scholarly journals Incidence and Outcomes of Laryngeal Complications Following Adult Cardiac Surgery: A National Analysis

Dysphagia ◽  
2021 ◽  
Author(s):  
Arjun Verma ◽  
Joseph Hadaya ◽  
Zachary Tran ◽  
Vishal Dobaria ◽  
Josef Madrigal ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Artery Bypass ◽  
International Classification Of Diseases ◽  
Financial Outcomes ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Rising Incidence ◽  
Nationally Representative ◽  
National Analysis

AbstractLaryngeal complications (LCs) following cardiac operations contribute to increased morbidity and resource utilization. Using a nationally representative cohort of cardiac surgical patients, we characterized the incidence of LC as well as its associated clinical and financial outcomes. All adults undergoing coronary artery bypass grafting and/or valvular operations were identified using the 2010–2017 Nationwide Readmissions Database. International Classification of Diseases 9th and 10th Revision diagnosis codes were used to identify LC. Trends were analyzed using a rank-based, non-parametric test (nptrend). Multivariable linear and logistic regressions were used to evaluate risk factors for LC, and its impact on mortality, complications, resource use and 30-day non-elective readmissions. Of an estimated 2,319,628 patients, 1.7% were diagnosed with perioperative LC, with rising incidence from 1.5% in 2010 to 1.8% in 2017 (nptrend < 0.001). After adjustment, female sex [adjusted odds ratio 1.08, 95% confidence interval (CI) 1.04–1.12], advancing age, and multi-valve procedures (1.51, 95% CI 1.36–1.67, reference: isolated CABG) were associated with increased odds of LC. Despite no risk-adjusted effect on mortality, LC was associated with increased odds of pneumonia (2.88, 95% CI 2.72–3.04), tracheostomy (4.84, 95% CI 4.44–5.26), and readmission (1.32, 95% CI 1.26–1.39). In addition, LC was associated with a 7.7-day increment (95% CI 7.4–8.0) in hospitalization duration and $24,200 (95% CI 23,000–25,400) in attributable costs. The present study found LC to be associated with increased perioperative sequelae and resource utilization. The development and application of active screening protocols for post-surgical LC are warranted to increase early detection and reduce associated morbidity.

scholarly journals Association Between Diagnosis Code Expansion and Changes in 30‐Day Risk‐Adjusted Outcomes for Cardiovascular Diseases

2021 ◽  
Author(s):  
Lauren Gilstrap ◽  
Rishi K. Wadhera ◽  
Andrea M. Austin ◽  
Stephen Kearing ◽  
Karen E. Joynt Maddox ◽  
...  
Keyword(s):  
Logistic Regression ◽  
International Classification Of Diseases ◽  
Fee For Service ◽  
Readmission Rates ◽  
Difference In Differences ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Changes In Risk ◽  
The Impact

BACKGROUND In January 2011, Centers for Medicare and Medicaid Services expanded the number of inpatient diagnosis codes from 9 to 25, which may influence comorbidity counts and risk‐adjusted outcome rates for studies spanning January 2011. This study examines the association between (1) limiting versus not limiting diagnosis codes after 2011, (2) using inpatient‐only versus inpatient and outpatient data, and (3) using logistic regression versus the Centers for Medicare and Medicaid Services risk‐standardized methodology and changes in risk‐adjusted outcomes. METHODS AND RESULTS Using 100% Medicare inpatient and outpatient files between January 2009 and December 2013, we created 2 cohorts of fee‐for‐service beneficiaries aged ≥65 years. The acute myocardial infarction cohort and the heart failure cohort had 578 728 and 1 595 069 hospitalizations, respectively. We calculate comorbidities using (1) inpatient‐only limited diagnoses, (2) inpatient‐only unlimited diagnoses, (3) inpatient and outpatient limited diagnoses, and (4) inpatient and outpatient unlimited diagnoses. Across both cohorts, International Classification of Diseases, Ninth Revision ( ICD‐9 ) diagnoses and hierarchical condition categories increased after 2011. When outpatient data were included, there were no significant differences in risk‐adjusted readmission rates using logistic regression or the Centers for Medicare and Medicaid Services risk standardization. A difference‐in‐differences analysis of risk‐adjusted readmission trends before versus after 2011 found that no significant differences between limited and unlimited models for either cohort. CONCLUSIONS For studies that span 2011, researchers should consider limiting the number of inpatient diagnosis codes to 9 and/or including outpatient data to minimize the impact of the code expansion on comorbidity counts. However, the 2011 code expansion does not appear to significantly affect risk‐adjusted readmission rate estimates using either logistic or risk‐standardization models or when using or excluding outpatient data.

scholarly journals Use of Diagnosis Codes and/or Wound Culture Results for Surveillance of Surgical Site Infection after Mastectomy and Breast Reconstruction

2010 ◽  
Vol 31 (05) ◽  
pp. 544-547 ◽  
Author(s):  
Margaret A. Olsen ◽  
Victoria J. Fraser
Keyword(s):  
Surgical Site Infection ◽  
Claims Data ◽  
Breast Surgery ◽  
International Classification Of Diseases ◽  
Site Infection ◽  
Wound Culture ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Major Breast

We compared surveillance of surgical site infection (SSI) after major breast surgery by using a combination of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and microbiology-based surveillance. The sensitivity of the coding algorithm for identification of SSI was 87.5%, and the sensitivity of wound culture for identification of SSI was 78.1%. Our results suggest that SSI surveillance can be reliably performed using claims data.

The prevalence of localised scleroderma in childhood assessed in the administrative claims data from the United States

2018 ◽  
Vol 4 (1) ◽  
pp. 77-78
Author(s):  
Timothy Beukelman ◽  
Fenglong Xie ◽  
Ivan Foeldvari
Keyword(s):  
United States ◽  
Systemic Sclerosis ◽  
Claims Data ◽  
International Classification Of Diseases ◽  
The United States ◽  
Administrative Claims ◽  
Administrative Claims Data ◽  
Diagnosis Codes ◽  
Classification Of Diseases

Juvenile localised scleroderma is believed an orphan autoimmune disease, which occurs 10 times more often than systemic sclerosis in childhood and is believed to have a prevalence of 1 per 100,000 children. To gain data regarding the prevalence of juvenile localised scleroderma, we assessed the administrative claims data in the United States using the International Classification of Diseases, Ninth Revision diagnosis codes. We found an estimated prevalence in each year ranging from 3.2 to 3.6 per 10,000 children. This estimate is significantly higher as found in previous studies.

scholarly journals Impact of Left Atrial Appendage Exclusion on Short-Term Outcomes in Isolated Coronary Artery Bypass Graft Surgery

Circulation ◽  
2020 ◽  
Vol 142 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Eitezaz Mahmood ◽  
Robina Matyal ◽  
Feroze Mahmood ◽  
Xinling Xu ◽  
Aidan Sharkey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
International Classification Of Diseases ◽  
Artery Bypass Graft ◽  
Classification Of Diseases

Background: The objective of this study was to evaluate the impact of left atrial appendage (LAA) exclusion on short-term outcomes in patients with atrial fibrillation undergoing isolated coronary artery bypass graft surgery. Methods: We queried the 2010 to 2014 National Readmissions Database for patients who underwent coronary artery bypass graft repair with and without LAA ligation by using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes ( International Classification of Diseases, Ninth Revision, Clinical Modification : 36.1xx). Only patients with a history of atrial fibrillation were included in our analysis. The primary outcome of our study was 30-day readmissions following discharge. Secondary outcomes were in-hospital mortality and stroke. To assess the postoperative outcomes, we used multivariate logistic regression models to adjust for clinical and demographic covariates. Results: In total, we analyzed 253 287 patients undergoing coronary artery bypass graft surgery, 7.0% of whom received LAA closure. LAA exclusion was associated with a greater risk of postoperative respiratory failure (8.2% versus 6.2%, P <0.0001) and acute kidney injury (21.8% versus 18.5%, P <0.0001), but it did not significantly change the rate of blood transfusions or occurrence of cardiac tamponade. LAA exclusion was associated with a nonsignificant reduction in stroke (7.9% versus 8.6%, P =0.12), no difference in in-hospital mortality (2.2% versus 2.2% P =0.99), and a greater risk of 30-day readmission (16.0% versus 9.6%, P <0.0001). After covariate adjustment, LAA ligation remained a significant predictor of 30-day readmission (odds ratio, 1.640 [95% CI, 1.603–1.677], P <0.0001). Conclusions: LAA exclusion during isolated coronary artery bypass graft surgery in patients with atrial fibrillation is associated with a higher rate of 30-day readmission. Postoperative measures to mitigate the loss of the hormonal and hemodynamic effects of the LAA may increase the therapeutic benefit of this procedure.

Evaluation of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Reporting Methicillin-Resistant Staphylococcus aureus Infections at a Hospital in Illinois

2010 ◽  
Vol 31 (05) ◽  
pp. 463-468 ◽  
Author(s):  
Melissa K. Schaefer ◽  
Katherine Ellingson ◽  
Craig Conover ◽  
Alicia E. Genisca ◽  
Donna Currie ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Mrsa Infection ◽  
Healthcare Associated

Background. States, including Illinois, have passed legislation mandating the use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for reporting healthcare-associated infections, such as methicillin-resistant Staphylococcus aureus (MRSA). Objective. To evaluate the sensitivity of ICD-9-CM code combinations for detection of MRSA infection and to understand implications for reporting. Methods. We reviewed discharge and microbiology databases from July through August of 2005, 2006, and 2007 for ICD-9-CM codes or microbiology results suggesting MRSA infection at a tertiary care hospital near Chicago, Illinois. Medical records were reviewed to confirm MRSA infection. Time from admission to first positive MRSA culture result was evaluated to identify hospital-onset MRSA (HO-MRSA) infections. The sensitivity of MRSA code combinations for detecting confirmed MRSA infections was calculated using all codes present in the discharge record (up to 15); the effect of reviewing only 9 diagnosis codes, the number reported to the Centers for Medicare and Medicaid Services, was also evaluated. The sensitivity of the combination of diagnosis codes for detection of HO-MRSA infections was compared with that for community-onset MRSA (CO-MRSA) infections. Results. We identified 571 potential MRSA infections with the use of screening criteria; 403 (71%) were confirmed MRSA infections, of which 61 (15%) were classified as HO-MRSA. The sensitivity of MRSA code combinations was 59% for all confirmed MRSA infections when 15 diagnoses were reviewed compared with 31% if only 9 diagnoses were reviewed (P &lt; .001). The sensitivity of code combinations was 33% for HO-MRSA infections compared with 62% for CO-MRSA infections (P &lt; .001). Conclusions. Limiting analysis to 9 diagnosis codes resulted in low sensitivity. Furthermore, code combinations were better at revealing CO-MRSA infections than HO-MRSA infections. These limitations could compromise the validity of ICD-9-CM codes for interfacility comparisons and for reporting of healthcare-associated MRSA infections.

scholarly journals Validity of the International Classification of Diseases, 10th revision discharge diagnosis codes for hyponatraemia in the Danish National Registry of Patients

BMJ Open ◽  
2014 ◽  
Vol 4 (4) ◽  
pp. e004956 ◽  
Author(s):  
Louise Holland-Bill ◽  
Christian Fynbo Christiansen ◽  
Sinna Pilgaard Ulrichsen ◽  
Troels Ring ◽  
Jens Otto Lunde Jørgensen ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
National Registry ◽  
International Classification ◽  
Discharge Diagnosis ◽  
Diagnosis Codes ◽  
Classification Of Diseases
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