Abstract
BackgroundThe American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) uses Current Procedural Terminology (CPT) codes for risk-adjusted calculations. This study evaluates the inter-rater reliability of coding colorectal resections across Canada by ACS-NSQIP surgical clinical nurse reviewers (SCNR) and its impact on risk predictions. MethodsSCNRs in Canada were asked to code simulated operative reports. Percent agreement and free-marginal kappa correlation were calculated. The ACS-NSQIP risk calculator was utilized to illustrate its impact on risk prediction. ResultsResponses from 44 of 150 (29.3 %) SCNRs revealed 3 to 6 different codes chosen per case, with agreement ranging from 6.7 % to 62.3 %. Free-marginal kappa correlation ranged from moderate agreement (0.53) to high disagreement (−0.17). ACS-NSQIP risk calculator predicted large absolute differences in risk for serious complications (0.2 %–13.7 %) and mortality (0.2 %–6.3 %). ConclusionThis study demonstrated low inter-rater reliability in coding ACS-NSQIP colorectal procedures in Canada among SCNRs, impacting risk predictions.
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