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How Valid is the ICD-9-CM Based AHRQ Patient Safety Indicator for Postoperative Venous Thromboembolism?

2009; Lippincott Williams & Wilkins; Volume: 47; Issue: 12 Linguagem: Inglês

10.1097/mlr.0b013e3181b58940

1537-1948

Richard H. White, Banafsheh Sadeghi, Daniel J. Tancredi, Patricia Zrelak, Joanne Cuny, Pradeep Sama, Garth H. Utter, Jeffrey Geppert, Patrick S. Romano,

Acute Myocardial Infarction Research

Background: Hospital administrative data are being used to identify patients with postoperative venous thromboembolism (VTE), either pulmonary embolism (PE) or deep-vein thrombosis (DVT). However, few studies have evaluated the accuracy of these ICD-9-CM codes across multiple hospitals. Methods and Materials: The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI)-12 was used to identify cases with postoperative VTE in 80 hospitals that volunteered for either an AHRQ or University HealthSystem Consortium (UHC) validation project. Trained abstractors using a standardized tool and guidelines retrospectively verified all coded VTE events. Results: In the combined samples, the positive predictive value of the set of prespecified VTE codes for any acute VTE at any time during the hospitalization was 451 of 573 = 79% (95% CI: 75%–82%). However, the positive predictive value for acute lower extremity DVT or PE diagnosed after an operation was 209 of 452 = 44% (95% CI: 37%–51%) in the UHC sample and 58 of 121 = 48% (95% CI: 42–67%) in the AHRQ sample. Fourteen percent of all cases had an acute upper extremity DVT, 6% had superficial vein thrombosis and 21% had no acute VTE, however, 61% of the latter had a documented prior/chronic VTE. In the UHC cohort, the sensitivity for any acute VTE was 95.5% (95% CI: 86.4%–100%); the specificity was 99.5% (95% CI: 99.4%–99.7%). Conclusion: Current PSI 12 criteria do not accurately identify patients with acute postoperative lower extremity DVT or PE. Modification of the ICD-9-CM codes and implementation of "present on admission" flags should improve the predictive value for clinically important VTE events.