Administrative Database Concerns Accuracy of International Classification of Diseases, Ninth Revision Coding Is Poor for Preoperative Anemia in Patients Undergoing Spinal Fusion
Administrative Database Concerns Accuracy of International Classification of Diseases, Ninth Revision Coding Is Poor for Preoperative Anemia in Patients Undergoing Spinal Fusion
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DOI：
10.1097/brs.0000000000000598
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发表时间：
2014-11-15
期刊：
影响因子：
3
通讯作者：
Grauer, Jonathan N.
中科院分区：
文献类型：
--
作者：
Golinvaux, Nicholas S.;Bohl, Daniel D.;Grauer, Jonathan N.
研究设计.横截面研究。客观评价国际疾病分类第九版（ICD-9）编码识别脊柱融合术患者术前贫血的能力，ICD-9编码是国家数据库行政编码的基础。脊柱外科的国家数据库研究继续上升。然而，基于行政编码数据（如全国住院患者样本）的研究的有效性取决于ICD-9编码的准确性。以前已经发现这种编码对肥胖和感染等状况的敏感性较差。在一个学术医学中心进行了一项横断面研究。将医院报告的贫血ICD-9编码（用于管理编码数据库）与图表记录的术前血细胞比容（真实实验室值）直接进行比较。如果患者术前红细胞压积低于正常范围的下限，则认为患者存在术前贫血（女性36.0%，男性41.0%）。该研究包括260名患者。其中，37例患者（14.2%）贫血;然而，只有10例患者（3.8%）接受了“贫血”ICD-9编码。在编码为贫血的10例患者中，7例根据定义为贫血，而3例不是贫血，因此被错误编码。这相当于ICD-9编码的敏感性为0.19，特异性为0.99，阳性和阴性预测值分别为0.70和0.88。本研究使用术前贫血来证明ICD-9编码的潜在不准确性。这些结果对使用从ICD-9编码数据编译的数据库的出版物有影响。此外，当前研究的结果引起了对其他合并症准确性的担忧。尽管管理数据库是提供大样本量的强大资源，但我们进一步考虑数据源相对于其预期目的的质量至关重要。
Study Design. Cross-sectional study.Objective. To objectively evaluate the ability of International Classification of Diseases, Ninth Revision (ICD-9) codes, which are used as the foundation for administratively coded national databases, to identify preoperative anemia in patients undergoing spinal fusion.Summary of Background Data. National database research in spine surgery continues to rise. However, the validity of studies based on administratively coded data, such as the Nationwide Inpatient Sample, are dependent on the accuracy of ICD-9 coding. Such coding has previously been found to have poor sensitivity to conditions such as obesity and infection.Methods. A cross-sectional study was performed at an academic medical center. Hospital-reported anemia ICD-9 codes (those used for administratively coded databases) were directly compared with the chart-documented preoperative hematocrits (true laboratory values). A patient was deemed to have preoperative anemia if the preoperative hematocrit was less than the lower end of the normal range (36.0% for females and 41.0% for males).Results. The study included 260 patients. Of these, 37 patients (14.2%) were anemic; however, only 10 patients (3.8%) received an "anemia" ICD-9 code. Of the 10 patients coded as anemic, 7 were anemic by definition, whereas 3 were not, and thus were miscoded. This equates to an ICD-9 code sensitivity of 0.19, with a specificity of 0.99, and positive and negative predictive values of 0.70 and 0.88, respectively.Conclusion. This study uses preoperative anemia to demonstrate the potential inaccuracies of ICD-9 coding. These results have implications for publications using databases that are compiled from ICD-9 coding data. Furthermore, the findings of the current investigation raise concerns regarding the accuracy of additional comorbidities. Although administrative databases are powerful resources that provide large sample sizes, it is crucial that we further consider the quality of the data source relative to its intended purpose.