Abstract
BackgroundSurgeries and other procedures can influence the risk of death in hospital. All published scales that predict post-operative death risk require clinical data and cannot be measured using administrative data alone. This study derived and internally validated an index that can be calculated using administrative data to quantify the independent risk of hospital death after a procedure.MethodsFor all patients admitted to a single academic centre between 2004 and 2009, we estimated the risk of all-cause death using the Kaiser Permanente Inpatient Risk Adjustment Methodology (KP-IRAM). We determined whether each patient underwent one of 503 commonly performed therapeutic procedures using Canadian Classification of Interventions codes and whether each procedure was emergent or elective. Multivariate logistic regression modeling was used to measure the association of each procedure-urgency combination with death in hospital independent of the KP-IRAM risk of death. The final model was modified into a scoring system to quantify the independent influence each procedure had on the risk of death in hospital.Results275 460 hospitalizations were included (137,730 derivation, 137,730 validation). In the derivation group, the median expected risk of death was 0.1% (IQR 0.01%-1.4%) with 4013 (2.9%) dying during the hospitalization. 56 distinct procedure-urgency combinations entered our final model resulting in a Procedural Index for Mortality Rating (PIMR) score values ranging from -7 to +11. In the validation group, the PIMR score significantly predicted the risk of death by itself (c-statistic 67.3%, 95% CI 66.6-68.0%) and when added to the KP-IRAM model (c-index improved significantly from 0.929 to 0.938).ConclusionsWe derived and internally validated an index that uses administrative data to quantify the independent association of a broad range of therapeutic procedures with risk of death in hospital. This scale will improve risk adjustment when administrative data are used for analyses.
Highlights
Surgeries and other procedures can influence the risk of death in hospital
We identified candidate procedures using their Canadian Classification of Interventions (CCI) code
Assessment of the Procedural Index for Mortality Risk (PIMR) score In the validation group, we described the distribution of the PIMR score and used logistic regression to measure the association of the PIMR score alone with risk of death in hospital
Summary
Surgeries and other procedures can influence the risk of death in hospital. All published scales that predict post-operative death risk require clinical data and cannot be measured using administrative data alone. Many different types of surgeries and procedures exist in different specialties, Quantifying the independent influence of a broad range of different types of procedures on outcomes would allow analysts, administrators, and researchers to measure, compare, and adjust for the importance of each procedure. Six indexes have been developed to quantify the risk of post-operative death after a range of surgeries (Table 1) [1,2,3,4,5,6]. Each of these indexes, van Walraven et al BMC Health Services Research 2011, 11:258 http://www.biomedcentral.com/1472-6963/11/258.
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