Development and evaluation of a list of high-risk inpatient procedures in patients 65 years and older.
Development and evaluation of a list of high-risk inpatient procedures in patients 65 years and older.
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制定和评估 65 岁及以上患者的高风险住院手术清单。
DOI：
10.1111/jgs.18685
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发表时间：
2024
影响因子：
6.3
通讯作者：
Weissman,JoelS
中科院分区：
文献类型：
--
作者：
Shah,SamirK;Xiang,Lingwei;Manful,Adoma;Shah,MihirM;Sharma,Gaurav;Adler,RachelR;Weissman,JoelS
背景住院手术是美国老年人常见的重要健康事件。为了促进手术结果的研究，我们试图创建和评估列表ofInternational Classification of Disease，Tenth Revision（ICD-10）codes for high-risk injury procedures，定义为至少有1%的住院mortality.MethodsThis retrospective national cohort study analyzes Medicare claims from 2018 for patients 65 years and older undergoing injury procedures.住院索赔中的手术诊断相关组（DRG）代码用于识别手术。我们确定了每例患者的主要ICD-10手术代码，然后将所有代码与至少1%的住院死亡率进行了汇编，产生了三个单独的列表：一个列表对择期与紧急/急诊状态设盲，一个列表对紧急/急诊和择期手术各设一个。由三名外科医生进行的临床审查用于删除不太可能是死亡近因的手术。为了进行评估，我们检查了2017年，2019年和2020年按服务付费的医疗保险受益人中每个代码的死亡率，以确定其中有多少人符合1%的死亡率标准。ResultsThis study includes 2，241，419名2018年接受住院手术的患者。最终结果包括三个列表的231个（择期vs紧急/急诊状态盲态）、167个（紧急/急诊状态）和119个（择期状态）ICD-10程序代码。我们对2017年、2019年和2020年的评估表明，在我们的主列表中，对择期与紧急/急诊状态不知情，97.8%的手术的住院死亡率至少为1%。在我们的紧急/急诊和择期手术的高风险程序列表中，100%和94.1%的代码符合此requirement.ConclusionsWe开发并评估了代表65岁及以上患者高风险程序的ICD-10代码列表。这些列表将成为研究手术结果的研究人员的有力工具。
BackgroundInpatient procedures are common and important health events for older Americans. To facilitate surgical outcomes research, we sought to create and evaluate lists ofInternational Classification of Disease, Tenth Revision(ICD‐10) codes for high‐risk inpatient procedures, defined as having at least a 1% inpatient mortality.MethodsThis retrospective national cohort study analyzes Medicare claims from 2018 for patients 65 years and older undergoing inpatient procedures. Surgical Diagnosis Related Group (DRG) codes in the inpatient claims were used to identify procedures. We identified the primary ICD‐10 procedure code for each patient and then compiled all codes with at least a 1% inpatient mortality yielding three separate lists: one list that was blind to elective versus urgent/emergent status, and one each for urgent/emergent and elective procedures. Clinical review by three surgeons was used to remove procedures unlikely to be the proximate cause of mortality. For evaluation, we examined the mortality of each code among fee‐for‐service Medicare beneficiaries in 2017, 2019, and 2020 to determine how many of these satisfied the 1% mortality criterion.ResultsThis study included 2,241,419 patients from 2018 undergoing inpatient procedures. The final result included 231 (blind to elective vs urgent/emergent status), 167 (urgent/emergent status), and 119 (elective status) ICD‐10 procedure codes for the three lists. Our evaluation from 2017, 2019, and 2020 demonstrated that in our master list, which was blind to elective versus urgent/emergent status, 97.8% of procedures had an inpatient mortality of at least 1%. In our high‐risk procedures lists for urgent/emergent and elective procedures, 100% and 94.1% of codes met this requirement.ConclusionsWe developed and evaluated lists of ICD‐10 codes representing high‐risk procedures in patients 65 years and older. These lists will be powerful tools for researchers studying surgical outcomes.