Is Administratively Coded Comorbidity and Complication Data in Total Joint Arthroplasty Valid?

Bozic, Kevin J.; Bashyal, Ravi K.; Anthony, Shawn G.; Chiu, Vanessa; Shulman, Brandon S.; Rubash, Harry E.

doi:10.1007/s11999-012-2352-1

Cited by 160 publications

(101 citation statements)

References 11 publications

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“…First, we relied on administrative claims data (which did not include laterality) to identify revisions and risk factors for early failure. However, previous investigators have reported reasonable correlation between administrative claims and the clinical record when evaluating causes and types of revision TJA procedures [2]. Second, our study was limited to Medicare patients, and therefore our findings may not be generalizable to the broader population of younger patients who undergo primary THA.…”

Section: Discussionmentioning

confidence: 83%

Risk Factors for Early Revision After Primary Total Hip Arthroplasty in Medicare Patients

Bozic

Lau

Ong

et al. 2013

Clin Orthop Relat Res

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106

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Background Patient, surgeon, health system, and device factors are all known to influence outcomes in THA. However, patient-related factors associated with an increased risk of early failure are poorly understood, particularly in elderly patients. Questions/purposes We identified specific demographic and clinical characteristics associated with increased risk of early revision in Medicare patients with THA. Methods The Medicare 5% national sample administrative database was used to calculate the relative risk of revision within 12 months following primary THA as a function of baseline medical comorbidities in 56,030 Medicare patients who underwent primary THA between 1998 and 2010. The impact of 29 comorbid conditions on risk of early revision was examined using Cox regression, controlling for age, sex, race, US Census region, socioeconomic status, and all other baseline comorbidities. Results Depression, rheumatologic disease, psychoses, renal disease, chronic urinary tract infection, and congestive heart failure were associated with revision THA within

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Section: Discussionmentioning

confidence: 83%

Risk Factors for Early Revision After Primary Total Hip Arthroplasty in Medicare Patients

Bozic

Lau

Ong

et al. 2013

Clin Orthop Relat Res

Self Cite

106

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“…First, as in all claims-based studies, coding misclassification can occur. It has been shown that administrative data tend to have high specificity (that is, a low false-positive rate) but low sensitivity (a high falsenegative rate) in identifying comorbidities and complications [11,22]. Thus, if anything, our data source underestimates the prevalence of opioid abuse and dependence.…”

Section: Discussionmentioning

confidence: 96%

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Menendez

Ring

Bateman

2015

Clinical Orthopaedics &Amp; Related Research

311

176

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Background Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting. Questions/purposes We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.

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“…Previous studies have found administrative claims to be useful in orthopaedic surgery [14,24], and specifically in THA [3][4][5]. Bozic et al [2] compared administrative claims data with institutional data and reported that it was highly specific ([ 92%) for each arthroplasty-relevant complication and comorbidity tested but variable in their sensitivity (29%-100%). This level of accuracy may be sufficient for this study but also could influence the results, especially if documentation was more thorough for revisions of one bearing surface type compared with the other.…”

Section: Discussionmentioning

confidence: 99%

“…This searchable database contains 100% of both inpatient and outpatient claims with more than 50 million unique patient records including 1.1 million THAs. This research tool has been used in various studies in orthopaedic surgery [14,24] and has been specifically validated for complications after total joint arthroplasty [2].…”

Section: Methodsmentioning

confidence: 99%

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Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

Penrose

Seyler

Wellman

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Isolated revision of the acetabular component in the setting of total hip arthroplasty has an increased risk of dislocation. With local soft tissue destruction frequently associated with failed metal-on-metal (MoM) bearings, it is presumed that acetabular revision of these hips will have even greater risk of complications. However, no study directly compares the complications of MoM with metal-on-polyethylene (MoP) acetabular revisions. Questions/purposes In the context of a large database analysis, we asked the following questions: (1) Are there differences in early medical or wound complications after isolated acetabular revision of MoM and MoP bearing surfaces? (2) Are there differences in the frequency of dislocation, deep infection, and rerevision based on the bearing surface of the original implant? Methods A review of the 100% Medicare database from 2005 to 2012 was performed using International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. We identified 451 patients with a MoM bearing and 628 patients with a MoP bearing who had an isolated acetabular revision and a minimum followup of 2 years. The incidence, odds ratios, and 95% confidence intervals for early medical or wound complications were calculated using a univariate analysis at 30 days with patient sex and age group-adjusted analysis for blood transfusion. The incidence, odds ratio, and 95% confidence intervals for dislocation, deep infection, and rerevision were calculated using a univariate analysis at 30 day, 90 days, 1 year, and 2 years using a subgroup analysis with the Cochran-Mantel-Haenszel test to adjust for patient gender and age groups. Results There were no differences between the MoM and MoP isolated acetabular revisions in the incidence of 30-day local complications.

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Is Administratively Coded Comorbidity and Complication Data in Total Joint Arthroplasty Valid?

Cited by 160 publications

References 11 publications

Risk Factors for Early Revision After Primary Total Hip Arthroplasty in Medicare Patients

Risk Factors for Early Revision After Primary Total Hip Arthroplasty in Medicare Patients

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty

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