Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Br J Surg. 2019 Feb;106(3):236-244. doi: 10.1002/bjs.10985. Epub 2018 Sep 18.
The ICD-10 codes are used globally for comparison of diagnoses and complications, and are an important tool for the development of patient safety, healthcare policies and the health economy. The aim of this study was to investigate the accuracy of verified complication rates in surgical admissions identified by ICD-10 codes and to validate these estimates against complications identified using the established Global Trigger Tool (GTT) methodology.
This was a prospective observational study of a sample of surgical admissions in two Norwegian hospitals. Complications were identified and classified by two expert GTT teams who reviewed patients' medical records. Three trained reviewers verified ICD-10 codes indicating a complication present on admission or emerging in hospital.
A total of 700 admissions were drawn randomly from 12 966 procedures. Some 519 possible complications were identified in 332 of 700 admissions (47·4 per cent) from ICD-10 codes. Verification of the ICD-10 codes against information from patients' medical records confirmed 298 as in-hospital complications in 141 of 700 admissions (20·1 per cent). Using GTT methodology, 331 complications were found in 212 of 700 admissions (30·3 per cent). Agreement between the two methods reached 83·3 per cent after verification of ICD-10 codes. The odds ratio for identifying complications using the GTT increased from 5·85 (95 per cent c.i. 4·06 to 8·44) to 25·38 (15·41 to 41·79) when ICD-10 complication codes were verified against patients' medical records.
Verified ICD-10 codes strengthen the accuracy of complication rates. Use of non-verified complication codes from administrative systems significantly overestimates in-hospital surgical complication rates.
ICD-10 代码在全球范围内用于比较诊断和并发症，是制定患者安全、医疗政策和卫生经济政策的重要工具。本研究旨在调查通过 ICD-10 代码识别的手术入院并发症的准确率，并通过使用既定的全球触发工具（GTT）方法识别的并发症来验证这些估计。
这是一项在挪威两家医院进行的前瞻性观察性研究，对部分手术入院患者进行了抽样调查。并发症由两个 GTT 专家小组进行识别和分类，他们查阅了患者的病历。三名经过培训的审核员验证了 ICD-10 代码，这些代码表示入院时存在或在医院内出现的并发症。
从 12966 例手术中随机抽取了 700 例住院患者。通过 ICD-10 代码共发现 519 例可能的并发症，在 700 例住院患者中的 332 例（47.4%）中发现。通过与患者病历信息进行验证，从 ICD-10 代码中确认了 298 例为院内并发症，在 700 例住院患者中的 141 例（20.1%）中发现。通过 GTT 方法，在 700 例住院患者中的 212 例（30.3%）中发现了 331 例并发症。对 ICD-10 代码进行验证后，两种方法之间的一致性达到 83.3%。使用 GTT 方法识别并发症的优势比从使用 ICD-10 并发症代码的 5.85（95%置信区间 4.06 至 8.44）增加到 25.38（15.41 至 41.79），当 ICD-10 并发症代码与患者病历记录进行验证时。
经验证的 ICD-10 代码可增强并发症发生率的准确性。使用来自管理系统的未经验证的并发症代码会显著高估院内手术并发症发生率。
