Validation of an electronic coding algorithm to identify the primary indication of orthopedic surgeries from administrative data

John C Giardina,Lauren Leavitt,Karen Sepucha,Thomas Cha,Steven J Atlas,Andrew A Freiberg,Felisha Marques,Michael J Barry

doi:10.1186/s12911-020-01175-1

John C Giardina, Lauren Leavitt + Show 6 more

Open Access

https://doi.org/10.1186/s12911-020-01175-1

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Abstract

BackgroundDetermining the primary indication of a surgical procedure can be useful in identifying patients undergoing elective surgery where shared decision-making is recommended. The purpose of this study was to develop and validate an algorithm to identify patients receiving the following combinations of surgical procedure and primary indication as part of a study to promote shared decision-making: (1) knee arthroplasty to treat knee osteoarthritis (KOA); (2) hip arthroplasty to treat hip osteoarthritis (HOA); (3) spinal surgery to treat lumbar spinal stenosis (SpS); and (4) spinal surgery to treat lumbar herniated disc (HD).MethodsConsecutive surgical procedures performed by participating spine, hip, and knee surgeons at four sites within an integrated care network were included. Study staff reviewed electronic medical records to ascertain a “gold standard” determination of the procedure and primary indication status. Electronic algorithms consisting of ICD-10 and CPT codes for each combination of procedure and indication were then applied to records for each case. The primary measures of validity for the algorithms were the sensitivity and specificity relative to the gold standard review.ResultsParticipating surgeons performed 790 procedures included in this study. The sensitivity of the algorithms in determining whether a surgical case represented one of the combinations of procedure and primary indication ranged from 0.70 (HD) to 0.92 (KOA). The specificity ranged from 0.94 (SpS) to 0.99 (HOA, KOA).ConclusionThe electronic algorithm was able to identify all four procedure/primary indication combinations of interest with high specificity. Additionally, the sensitivity for the KOA cases was reasonably high. For HOA and the spine conditions, additional work is needed to improve the sensitivity of the algorithm to identify the primary indication for each case.

Highlights

Determining the primary indication of a surgical procedure can be useful in identifying patients undergoing elective surgery where shared decision-making is recommended
This process relies on researchers’ ability to use administrative data to accurately identify patients with the clinical characteristics relevant to the study. This is not, a straightforward task, since administrative claims data are usually recorded for billing purposes, and are not necessarily well suited to make clinical determinations in a research setting [1]. This task is especially difficult for research that is focused on more subtle clinical differences, such as studies evaluating the use of shared decision-making (SDM) for orthopedic surgery decisions
For SDM research in orthopedics, the focus is on identifying whether a certain procedure was performed, and on identifying whether it was performed for a specific clinical indication that is considered elective in that it is based on patient symptoms and functional impairment that have other potential treatment options

Summary

Introduction

Determining the primary indication of a surgical procedure can be useful in identifying patients undergoing elective surgery where shared decision-making is recommended. Administrative data are commonly used in orthopedics research, since the data allow investigators to gather information about large numbers of patients over time and analyze the relationship between diagnoses, procedures, costs, and outcomes [1]. This process relies on researchers’ ability to use administrative data to accurately identify patients with the clinical characteristics relevant to the study. This is not, a straightforward task, since administrative claims data are usually recorded for billing purposes, and are not necessarily well suited to make clinical determinations in a research setting [1]. For SDM research in orthopedics, the focus is on identifying whether a certain procedure was performed, and on identifying whether it was performed for a specific clinical indication (e.g. total knee replacement to treat knee osteoarthritis) that is considered elective in that it is based on patient symptoms and functional impairment that have other potential treatment options (e.g., conservative treatment options, such as physical therapy)

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