Abstract
BackgroundClaims databases are generally considered inadequate for obesity research due to suboptimal capture of body mass index (BMI) measurements. This might not be true for bariatric surgery because of reimbursement requirements and changes in coding systems. We assessed the availability and validity of claims-based weight-related diagnosis codes among bariatric surgery patients.MethodsWe identified three nested retrospective cohorts of adult bariatric surgery patients who underwent adjusted gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy between January 1, 2011 and June 30, 2018 using different components of OptumLabs® Data Warehouse, which contains linked de-identified claims and electronic health records (EHRs). We measured the availability of claims-based weight-related diagnosis codes in the 6-month preoperative and 1-year postoperative periods in the main cohort identified in the claims data. We created two claims-based algorithms to classify the presence of severe obesity (a commonly used cohort selection criterion) and categorize BMI (a commonly used baseline confounder or postoperative outcome). We evaluated their performance by estimating sensitivity, specificity, positive predictive value, negative predictive value, and weighted kappa in two sub-cohorts using EHR-based BMI measurements as the reference.ResultsAmong the 29,357 eligible patients identified using claims only, 28,828 (98.2%) had preoperative weight-related diagnosis codes, either granular indicating BMI ranges or nonspecific denoting obesity status. Among the 27,407 patients with granular preoperative codes, 12,346 (45.0%) had granular codes and 9355 (34.1%) had nonspecific codes in the 1-year postoperative period. Among the 3045 patients with both preoperative claims-based diagnosis codes and EHR-based BMI measurements, the severe obesity classification algorithm had a sensitivity 100%, specificity 71%, positive predictive value 100%, and negative predictive value 78%. The BMI categorization algorithm had good validity categorizing the last available preoperative or postoperative BMI measurements (weighted kappa [95% confidence interval]: preoperative 0.78, [0.76, 0.79]; postoperative 0.84, [0.80, 0.87]).ConclusionsClaims-based weight-related diagnosis codes had excellent validity before and after bariatric surgical operation but suboptimal availability after operation. Claims databases can be used for bariatric surgery studies of non-weight-related effectiveness and safety outcomes that are well-captured.
Highlights
Claims databases are generally considered inadequate for obesity research due to suboptimal capture of body mass index (BMI) measurements
We evaluated the availability and validity of weight-related diagnosis codes before and after bariatric surgical operations in a large claims database linked to an electronic health record (EHR) database with actual BMI measurements
Cohort 1 Using the claims data, we identified a retrospective cohort of patients aged 18 years or older who underwent adjusted gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), or sleeve gastrectomy (SG) between January 1, 2011 and June 30, 2018
Summary
Claims databases are generally considered inadequate for obesity research due to suboptimal capture of body mass index (BMI) measurements. Claims databases are generally considered inadequate for obesityrelated research due to the lack of body mass index (BMI) measurements and the underuse and poor validity of weightrelated diagnosis codes [7,8,9,10] This limitation may not necessarily apply to bariatric surgery research because most health insurers in the United States require surgical facilities to receive approval to perform a given bariatric operation (a.k.a., “prior authorization”). This process involves documentation of eligibility, including having a BMI measurement ≥40 kg/m2, or a BMI measurement ≥35 kg/m2 with at least 1 obesity-related co-morbidity, which are typically converted into diagnosis codes in the patient’s medical record and reimbursement claims [11,12,13]. These coding changes and the prior authorization requirements may considerably improve the availability and validity of weightrelated diagnosis codes in claims databases among bariatric surgery patients
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