Hui H. Chang, Amit K. Mathur, Raman C. Mahabir, Nitin Mishra, David A. Etzioni, James A. Madura, Heather D. Lucas, Cynthia Lessow |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Databases Factual MEDLINE 030230 surgery Health administration 03 medical and health sciences 0302 clinical medicine Hospital Administration Chart Abstraction medicine Humans Surgical Wound Infection Registries Retrospective Studies Inpatients business.industry Incidence Incidence (epidemiology) Postoperative complication Retrospective cohort study Middle Aged Hospital Records United States 030220 oncology & carcinogenesis Emergency medicine Cohort Female Surgery business Complication Follow-Up Studies |
| Zdroj: | Annals of Surgery. 267:81-87 |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/sla.0000000000002041 |
| Popis: | Objective To characterize reasons for discordance between administrative data and registry data in the determination of postoperative infectious complications. Background Data regarding the occurrence of postoperative surgical complications are identified through either administrative or registry data. Rates of complications vary significantly between these two types of data; the reasons for this are not well-understood. Methods The occurrence of 30-day inpatient infectious complications (pneumonia, sepsis, surgical site infection, and urinary tract infection) was compared between the NSQIP and administrative mechanisms at 4 academic hospitals between 2012 and 2014. In each situation where the NSQIP and administrative data were discordant regarding the occurrence of a specific complication, a 2-clinician chart abstraction was performed to characterize the reasons for discordance as (i) administrative coding error, (ii) NSQIP coding error, (iii) "question of criteria", where the discordance was the result of differences in criteria, or (iv) "dually incorrect", where both data sources coded the complication incorrectly. Results The cohort included 19,163 patients undergoing surgery in 4 different academic hospitals. Rates of infectious complications varied up to 5-fold between the two data sources. A total of 717 discordant complications were identified. Of these, the greatest portion (43%) was due to "question of criteria," followed by administrative coding error (37%), NSQIP error (15%), and dually incorrect (5%). Conclusions With a goal of improving existing mechanisms for measuring surgical quality, definitions for the occurrence of a postoperative complication need to be developed and applied consistently. Progress toward this goal will enable patients and payers to better take advantage of recent advances in healthcare data transparency. |
| Databáze: | OpenAIRE |
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