Hernia

, Volume 22, Issue 2, pp 243–248 | Cite as

Accuracy of co-morbidity data in patients undergoing abdominal wall hernia repair: a retrospective study

  • S. Hajibandeh
  • S. Hajibandeh
  • R. Deering
  • D. McEleney
  • J. Guirguis
  • S. Dix
  • A. Sreh
  • E. Toner
  • A. El Muntasar
  • A. Kausar
  • G. Sheikh
  • D. OShea
  • A. Shafiq
  • A. Kelly
  • A. Khan
  • D. Arumugam
  • A. Evans
Original Article

Abstract

Objectives

To determine the baseline accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of routinely collected co-morbidity data in patients undergoing abdominal wall hernia repair.

Methods

All patients aged > 18 who underwent umbilical, para-umbilical, inguinal or incisional hernia repair between 1 January 2015 and 1 November 2016 were identified. All parts of the clinical notes were searched for co-morbidities by two authors independently. The following co-morbidities were considered: hypertension, ischaemic heart disease (IHD), diabetes, asthma, chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CVD), chronic kidney disease (CKD), hypercholesterolemia, obesity and smoking. The co-morbidities data from clinical notes were compared with corresponding data in hospital episode statistics (HES) database to calculate accuracy, sensitivity, specificity, PPV and NPV of HES codes for co-morbidities. To assess the agreement between clinical notes and HES data, we also calculated Cohen’s Kappa index value as a more robust measure of agreement.

Results

Overall, 346 patients comprising 3460 co-morbidity codes were included in the study. The overall accuracy of HES codes for all co-morbidities was 77% (Kappa: 0.13). When calculated separately for each co-morbidity, the accuracy was 72% (Kappa: 0.113) for hypertension, 82% (Kappa: 0.232) for IHD, 85% (Kappa: 0.203) for diabetes, 86% (Kappa: 0.287) for asthma, 91% (Kappa: 0.339) for COPD, 92% (Kappa: 0.374) for CVD, 94% (Kappa: 0.424) for CKD, 74% (Kappa: 0.074) for hypercholesterolemia, 71% (Kappa: 0.66) for obesity and 24% (Kappa: 0.005) for smoking. The overall sensitivity, specificity, PPV and NPV of HES codes were 9, 100, 100, and 77%, respectively. The results were consistent when individual co-morbidities were analyzed separately.

Conclusions

Our results demonstrated that HES co-morbidity codes in patients undergoing abdominal wall hernia repair are specific with good positive predictive value; however, they have substandard accuracy, sensitivity, and negative predictive value. The presence of a relatively large number of false negative or missed cases in HES database explains our findings. Better documentation of co-morbidities in admission clerking proforma may help to improve the quality of source documents for coders, which in turn may improve the accuracy of coding.

Keywords

Hernia Coding Co-morbidity Accuracy Hospital episode statistics 

Notes

Author contributions

Conception and design: SH, SH. Data collection: All authors. Analysis and interpretation: SH, SH. Writing the article: SH, SH. Final approval of the article: All authors. Statistical analysis: SH, SH.

Compliance with ethical standards

Conflict of interest

SH: declares no conflict of interest. SH: declares no conflict of interest. RD: declares no conflict of interest. DM: declares no conflict of interest. JG: declares no conflict of interest. SD: declares no conflict of interest. AS: declares no conflict of interest. ET: declares no conflict of interest. AE: declares no conflict of interest. AK: declares no conflict of interest. GS: declares no conflict of interest. DO: declares no conflict of interest. AS: declares no conflict of interest. AK: declares no conflict of interest. AK: declares no conflict of interest. DA: declares no conflict of interest. AE: declares no conflict of interest.

Ethical approval

Not required. The protocol was approved by Clinical Governance Development Unit.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Informed consent

Considering the design of our study, patient consent was not required.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2017

Authors and Affiliations

  • S. Hajibandeh
    • 1
    • 2
  • S. Hajibandeh
    • 1
    • 3
  • R. Deering
    • 1
  • D. McEleney
    • 1
  • J. Guirguis
    • 1
  • S. Dix
    • 1
  • A. Sreh
    • 1
  • E. Toner
    • 1
  • A. El Muntasar
    • 1
  • A. Kausar
    • 1
  • G. Sheikh
    • 1
  • D. OShea
    • 1
  • A. Shafiq
    • 1
  • A. Kelly
    • 1
  • A. Khan
    • 1
  • D. Arumugam
    • 1
  • A. Evans
    • 1
  1. 1.Department of General SurgeryRoyal Blackburn HospitalBlackburnUK
  2. 2.Department of General SurgerySalford Royal Foundation TrustSalfordUK
  3. 3.Department of General SurgeryNorth Manchester General HospitalManchesterUK

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