Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
J Surg Res. 2024 Oct;302:428-436. doi: 10.1016/j.jss.2024.07.076. Epub 2024 Aug 17.
Nonoperative management (NOM) of uncomplicated appendicitis is increasingly common. Effectiveness of NOM has been studied by identifying patients via International Classification of Diseases (ICD) 9/ICD-10 codes for uncomplicated appendicitis and no code for appendectomy. We sought to assess the accuracy of such administrative definitions.
We retrospectively identified patients with ICD-9/ICD-10 codes for appendicitis at five sites across the United States. Initial management plan and clinical severity were recorded by trained abstractors. We identified a gold standard cohort of patients with surgeon-diagnosed uncomplicated appendicitis and planned NOM. We defined two administrative cohorts with ICD-9/ICD-10 codes for uncomplicated appendicitis and either no surgery during initial admission (definition #1) or no surgery on day 0-1 of admission (definition #2). We compared each definition to the gold standard.
Among 1224 patients with uncomplicated appendicitis, 72 (5.9%) underwent planned NOM. NOM patients were older (median [Q1-Q3] of 37 [27-56] versus 32 [25-44] y) and less frequently male (51.4% versus 54.9%), White (54.1% versus 67.6%), and privately insured (38.9% versus 50.2%) than patients managed operatively. Definition #1 had sensitivity of 0.81 and positive predictive value of 0.87 for NOM of uncomplicated appendicitis. Definition #2 had sensitivity of 0.83 and positive predictive value of 0.72. The gold standard cohort had a true failure/recurrence rate of 23.6%, compared with apparent rates of 25.4% and 39.8%, respectively.
Administrative definitions are prone to misclassification in identifying planned NOM of uncomplicated appendicitis. This likely impacts outcomes in studies using administrative databases. Investigators should disclose how misclassification may affect results and select an administrative definition that optimally balances sensitivity and specificity for their research question.
非手术治疗（NOM）已广泛用于治疗单纯性阑尾炎。通过使用国际疾病分类（ICD）9/ICD-10 代码来识别患有单纯性阑尾炎且无阑尾切除术代码的患者，已对 NOM 的有效性进行了研究。我们旨在评估此类行政定义的准确性。
我们在美国五个地点回顾性地识别出具有 ICD-9/ICD-10 阑尾炎代码的患者。训练有素的摘要记录员记录了初始管理计划和临床严重程度。我们确定了一个金标准队列，该队列的患者具有外科医生诊断的单纯性阑尾炎和计划的 NOM。我们定义了两个行政队列，这些队列具有 ICD-9/ICD-10 单纯性阑尾炎代码，要么在初始入院期间未进行手术（定义 1），要么在入院第 0-1 天未进行手术（定义 2）。我们将每个定义与金标准进行了比较。
在 1224 例单纯性阑尾炎患者中，有 72 例（5.9％）接受了计划的 NOM。NOM 患者年龄较大（中位数[Q1-Q3]为 37[27-56]岁，而 32[25-44]岁），男性较少（51.4％对 54.9％），白人（54.1％对 67.6％），私人保险（38.9％对 50.2％）。与接受手术治疗的患者相比，接受手术治疗的患者较少。定义 1 对单纯性阑尾炎的 NOM 的敏感性为 0.81，阳性预测值为 0.87。定义 2 的敏感性为 0.83，阳性预测值为 0.72。金标准队列的真实失败/复发率为 23.6％，而表观率分别为 25.4％和 39.8％。
行政定义在识别单纯性阑尾炎的计划 NOM 时容易出现分类错误。这可能会影响使用管理数据库的研究结果。研究人员应披露分类错误如何影响结果，并为他们的研究问题选择最佳的管理定义，以平衡敏感性和特异性。
