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

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
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Clinical Orthopaedics and Related Research®



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.


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


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.


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%).


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.

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We thank Mr Michael P. Fleming for his assistance with data collection.

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Authors and Affiliations


Corresponding author

Correspondence to Kevin J. Bozic MD, MBA.

Additional information

Financial support was received from the Orthopaedic Research and Education Foundation. One author (HER) receives royalties from Zimmer, Inc. (Warsaw, IN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that the institution where the work was performed approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at University of California, San Francisco, San Francisco, CA, USA, and Massachusetts General Hospital, Boston, MA, USA.

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Bozic, K.J., Bashyal, R.K., Anthony, S.G. et al. Is Administratively Coded Comorbidity and Complication Data in Total Joint Arthroplasty Valid?. Clin Orthop Relat Res 471, 201–205 (2013).

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