Validation of Using Claims Data to Measure Safety of Lumbar Fusion Surgery

Abstract

Study Design Retrospective analysis of patients undergoing elective lumbar fusion operations, comparing rates of repeat spine surgery based on method of ascertainment. Objective We report the accuracy of a claims-based approach for reporting repeat surgery compared to medical records abstraction as the “gold standard.” Summary of Background Information Previous studies have reported the validity of a claims-based algorithm for grouping patients by surgical indication and classifying operative features, but their accuracy in measuring surgical quality indicators has not been widely examined. Methods We identified a subset of patients undergoing elective lumbar fusion operations at a single institution from 1996-2011, excluding those with spinal fracture, spinal cord injury, or cancer. From the medical record we abstracted the incidence of repeat spine operation or re-hospitalization at one-year. We cross-classified each event record with its corresponding value derived from claims. The sensitivity and specificity of the claims-based approach were calculated for reoperation within 30, 90, and 365 days, and all-cause hospital readmission within 30 days. Results Medical records linked to claims data were obtained for 520 patients undergoing elective lumbar fusion. Reoperation rates based on chart review were 1.0%, 1.3%, 3.6%, compared to 0.8%, 1.7%, and 3.8% based on the final claims methods at 30, 90, and 365 days, respectively. The claims-based algorithm had sensitivities of 80.0%, 100%, and 94.1% and specificities of 100%, 99.6%, 99.2% for repeat surgery within 30, 90, and 365 days, respectively. The sensitivity for all-cause readmission was 50%. Conclusion Health care quality improvement efforts often rely on administrative data to report surgical safety. We found that claims-based ascertainment of safety at a single institution was very accurate. However, accuracy depended on careful attention to the timing of outcomes, as well as the definitions and coding of repeat surgery, including how orthopaedic device removal codes are classified.

The Effect of Including Benchmark Prevalence Data of Common Imaging Findings in Spine Image Reports on Health Care Utilization Among Adults Undergoing Spine Imaging

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Timing of Lumbar Spinal Fusion Affects Total Hip Arthroplasty Outcomes

“…Evidence in both the arthroplasty and spine literature is mixed on the accuracy and validity of administrate claims in identifying postoperative complications. [28][29][30][31] Moreover, we do not have patient-specific identifiers or direct clinical information that allows for more complex multivariate regression analysis. Although we were able to match patients by age and sex, there were still differences in comorbidities among the groups which may confound our surgical outcomes.…”

Repeat decompression and fusions following posterolateral fusion versus posterior/transforaminal lumbar interbody fusion for lumbar spondylosis: a national database study

“…National population-based databases provide complete information about reoperations without the follow-up loss because the patients had the reoperations in the hospitals in Korea, even after they discharged from the initial hospital after the index operation. The claim-based approach for reporting reoperation was comparably accurate compared with medical records abstraction because the fee-for-service reimbursement system in Korea requires procedure codes of service for every surgical fee 10 . No study has been conducted to evaluate the difference in the reoperation rates between the different lumbar surgical fusion procedures subgroups with the national population database.…”