Objectives: To compare the recording of 30-day postoperative complications between a national clinical registry and Medicare inpatient claims data and to determine whether the addition of outpatient claims data improves concordance with the clinical registry.
Background: Policymakers are increasingly discussing use of postoperative complication rates for value-based purchasing. There is debate regarding the optimal data source for such measures.
Methods: Patient records (2005–2008) from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were linked to Medicare inpatient and outpatient claims data sets. We assessed the ability of (1) Medicare inpatient claims and (2) Medicare inpatient and outpatient claims to detect a core set of ACS-NSQIP 30-day postoperative complications: superficial surgical site infection (SSI), deep/organ-space SSI, any SSI (superficial and/or deep/organ-space), urinary tract infection, pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism, venous thromboembolism (DVT and/or pulmonary embolism), and myocardial infarction. Agreement of patient-level complications by ACS-NSQIP versus Medicare was assessed by κ statistics.
Results: A total of 117,752 patients from more than 200 hospitals were studied. The sensitivity of inpatient claims data for detecting ACS-NSQIP complications ranged from 0.27 to 0.78; the percentage of false-positives ranged from 48% to 84%. Addition of outpatient claims data improved sensitivity slightly but also greatly increased the percentage of false-positives. Agreement was routinely poor between clinical and claims data for patient-level complications.
Conclusions: This analysis demonstrates important differences between ACS-NSQIP and Medicare claims data sets for measuring surgical complications. Poor accuracy potentially makes claims data suboptimal for evaluating surgical complications. These findings have meaningful implications for performance measures currently being considered.
Policymakers are increasingly discussing use of postoperative complication rates for value-based purchasing. We compare the recording of 30-day postoperative complications between a national clinical registry and comprehensive Medicare claims data and demonstrate important differences between these 2 data sources.
*David Geffen School of Medicine, University of California, Los Angeles, CA
†RAND Corporation, Santa Monica, CA
‡UCLA Jonathan and Karin Fielding School of Public Health
§Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL
‖School of Medicine and Barnes Jewish Hospital, Saint Louis Veterans Affairs Medical Center, and Center for Health Policy and Olin Business School, Washington University in Saint Louis, MO
¶Centers for Medicare & Medicaid Services, Baltimore, MD
#Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
**VA Greater Los Angeles Healthcare System, Los Angeles, CA.
Reprints: Elise H. Lawson, MD, MSHS, David Geffen School of Medicine at UCLA, Department of Surgery, 10833 Le Conte Avenue, 72–215 CHS, Los Angeles, CA 90095. E-mail: firstname.lastname@example.org.
Disclosure: E.H.L.'s time was supported by the VA Health Services Research and Development program (RWJ 65–020) and the American College of Surgeons through the Robert Wood Johnson Foundation Clinical Scholars Program. This study was funded by a contract from the Centers for Medicare & Medicaid Services (CMS). None of the remaining authors had any conflicts of interests to declare. The views expressed in this article represent the authors' views and do not necessarily represent official policy or opinions of the Department of Health and Human Services, the Centers for Medicare & Medicaid Services.