Predictive value of Medicare claims data for identifying revision of index hip replacement was modest

Abstract

Objective To determine the positive predictive value of Medicare claims for identifying revision of total hip replacement (THR), a frequent marker of THR quality and outcome. Study Design and Setting We obtained Medicare Part A (Hospital) claims from seven states on patients that had primary THR from July 1995 through June 1996. We searched claims to determine whether these THR recipients had a subsequent revision THR through December 2006. We selected a sample of subjects with codes indicating both index primary and subsequent revision THR. We obtained medical records for both procedures to establish whether the revision occurred on the same side as index primary THR. Results Three hundred seventy-four subjects had codes indicating primary THR in 1995–96 and subsequent revision. Seventy-one percent (95% confidence interval: 66, 76) of the revisions were performed on the index joint and would be correctly attributed as revisions of the index THR, using Medicare Claims data. Conclusion Claims data on revision THR that do not contain information on the side that was operated on are ambiguous with respect to whether the revision was performed on the index or contralateral side. Claims-based analyses of revisions after an index THR should acknowledge and adjust for this source of potential misclassification.

Twelve-Year Risk of Revision After Primary Total Hip Replacement in the U.S. Medicare Population

“…Up to 30% of the revisions that occur following primary total hip replacement are performed on the contralateral side, even with censoring of patients who had a second primary total hip replacement during the follow-up period 12 . The likelihood that the revision is performed on the index compared with the contralateral hip is not influenced by patient age or sex or surgeon volume, the three factors associated with revision risk in this analysis 12 . However, the revision risks shown in Figures 1 and 2 may be overstated by as much as 30%, and the misclassification may have blunted the associations we observed.…”

“…The code for revision was 81.53 prior to September 30, 2005, and 00.70 to 00.73 subsequently. We recognized that revisions on the right and left side cannot be distinguished in Medicare claims 12 . Therefore, if subjects had a primary total hip replacement on the contralateral side after the index primary procedure, we censored the subject at the time of the subsequent primary procedure because a revision following these two primary total hip replacements could not reliably be attributed to the index total hip replacement.…”

A systematic review of validated methods for identifying orthopedic implant removal and revision using administrative data

“…Of these, we reviewed full text for 55 articles after excluding three duplicate articles. Of these, only five studies had some data on validation, which are the focus of this report . Details of the other 31 articles with nonvalidated algorithms are provided in the final evidence report on the Mini‐Sentinel Web site (http://mini-sentinel.org/foundational_activities/related_projects/default.aspx).…”

“…Of these four studies, three studies (Heck et al ., Katz et al ., and Mahomed et al .,) used the International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD‐9‐CM ) and/or the Current Procedural Terminology ( CPT ) codes in Medicare databases (Table ). The fourth study (Katz et al .,) used ICD‐9‐CM codes for revision total hip arthroplasty (THA) and ICD‐9‐CM and CPT codes for primary THA. This study differed from the other four studies because its purpose was to assess whether a revision THA following a primary THA in Medicare recipients can be attributed to the same side, with medical records serving as the gold standard.…”

Use of routine hospital morbidity data together with weight and height of patients to predict in-hospital complications following total joint replacement

“…To study these outcomes, researchers have used existing large databases including joint replacement registries and hospital morbidity data. The latter have frequently been used to characterize the rates of immediate postoperative outcomes of both primary [15-18] and revision total joint replacement [15,19]. Methods to improve existing data sources, such as HMD, to predict complications following TJR have never been documented.…”