资源有限环境下用于结果测量和质量改进的简短外科手术程序代码列表。

Brief surgical procedure code lists for outcomes measurement and quality improvement in resource-limited settings.

作者信息

Liu Charles, Kayima Peter, Riesel Johanna, Situma Martin, Chang David, Firth Paul

机构信息

Stanford University Medical Center, Stanford, CA.

Mbarara University of Science and Technology, Mbarara Regional Referral Hospital, Mbarara, Uganda.

出版信息

Surgery. 2017 Nov;162(5):1163-1176. doi: 10.1016/j.surg.2017.07.002. Epub 2017 Aug 30.

DOI:10.1016/j.surg.2017.07.002

PMID:28864101

Abstract

BACKGROUND

The lack of a classification system for surgical procedures in resource-limited settings hinders outcomes measurement and reporting. Existing procedure coding systems are prohibitively large and expensive to implement. We describe the creation and prospective validation of 3 brief procedure code lists applicable in low-resource settings, based on analysis of surgical procedures performed at Mbarara Regional Referral Hospital, Uganda's second largest public hospital.

METHODS

We reviewed operating room logbooks to identify all surgical operations performed at Mbarara Regional Referral Hospital during 2014. Based on the documented indication for surgery and procedure(s) performed, we assigned each operation up to 4 procedure codes from the International Classification of Diseases, 9th Revision, Clinical Modification. Coding of procedures was performed by 2 investigators, and a random 20% of procedures were coded by both investigators. These codes were aggregated to generate procedure code lists.

RESULTS

During 2014, 6,464 surgical procedures were performed at Mbarara Regional Referral Hospital, to which we assigned 435 unique procedure codes. Substantial inter-rater reliability was achieved (κ = 0.7037). The 111 most common procedure codes accounted for 90% of all codes assigned, 180 accounted for 95%, and 278 accounted for 98%. We considered these sets of codes as 3 procedure code lists. In a prospective validation, we found that these lists described 83.2%, 89.2%, and 92.6% of surgical procedures performed at Mbarara Regional Referral Hospital during August to September of 2015, respectively.

CONCLUSION

Empirically generated brief procedure code lists based on International Classification of Diseases, 9th Revision, Clinical Modification can be used to classify almost all surgical procedures performed at a Ugandan referral hospital. Such a standardized procedure coding system may enable better surgical data collection for administration, research, and quality improvement in resource-limited settings.

摘要

背景

资源有限环境下缺乏手术操作分类系统，这阻碍了结果测量和报告。现有的手术编码系统规模过大，实施成本过高。我们基于对乌干达第二大公立医院姆巴拉拉地区转诊医院所施行手术操作的分析，描述了适用于资源匮乏环境的3个简短手术编码列表的创建及前瞻性验证情况。

方法

我们查阅手术室日志，以确定2014年在姆巴拉拉地区转诊医院进行的所有外科手术。根据记录的手术指征和所施行的手术操作，我们从《国际疾病分类》第9版临床修订本中为每台手术分配了至多4个手术编码。手术编码由2名研究人员进行，随机抽取20%的手术由两名研究人员共同编码。这些编码汇总后生成手术编码列表。

结果

2014年，姆巴拉拉地区转诊医院共进行了6464例外科手术，我们为其分配了435个唯一的手术编码。实现了较高的评分者间信度（κ = 0.7037）。111个最常见的手术编码占所有分配编码的90%，180个占95%，278个占98%。我们将这些编码集视为3个手术编码列表。在前瞻性验证中，我们发现这些列表分别描述了2015年8月至9月在姆巴拉拉地区转诊医院进行的83.2%、89.2%和92.6%的外科手术。