Symposium: Papers Presented at the Annual Meetings of the Knee Society

Clinical Orthopaedics and Related Research®

, Volume 471, Issue 1, pp 201-205

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

  • Kevin J. BozicAffiliated withDepartment of Orthopaedic Surgery, University of CaliforniaPhilip R. Lee Institute for Health Policy Studies, University of California Email author 
  • , Ravi K. BashyalAffiliated withDepartment of Orthopaedic Surgery, NorthShore University HealthSystem
  • , Shawn G. AnthonyAffiliated withDepartment of Orthopaedic Surgery, Massachusetts General Hospital
  • , Vanessa ChiuAffiliated withDepartment of Orthopaedic Surgery, University of CaliforniaPhilip R. Lee Institute for Health Policy Studies, University of California
  • , Brandon ShulmanAffiliated withPerlman School of Medicine, University of Pennsylvania
  • , Harry E. RubashAffiliated withDepartment of Orthopaedic Surgery, Massachusetts General Hospital

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Abstract

Background

Administrative claims data are increasingly being used in public reporting of provider performance and health services research. However, the concordance between administrative claims data and the clinical record in lower extremity total joint arthroplasty (TJA) is unknown.

Questions/purposes

We evaluated the concordance between administrative claims and the clinical record for 13 commonly reported comorbidities and complications in patients undergoing TJA.

Methods

We compared 13 administratively coded comorbidities and complications derived from hospital billing records with clinical documentation from a consecutive series of 1350 primary and revision TJAs performed at three high-volume institutions during 2009.

Results

Concordance between administrative claims and the clinical record varied across comorbidities and complications. Concordance between diabetes and postoperative myocardial infarction was reflected by a kappa value > 0.80; chronic lung disease, coronary artery disease, and postoperative venous thromboembolic events by kappa values between 0.60 and 0.79; and for congestive heart failure, obesity, prior myocardial infarction, peripheral arterial disease, bleeding complications, history of venous thromboembolism, prosthetic-related complications, and postoperative renal failure by kappa values between 0.40 and 0.59. All comorbidities and complications had a high degree of specificity (> 92%) but lower sensitivity (29%–100%).

Conclusions

The data suggest administratively coded comorbidities and complications correlate reasonably well with the clinical record. However, the specificity of administrative claims is much higher than the sensitivity, indicating that comorbidities and complications coded in the administrative record were accurate but often incomplete.

Level of Evidence

Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.