Background
Information extracted from the hospital discharge data set is used increasingly for
outcomes research and for benchmarking hospital and provider performance. The accuracy
of these data in detecting vascular complications has never been validated.
Methods
We compared morbidity and mortality data derived from the hospital discharge data
set to similar data recorded concurrently by our Surgical Activity Tracking System
(SATS) for 1 year on the vascular surgery service.
Results
Of 798 total admissions, no complications were detected by either system in 598 admissions
(75%). In 200 admissions (25%), there were 335 complications, including 24 deaths
(3.0%), that occurred either in-hospital or within 30 days of the date of operation
or the date of discharge for nonoperative admissions. Of the 335 complications, 180
(53.7%) were recorded by both systems; the SATS missed 59 complications recorded in
the hospital discharge data set (17.6%), whereas the hospital discharge data set missed
96 complications recorded in the SATS (28.7%, P = .003). Of the 289 in-hospital complications, the SATS recorded 230 (79.5%), whereas
the hospital discharge data set recorded 229 (79.2%). Of the 24 deaths, the hospital
discharge data set missed 6 that occurred after discharge but within the 30-day reporting
period
Conclusions
Both systems are not completely accurate for tracking inpatient complications. The
SATS was more representative than the hospital discharge data set in capturing 30-day
morbidity and mortality. An amalgamation of the 2 systems would provide more optimal
tracking of complications.
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References
Centers for Medicare and Medicaid Services. Hospital Quality Initiative (HQI). [Centers for Medicare & Medicaid Services Web site.] Available at: http://www.cms.hhs.gov/quality/hospital. Accessed September 1, 2005.
University Health System Consortium. [University Health System Consortium Web site.] Available at: http://www.uhc.edu. Accessed September 1, 2005.
- Experience in the United States with intact abdominal aortic aneurysm repair.J Vasc Surg. 2001; 33: 304-311
- The outcome in the United States after thoracoabdominal aortic aneurysm repair, renal artery bypass, and mesenteric revascularization.J Vasc Surg. 2001; 34: 54-61
- Racial disparity in surgical complications in New York State.Ann Surg. 2005; 242: 151-155
- Accuracy of hospital discharge abstracts for identifying stroke.Stroke. 1994; 25: 2348-2355
- Complications, comorbidities, and mortality: improving classification and prediction.HSR: Health Services Research. 1997; 32: 229-238
- Identifying patient preoperative risk factors and postoperative adverse events in administrative databases: results from the Department of Veterans Affairs National Surgical Quality Improvement Program.J Am Coll Surg. 2002; 194: 257-266
- Does clinical evidence support ICD-9-CM diagnosis coding of complications?.Med Care. 2000; 38: 868-876
- Can administrative data be used to compare postoperative complication rates across hospitals?.Med Care. 2002; 40: 856-867
Surgical Care Improvement Project (SCIP). Available at: http://www.medqic.org/scip/scip_homepage.html. Accessed March 30, 2006.
- Complications in surgical patients.Arch Surg. 2002; 137: 611-618
- Presidential address: Vascular surgery–Comparing outcomes.J Vasc Surg. 1996; 23: 5-17
- Icd-9-cm coding handbook, without answers 2004. Health Forum Inc, Chicago (IL)2004: 19
- Hart A.C. Hopkins C.A. Icd-9-cm 2005 Professional for Hospitals. 6th ed. Eden Prairie (MN), 2005: iii
- Suggested standards for reporting complications in vascular surgery.in: Towne J.B. Bernhard W.M. Complications in vascular surgery. 3rd ed. Quality Medical Publishing, Inc, St Louis1991: 1-10
- Suggested standards for reports dealing with lower extremity ischemia.J Vasc Surg. 1986; 4: 80-94
- Suggested standards for reports dealing with cerebrovascular disease.J Vasc Surg. 1988; 8: 721-729
- Reporting standards in venous disease.J Vasc Surg. 1988; 8: 172-181
- Suggested standards for reporting on arterial aneurysms.J Vasc Surg. 1991; 13: 452-458
- Reporting standards for lower extremity arterial endovascular procedures.J Vasc Surg. 1993; 17: 1103-1107
- Recommended standards for reports dealing with lower extremity ischemia: revised version.J Vasc Surg. 1997; 26: 517-538
- International Consensus Committee on Chronic Venous Disease.J Vasc Surg. 1995; 21: 635-645
- Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes?.J Thorac Cardiovasc Surg. 2005; 129: 1309-1317
- The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program.Ann Surg. 1998; 228: 491-507
- The meaning of early mortality after CABG.Eur J Cardiothorac Surg. 1999; 15: 401-407
- Effective audit: reporting to the National Confidential Enquiry into Perioperative Deaths.BMJ. 1992; 304: 1472-1474
- Identifying priorities in methodological research using ICD-9-CM and ICD-10 administrative data: report from an international consortium.BMC Health Services Research. 2006; 6 (Available at: http://www.biomedcentral.com/1472-6963/6/77. Accessed August 28, 2006.): 77
Article info
Publication history
Accepted:
October 1,
2006
Received in revised form:
September 13,
2006
Received:
April 12,
2006
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
