1Norton Leatherman Spine Center, Louisville, Kentucky.
2Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neurological Institute, Carolinas Healthcare System, Charlotte, North Carolina.
J Neurosurg Spine. 2023 May 19;39(3):404-410. doi: 10.3171/2023.4.SPINE23135. Print 2023 Sep 1.
OBJECTIVE: Clear diagnostic delineation is necessary for the development of a strong evidence base in lumbar spinal surgery. Experience with existing national databases suggests that International Classification of Diseases, Tenth Edition (ICD-10) coding is insufficient to support that need. The purpose of this study was to assess agreement between surgeon-specified diagnostic indication and hospital-reported ICD-10 codes for lumbar spine surgery. METHODS: Data collection for the American Spine Registry (ASR) includes an option to denote the surgeon's specific diagnostic indication for each procedure. For cases treated between January 2020 and March 2022, surgeon-delineated diagnosis was compared with the ICD-10 diagnosis generated by standard ASR electronic medical record data extraction. For decompression-only cases, the primary analysis focused on the etiology of neural compression as determined by the surgeon versus that determined on the basis of the related ICD-10 codes extracted from the ASR database. For lumbar fusion cases, the primary analysis compared structural pathology, which may have required fusion, as determined by the surgeon versus that determined on the basis of the extracted ICD-10 codes. This allowed for identification of agreement between surgeon delineation and extracted ICD-10 codes. RESULTS: In 5926 decompression-only cases, agreement between the surgeon and ASR ICD-10 codes was 89% for spinal stenosis and 78% for lumbar disc herniation and/or radiculopathy. Both the surgeon and database indicated no structural pathology (i.e., none) suggesting the need for fusion in 88% of cases. In 5663 lumbar fusion cases, agreement was 76% for spondylolisthesis but poor for other diagnostic indications. CONCLUSIONS: Agreement between surgeon-specified diagnostic indication and hospital-reported ICD-10 codes was best for patients who underwent decompression only. In the fusion cases, agreement with ICD-10 codes was best in the spondylolisthesis group (76%). In cases other than spondylolisthesis, agreement was poor due to multiple diagnoses or lack of an ICD-10 code that reflected the pathology. This study suggested that standard ICD-10 codes may be inadequate to clearly define the indications for decompression or fusion in patients with lumbar degenerative disease.
目的：腰椎脊柱手术需要明确的诊断界限，以便建立坚实的证据基础。现有国家数据库的经验表明，国际疾病分类第十版（ICD-10）编码不足以满足这一需求。本研究旨在评估外科医生指定的诊断指征与医院报告的腰椎脊柱手术 ICD-10 编码之间的一致性。
方法：美国脊柱登记处（ASR）的数据收集包括为每个手术选择外科医生特定诊断指征的选项。对于 2020 年 1 月至 2022 年 3 月期间治疗的病例，比较外科医生界定的诊断与标准 ASR 电子病历数据提取生成的 ICD-10 诊断。对于仅减压的病例，主要分析侧重于外科医生确定的神经压迫病因与从 ASR 数据库中提取的相关 ICD-10 代码确定的病因之间的关系。对于腰椎融合病例，主要分析比较了外科医生确定的结构病理学与基于提取的 ICD-10 代码确定的结构病理学之间的关系，这些病例可能需要融合。这允许确定外科医生描述与提取的 ICD-10 代码之间的一致性。
结果：在 5926 例仅减压病例中，外科医生和 ASR ICD-10 代码之间的一致性在椎管狭窄症方面为 89%，在腰椎间盘突出症和/或神经根病方面为 78%。外科医生和数据库均未表明 88%的病例需要融合，表明没有结构病理学（即无）。在 5663 例腰椎融合病例中，对滑脱的一致性为 76%，但对其他诊断指征的一致性较差。
结论：仅减压患者的外科医生指定诊断指征与医院报告的 ICD-10 代码之间的一致性最好。在融合病例中，与 ICD-10 代码的一致性在滑脱组（76%）中最好。在滑脱以外的病例中，由于存在多种诊断或缺乏反映病理学的 ICD-10 代码，因此一致性较差。本研究表明，标准 ICD-10 代码可能不足以明确界定腰椎退行性疾病患者减压或融合的适应证。
J Neurosurg Spine. 2023-9-1
J Neurosurg Spine. 2014-12
Neurosurg Focus. 2014-6
Acta Chir Orthop Traumatol Cech. 2023
Zotero 插件