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

Abstract

Purpose To identify studies that have validated administrative and claims database algorithms for identifying patients with orthopedic device revision or removal. Methods As a part of the Food and Drug Administration's Mini-Sentinel pilot program, we performed a systematic review to identify algorithms for orthopedic implant removal/revision in administrative and claims databases in the USA or Canada. Results Five studies examined the validity of database algorithms against a gold standard of documentation in medical records (n = 3) or codes/documentation in another database (n = 2). The positive predictive values (PPV) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and/or the Current Procedural Terminology codes for revision total hip arthroplasty (THA) in the US Medicare population compared with medical record review were 92%and 91%, respectively. In another study of the US Medicare population, multiple ICD-9 codes for revision total knee arthroplasty were compared with newly available single ICD-9-CM codes for revision knee arthroplasty; sensitivity was 87% and specificity was 99% (PPV not provided). The fourth study validated the ICD-9-CM codes for revision total knee arthroplasty against Ontario health insurance physician fee service claims as the gold standard and found a PPV of 32%. In the last study in Medicare population, the accuracy of the attribution of revision THA to the same side as the earlier index primary THA was examined; PPV for same laterality of revision THA was 71% (using ICD-9-CM codes). Conclusions Validation data, with regard to the ICD-9-CM or the Current Procedural Terminology code algorithms for revision THA in the Medicare population, exist. More validation studies are needed to confirm these findings and examine other large databases.

Opioid use after total hip arthroplasty surgery is associated with revision surgery

“…Our study is also an exploratory analysis of the association of opioid amounts and the risk of revision surgery in the short and mid-term, we did not conduct multiple hypothesis adjustments to our analysis but would recommend it for subsequent confirmatory analysis. Finally, while we used published methodology to identify revision cases, it is possible the revision surgery was linked to incorrect primary procedures due to the lack of laterality in our data [ 26 , 27 ]. We do not believe this to be different between the groups studied and do not expect this to impact our estimations.…”

Effects of the Length of Stay on the Cost of Total Knee and Total Hip Arthroplasty from 2002 to 2013

“…This study also utilized ICD-9-CM coding to identify total joint arthroplasties and their associated costs, which may misclassify procedures such as unicompartmental knee arthroplasty compared with total knee arthroplasty. Although, to our knowledge, there have been only a few studies examining the validity of ICD-9-CM codes for accurately identifying joint replacement [22][23][24] , the general consensus is that administrative codes accurately identify knee and hip arthroplasty. Finally, the analysis of databases containing large samples can increase the possibility of a type-I error, falsely concluding that there is an important association where none exists.…”

The John N. Insall Award: Do Intraarticular Injections Increase the Risk of Infection After TKA?

“…Although the accuracy of this specific administrative claims data set has not been formally studied, some studies detailing the sensitivity of administrative claims data for detecting orthopaedic-specific complications or revision surgery have been performed. For example, a systematic review published by Singh et al [17] summarized validated coding algorithms to identify orthopaedic hip and knee arthroplasty revision procedures from administrative claims data with sensitivity and specificity ranging from 77.7% to 87.2% and 97.6% to 99.0%, respectively. Additionally, a study by Murphy et al [13] assessed the use of claims data in identifying infection 6 months after anterior cruciate ligament (ACL) reconstruction.…”