Comparison of ICD-9 based, retrospective, and prospective assessments of perioperative complications assessment of accuracy in reporting Clinical article
Comparison of ICD-9 based, retrospective, and prospective assessments of perioperative complications assessment of accuracy in reporting Clinical article
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DOI：
10.3171/2010.9.spine10151
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发表时间：
2011-01-01
影响因子：
2.8
通讯作者：
Ratliff, John K.
中科院分区：
文献类型：
--
作者：
Campbell, Peter G.;Malone, Jennifer;Ratliff, John K.
目的基于ICD 9的并发症和医院获得性疾病（HAC）病历回顾的大型研究尚未通过与围手术期不良事件发生率的前瞻性评估进行比较来验证回顾性病历回顾，而通常认为并发症发生率低报，尚未进行前瞻性研究，目前尚不清楚ICD-9- 10是否适用于基于人群的研究比回顾性综述更准确，或者可能同样容易受到偏倚的影响。基于对围手术期并发症的评估，作者比较了ICD-9对此类并发症的前瞻性独立评估，基于接受脊柱手术的患者队列中的HAC数据为了进一步比较，对同一组患者进行了一项单独的回顾性研究，方法前瞻性评估6个月内脊柱手术的并发症，（2008年5月至12月）使用独立审计员和经验证的围手术期并发症定义完成。审计员维护了前瞻性数据库，其中包括手术后最初30天内发生的并发症所有医学不良事件都包括在评估中所有在研究期间接受脊柱手术的患者都有资格入选，使用的唯一排除标准是患者评估的审计员的可用性。提取这些患者以供进一步审查，从编码器数据中获得基于ICD-9的HAG数据。使用图表和电子病历审查单独完成并发症发生率的回顾性评估。围手术期不良事件的相同定义和医疗不良事件的纳入应用于前瞻性，基于ICD-9，结果92例患者有足够的ICD-9评估记录，98例患者有足够的病历信息进行回顾性评估，两组患者的总体并发症发生率相似主要并发症ICD-9占17.4%，回顾性占19.4%，前瞻性占22.4%，次要并发症ICD-9占43.8%，回顾性占31.6%，和前瞻性429%），但ICD-9-基于评估包括许多未被稽查员视为并发症的轻微医疗事件，ICD-9和回顾性评估ICD 9评估低估了感染、再次手术的需要、深部伤口感染、深静脉血栓形成和新发神经功能缺损（分别为p = 0003，p <00001，p <00001，p = 00025，p = 004）回顾性分析低估了感染的发生率，需要翻修和深部伤口感染（p <0.0001）只有在新的心脏事件的捕获中，基于ICD-9的报告比前瞻性数据积累更准确（p = 004）评价并发症发生率的最敏感指标是前瞻性综述，其次是基于ICD 9的评估（p = 0 0 5）结论脊柱手术患者围手术期不良事件和主要并发症的ICD-9编码显示总体并发症发生率与前瞻性测量结果相似。相反，回顾性分析低估了并发症发生率。基于ICD-9的审查捕获了许多临床意义有限的医学事件，从而推高了该方法所证实的不良事件的总体发生率，在多种类别的重大临床显著围手术期并发症中，基于和回顾性评估显著低估了并发症发生率这些结果说明了使用基于人群的ICD-9和回顾性并发症记录时的一个显著潜在弱点和不准确性来源（DOI 10 3171/2010 9 SPINE 10151）
Object Large studies of ICD 9-based complication and hospital-acquired condition (HAC) chart reviews have not been validated through a comparison with prospective assessments of perioperative adverse event occurrence Retrospective chart review, while generally assumed to underreport complication occurrence, has not been subjected to prospective study It is unclear whether ICD-9-based population studies are more accurate than retrospective reviews or are perhaps equally susceptible to bias To determine the validity of an ICD-9-based assessment of perioperative complications the authors compared a prospective Independent evaluation of such complications with ICD-9-based HAC data in a cohort of patients who underwent spine surgery For further comparison, a separate retrospective review of the same cohort of patients was completed as wellMethods A prospective assessment of complications in spine surgery over a 6-month period (May to December 2008) was completed using an independent auditor and a validated definition of perioperative complications The auditor maintained a prospective database, which Included complications occurring in the initial 30 days after surgery All medical adverse events were included in the assessment All patients undergoing spine surgery during the study period were eligible for inclusion, the only exclusionary criterion used was the availability of the auditor for patient assessment From the overall patient database 100 patients were randomly extracted for further review, in these patients ICD-9-based HAG data were obtained from coder data Separately a retrospective assessment of complication incidence was completed using chart and electronic medical record review The same definition of perioperative adverse events and the inclusion of medical adverse events were applied in the prospective, ICD-9-based, and retrospective assessmentsResults Ninety-two patients had adequate records for the ICD-9 assessment whereas 98 patients had adequate chart information for retrospective review The overall complication incidence among the groups was similar (major complications ICD 9 17 4%, retrospective 19 4%, and prospective 22 4%, minor complications ICD-9 43 8%, retrospective 31 6%, and prospective 42 9%) However the ICD-9-based assessment included many minor medical events not deemed complications by the auditor Rates of specific complications were consistently underreported in both the ICD-9 and the retrospective assessments The ICD 9 assessment underreported infection, the need for reoperation, deep wound infection, deep venous thrombosis and new neurological deficits (p = 0003, p < 0 0001, p < 0 0001, p = 0 0025, and p = 0 04, respectively) The retrospective review underestimated incidences of infection, the need for revision and deep wound infection (p < 0 0001 for each) Only in the capture of new cardiac events was ICD-9-based reporting more accurate than prospective data accrual (p = 0 04) The most sensitive measure for the appreciation of complication occurrence was the prospective review followed by the ICD 9-based assessment (p = 0 05)Conclusions An ICD-9-based coding of perioperative adverse events and major complications in a cohort of spine surgery patients revealed an overall complication incidence similar to that in a prospectively executed measure In contrast a retrospective review underestimated complication incidence The ICD-9-based review captured many medical events of limited clinical import inflating the overall incidence of adverse events demonstrated by this approach In multiple categories of major clinically significant perioperative complications ICD-9-based and retrospective assessments significantly underestimated complication incidence These findings illustrate a significant potential weakness and source of inaccuracy in the use of population based ICD-9 and retrospective complication recording (DOI 10 3171/2010 9 SPINE10151)