Administrative data set not always best source for number of surgical complications

November 27, 2012, Journal of Neurosurgery Publishing Group

Hospital administrative databases, designed to provide general information on hospital stays and associated costs, are frequently used to find information that can lead to quality assessments of care or clinical research. Researchers at the University of California, San Francisco (UCSF) extracted data on hospital readmissions following spine surgery at their institution from an administrative database to assess the clinical relevance of the information and to define clinically relevant predictors of readmission. What they found were readmission numbers substantially larger than expected or appropriate. The researchers' findings are reported in the article "Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets. Clinical article," by Beejal Y. Amin, M.D., and colleagues, published online today, ahead of print, in the Journal of Neurosurgery: Spine.

UCSF is a member of the UHC (University HealthSystem Consortium), an alliance of 116 and more than 270 affiliated hospitals that form the Quality and Accountability Study. The UHC houses a repository for data provided by member hospitals, which can be used for benchmarking and to improve patient care. Using this database the researchers identified 5780 initial patient encounters with spine surgeons at UCSF. Among these cases there were 281 instances of readmission ( within 30 days after ; 4.9% of cases). The researchers examined individual patient files to identify the specific reasons for the readmissions. They found that 69 readmissions (25% of the total 281 readmissions) had nothing to do with complications of spine surgery. In 14 cases, the patient returned to the hospital to undergo surgery that had been rescheduled; in 39 cases, the second admission was for the second part of a staged surgery; and in the other 16 cases, the reason for readmission was unrelated to spine surgery. In all these cases the "readmissions" were necessary and unavoidable. The other 212 readmissions (75%) were related to complications of the initial spine surgery.

The researchers note that after exclusion of the 69 readmissions unrelated to complications, the costs of hospital readmissions dropped 29%, reflecting a cost variance exceeding $3 million.

The authors state their concerns that the all-cause data collected from administrative databases on hospital readmissions following spine surgery may not accurately represent how patients fare following . The researchers believe that unfiltered administrative data in this instance may lead to misinterpretations of both the quality and costs of patient care. This in turn could lead third-party payers (such as Medicare) to deny payments for some "readmissions" that are unavoidable.

Inclusion of spine surgeons in defining the clinical relevance of data is important, say the authors. According to one coauthor, Dr. Praveen Mummaneni, "Our findings identify the potential pitfalls in the calculation of readmission rates from administrative data sets. Benchmarking algorithms for defining hospitals' must take into account planned, staged surgery and eliminate unrelated reasons for readmission, which are not clinically preventable. With these adjustments in the calculation method, the readmission rate will be more clinically relevant. Current tools overestimate the clinically relevant rate and cost, and spine surgeons' input is vital to ensure the relevance of such databases."

Explore further: Hospital readmission rates misleading, study finds

More information: Amin BY, Tu T-H, Schairer WW, Na L, Takemoto S, Berven S, Deviren V, Ames C, Chou D, Mummaneni PV. Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets. Clinical article, Journal of Neurosurgery: Spine, published online November 27, 2012, ahead of print; DOI: 10.3171/2012.10.SPINE12559

This article is accompanied by an editorial: Angevine PD, McCormick PC. Editorial. Readmissions. Journal of Neurosurgery: Spine, published online November 27, 2012, ahead of print; DOI: 10.3171/2012.9.SPINE12856

Related Stories

Hospital readmission rates misleading, study finds

October 10, 2012
When hospital patients have to be readmitted soon after discharge, hospitals look bad.

Spinal surgeries more successful than reflected in public reported statistics: UCSF

April 17, 2012
The odds that someone undergoing spinal surgery at a particular hospital will have to be readmitted to the same hospital within 30 days is an important measure of the quality of care patients receive. That's because these ...

Hospital readmission rates not accurate measure of care quality

August 22, 2011
Avoidable readmissions after discharge from hospital are fairly uncommon and are not an accurate measure of quality of care, found a study in CMAJ (Canadian Medical Association Journal).

General surgeons identify postoperative complications posing strongest readmission risk

August 28, 2012
Postoperative complications are the most significant independent risk factor leading to 30-day hospital readmissions among general surgery patients, according to a new exploratory study published in the September issue of ...

Hospital rankings dramatically affected by calculation methods for readmissions and early deaths

October 9, 2012
Hospital readmission rates and early death rates are used to rank hospital performance but there can be significant variation in their values, depending on how they are calculated, according to a new study in CMAJ (Canadian ...

Overall hospital admission rates in US linked with high rates of readmission

December 14, 2011
High hospital readmission rates in different regions of the U.S. may have more to do with the overall high use of hospital services in those regions than with the severity of patients' particular conditions or problems in ...

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.