Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON.
Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON.
J Obstet Gynaecol Can. 2022 Apr;44(4):353-358. doi: 10.1016/j.jogc.2021.10.018. Epub 2021 Nov 10.
The Canadian Institute of Health Information (CIHI) Discharge Abstract Database (DAD) is the main source of routinely collected data for gynaecologic surgery in Canada and is increasingly used for research. These data are prone to error as they were originally collected for administrative purposes, and they therefore should be validated for clinical research. The objective of this study was to validate hysterectomy codes from the DAD at a single institution.
This was a retrospective observational study using an existing hospital database. We obtained a consecutive sample of all gynaecologic procedures performed at The Ottawa Hospital from April 2016 to March 2017 using the DAD. Patient data, including diagnosis, procedure type, concomitant procedure, and surgical approach, were reabstracted from records. These data were compared with the DAD Canadian Classification of Health Interventions (CCI) codes using sensitivity, specificity, positive predictive value (PPV), and κ coefficient with associated 95% confidence intervals (CIs).
Of 1068 gynaecologic procedures, 639 hysterectomies were performed: 39.2% vaginally, 35.4% laparoscopically, and 25.4% abdominally. Median patient age was 46 years (IQR 41-54 y). The κ, sensitivity, specificity, and PPV for all hysterectomies were 0.92 (95% CI 0.90-0.95), 95.1% (95% CI 93.2-96.7), 97.9% (95% CI 96.6-99.3), and 98.5% (95% CI 97.6-99.5), respectively. The κ coefficients for vaginal, laparoscopic, and abdominal hysterectomy were 0.91 (95% CI 0.88-0.94), 0.92 (95% CI 0.89-0.95), and 0.92 (95% CI 0.89-0.95), respectively. Agreement for sub-total hysterectomy and bilateral salpingectomy with oophorectomy was excellent, with κ exceeding 0.80. The level of agreement for salpingectomy alone was poor, though specificity and PPV were high.
Our study suggests that hysterectomy-associated CCI codes in CIHI's DAD have a high level of validity for clinical research purposes.
加拿大健康信息研究所（CIHI）的出院摘要数据库（DAD）是加拿大妇科手术的主要常规数据来源，并且越来越多地用于研究。由于这些数据最初是为管理目的而收集的，因此容易出现错误，因此应进行验证，以用于临床研究。本研究的目的是在单一机构验证 DAD 中的子宫切除术代码。
这是一项使用现有医院数据库的回顾性观察性研究。我们使用 DAD 从 2016 年 4 月至 2017 年 3 月获得了渥太华医院所有妇科手术的连续样本。从记录中重新提取患者数据，包括诊断、手术类型、伴随手术和手术途径。使用灵敏度、特异性、阳性预测值（PPV）和相关 95%置信区间（CI）的κ系数，将这些数据与 DAD 的加拿大卫生干预分类（CCI）代码进行比较。
在 1068 例妇科手术中，进行了 639 例子宫切除术：阴道 39.2%，腹腔镜 35.4%，腹部 25.4%。中位患者年龄为 46 岁（IQR 41-54 岁）。所有子宫切除术的κ、灵敏度、特异性和 PPV 分别为 0.92（95%CI 0.90-0.95）、95.1%（95%CI 93.2-96.7）、97.9%（95%CI 96.6-99.3）和 98.5%（95%CI 97.6-99.5）。阴道、腹腔镜和剖腹子宫切除术的κ系数分别为 0.91（95%CI 0.88-0.94）、0.92（95%CI 0.89-0.95）和 0.92（95%CI 0.89-0.95）。次全子宫切除术和双侧输卵管卵巢切除术的总体吻合度极佳，κ 值超过 0.80。单独输卵管切除术的吻合度较差，但特异性和 PPV 较高。
我们的研究表明，CIHI 的 DAD 中与子宫切除术相关的 CCI 代码在临床研究目的方面具有很高的有效性。
