Identifying and Codifying Complications after Radical Cystectomy: Comparison of Administrative Diagnostic and Procedure Codes, and Clinical Chart Review

Abstract

Purpose: To our knowledge the reliability of administrative claims codes to report postoperative radical cystectomy complications has not been examined. We compared complications identified by claims data to those abstracted from clinical chart review following radical cystectomy. Methods:We manually reviewed the charts of 268 patients treated with radical cystectomy between 2014 and 2016 for 30-day complications and queried administrative complication coding using 805 ICD-9/10 codes. Complications were categorized. Using Cohen κ statistics we assessed agreement between the 2 methods of complication reporting for 1 or more postoperative complications overall, categorical complications and complications stratified by the top quartile length of hospital stay and patients who were readmitted. Results:At least 1 or more complications were recorded in 122 patients (45.5%) through manual chart review and 80 (29.9%) were recorded via claim coding data with a concordance rate of κ = 0.16, indicating weak agreement. Concordance was generally weak for categorical complication rates (range 0.05 to 0.36). However, when examining only the top length of stay quartile, 1 or more complications were reported in 32 patients (65%) by the manual chart review and in 12 (25%) via coding data with a concordance rate of κ = −0.2. Agreement was weak, similar to the total cohort. Conclusions:Manual chart review and claim code identification of complications are not highly concordant even when stratified by patients with an extended length of stay, who are known to have more frequent complications. Researchers and administrators should be aware of these differences and exercise caution when interpreting complication reports.

Dissecting the role of radical cystectomy and urinary diversion in post-operative complications: an analysis using the American College of Surgeons national surgical quality improvement program database

“…Lastly, it is inherently difficult to generalize the outcomes to pre-existing literature, as there is much pre--existing literature demonstrating a large discordance in the consistency of data collection and urologic oncology outcome reporting (7,29,30). A strength of the NSQIP database however is that it collects data using standardized, clinical chart abstraction, which has been shown to be more comprehensive and reliable than administrative databases to identify complications (31).…”

This Month in Adult Urology

“…Peyton et al (page 913) from Tampa, Florida compared the accuracy of claims based data to chart review for complications of radical cystectomy. 8 Chart review identified 1 or more complication in 45% of cases compared to only 29% from claims coding data. The difference was even greater for cases with increased length of stay wherein a higher rate of complications is expected.…”

Surgical outcomes of robot‐assisted radical cystectomy in octogenarian or older patients: A Japanese nationwide study

“…The indicator of in-hospital mortality included disease-related death and death from other causes. According to previous studies, [15][16][17][18][19] complications were defined using ICD-10 codes as registration of the following diseases: (i) sepsis (A32.7, A40.x, A41.x, A42.7, B37.7, and T81.4); (ii) disseminated intravascular coagulation (D65); (iii) pulmonary embolism (I26.x); (iv) cardiac events (ischemic heart disease [I20.x-I24.x] and heart failure [I11.0 and I50.x]); (v) other vascular complications (I71.x, I73.9, I74.x, I77.x, I80-I83.x, I89.x, K55.0, K55.9, T79.0, T79.1, and T81.7); (vi) stroke (I60.x-I64); (vii) pneumonia or influenza (J10.x-J18.x); (viii) other respiratory complications (J46, J69.0, J70.x, J80-J86.x, J93.x, J94.2, J95.x, and J96.x); (ix) peritonitis or peritoneal abscess (K65.x, N73.3, and N73.5); (x) ileus (K56.x and K91.3); (xi) acute renal failure (N17x, N28.0, and N99.0); (xii) genitourinary infection (N10, N30.x, N41.x, N45.x, N70.x-N73.x, and N76); (xiii) other genitourinary complications (N13.x, N32.x, N35.x, N36.x, N82.x, and N99.x); (xiv) disruption of an operation wound (T81.3); and (xv) intraoperative complications (S34.x-S39.x and T81.2).…”