Can Additional Information Be Obtained from Claims Data to Support Surgical Site Infection Diagnosis Codes?

Abstract

OBJECTIVE. International Classification of Diseases, Ninth Revision, diagnosis codes are increasingly used to identify healthcare-associated infections, often with insufficient evidence demonstrating validity of the codes used. Absent medical record verification, we sought to confirm a claims algorithm to identify surgical site infections (SSIs) by examining the presence of clinically expected SSI treatment.METHODS. We performed a retrospective cohort study, using private insurer claims data from persons less than 65 years old with ICD-9-CM procedure or Current Procedure Terminology (CPT-4) codes for anterior cruciate ligament (ACL) reconstruction from lanuary 2004 through December 2010. SSIs occurring within 90 days after ACL reconstruction were identified by ICD-9-CM diagnosis codes. Antibiotic utilization, surgical treatment, and microbiology culture claims within 14 days of SSI codes were used as evidence to support the SSI diagnosis.RESULTS. Of 40,702 procedures, 401 (1.0%) were complicated by SSI, 172 (0.4%) of which were specifically identified as septic arthritis. Most SSIs were associated with an inpatient admission (232/401 [58%]), and/or surgical procedure(s) for treatment (250/401 [62%]). Temporally associated antibiotics, surgical treatment procedures, and cultures were present for 84% (338/401), 61% (246/401), and 59% (238/401), respectively. Only 5.7% (23/401) of procedures coded for SSI after the procedure had no antibiotics, surgical treatments, or cultures within 14 days of the SSI claims.CONCLUSIONS. More than 94% of patients identified by our claims algorithm as having an SSI received clinically expected treatment for infection, including antibiotics, surgical treatment, and culture, suggesting that this algorithm has very good positive predictive value. This method may facilitate retrospective SSI surveillance and comparison of SSI rates across facilities and providers.

Incidence of Surgical Site Infection Following Mastectomy With and Without Immediate Reconstruction Using Private Insurer Claims Data

“…7 Data include all fully-adjudicated claims submitted from providers, facilities, and outpatient pharmacies linked to health plan enrollment information. Fully insured women with enrollment in a fee-for-service plan with medical coverage of hospital and physician services were eligible for inclusion in the cohort.…”

Use of Quantile Regression to Determine the Impact on Total Health Care Costs of Surgical Site Infections Following Common Ambulatory Procedures

“…24 This is consistent with our finding that the proportion of “serious” infections resulting in reoperation during an inpatient hospitalization after BCS was very small (10.7%), while almost 50% of the “serious” SSIs were categorized as such based on a wound care procedure performed outside of the operating room (i.e., in a clinic or at the bedside). In contrast, as we reported previously the majority of SSIs after ACL were coded for septic arthritis, 18 which would be expected to result in high costs due to the need for prolonged intravenous antibiotics and surgical treatment, often leading to removal of ligament allografts and subsequent revision surgery. In our cohort, 56% of the serious SSIs after ACL required surgical treatment in the operating room during an inpatient hospitalization.…”

Impact of antibiotic prophylaxis for intrathecal baclofen pump surgery in pediatric patients

“…As in prior study designs, 9,18 we avoided complicated cases associated with long hospitalizations prior to ITBP surgery. Patients were discharged between July 1, 2004, and March 31, 2014, and had a minimum of 180 days of prior screening in the database along with a minimum 180-day follow-up period.…”

“…All complication and infection events were identified through ICD-9-CM diagnosis codes: 996.2X, 996.6X, 996.7X, 997.0X, 997.3X, 998.0X, 998.1X-998.4X, 998.7X-998.9X, and 998.5X. 15,18 statistical Analysis…”