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Mallick S, Sakowitz S, Bakhtiyar SS, Chervu N, Valenzuela A, Kim S, Benharash P. Administrative coding of frailty: Its association with clinical outcomes and resource use in kidney transplantation. Clin Transplant 2024; 38:e15200. [PMID: 38041448 DOI: 10.1111/ctr.15200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Although not formalized into current risk assessment models, frailty has been associated with negative postoperative outcomes in many specialties. However, national analyses of the association between frailty and post-transplant outcomes following kidney transplantation (KT) are lacking. METHODS This was a retrospective cohort study of adults undergoing KT from 2016 to 2020 in the Nationwide Readmissions Databases. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator. RESULTS Of an estimated 95 765 patients undergoing KT during the study period, 4918 (5.1%) were frail. After risk adjustment, frail patients were associated with significantly higher odds of in-hospital mortality (AOR 2.17, 95% CI: 1.33-3.57) compared to their non-frail counterparts. Our findings indicate that frail patients had an average increase in postoperative hospital stay of 1.44 days, a $2300 increase in hospitalization costs, as well as higher odds of developing a major perioperative complication as compared to their non-frail counterparts. Frailty was also associated with greater adjusted risk of non-home discharge. CONCLUSIONS Frailty, as identified by administrative coding, is independently associated with worse surgical outcomes, including increased mortality and resource use, in adults undergoing KT. Given the already limited donor organ pool, novel efforts are needed to ensure adequate optimization and timely post-transplantation care of the growing frail cohort undergoing KT.
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Affiliation(s)
- Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alberto Valenzuela
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Shineui Kim
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Kim S, Sakowitz S, Hadaya J, Curry J, Chervu NL, Bakhtiyar SS, Mallick S, Cho NY, Benharash P. Association of frailty with postoperative outcomes following thoracic transplantation: A national analysis. JTCVS OPEN 2023; 16:1038-1048. [PMID: 38204667 PMCID: PMC10775095 DOI: 10.1016/j.xjon.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 01/12/2024]
Abstract
Objective Frailty has been repeatedly associated with inferior outcomes after surgical hospitalizations. However, a thorough evaluation of the impact of frailty on the clinical and financial outcomes of patients undergoing solid-organ thoracic transplantation is sparse in the literature. We evaluated the association of frailty, as determined by an administrative tool, with postoperative outcomes and healthcare resource use after heart or lung transplantation. Methods The Nationwide Readmissions Database was used to identify all adult hospitalizations for heart or lung transplant from 2014 to 2020. Patients were grouped as frail or nonfrail using International Classification of Diseases codes associated with conditions in the Johns Hopkins Adjusted Clinical Groups cluster. Multivariable regression models were developed to evaluate the association of frailty status on in-hospital mortality, complications, length of stay, costs, and unplanned readmissions. Results Of an estimated 35,862 heart or lung transplant recipients, 7316 (20.4%) were considered frail. After multivariable adjustment, frailty in heart transplantation was associated with greater odds of in-hospital mortality (adjusted odds ratio, 1.54; 95% CI, 1.19-1.99) and infectious complications (adjusted odds ratio, 1.77; 95% CI, 1.45-2.15; P < .001). Frailty in lung transplantation was also associated with higher odds of in-hospital mortality (adjusted odds ratio, 1.38; 95% CI, 1.11-1.69) and infectious complications (adjusted odds ratio, 1.93; 95% CI, 1.60-2.31). In addition, frailty in both heart transplantation and lung transplantation was associated with increased postoperative length of stay and greater costs. Conclusions Among transplant recipients, those classified as frail were associated with increased in-hospital mortality, perioperative complications, and resource use.
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Affiliation(s)
- Shineui Kim
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, Calif
| | - Joanna Curry
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Nikhil L. Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, Calif
| | | | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, Calif
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Seltzer RA, Van Rysselberghe NL, Fithian AT, LaPrade CM, Sharma J, Oquendo YA, Michaud JB, DeBaun MR, Gardner MJ, Bishop JA. ICD-10 codes do not accurately reflect ankle fracture injury patterns. Injury 2022; 53:752-755. [PMID: 34654551 DOI: 10.1016/j.injury.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/05/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the accuracy of International Classification of Disease Version 10 (ICD-10) coding for ankle fracture injury patterns. DESIGN Retrospective cohort study PATIENTS: 97 adult patients with fractures about the ankle (rotational ankle fracture or distal tibia fracture) from 2016 to 2020, selected by stratified random sampling. INTERVENTION Assignment of an ICD-10 code representative of a rotational ankle fracture, pilon fracture, or unspecified fracture of the lower leg. OUTCOME MEASUREMENTS Injury radiographs were reviewed by three authors to determine the correct code. Agreement between the correct code and the electronic medical record (EMR) assigned code was determined using kappa's statistic in the aggregate as well as percent agreement, sensitivity, specificity, and positive predictive value (PPV) between individual codes. RESULTS 59 of 97 cases (60.8%) demonstrated discordance between the existing EMR and surgeon-assigned codes. Aggregate agreement between all codes was fair (K = 0.26). Lateral malleolus fracture codes demonstrated the highest PPV (0.91, 95% CI 0.72-0.99), while the lowest PPV was found for "other fractures of the lower leg" (0.05, 95% CI 0.0-0.24) and "other fracture of the fibula" (0.0, 95% CI 0.0-0.15). Generalized "other fracture" codes comprised 45% of EMR codes compared to only 6% of assigned codes (p < 0.001). EMR codes were specific but not sensitive. CONCLUSION There is substantial discordance between existing EMR and surgeon-assigned ICD-10 codes for ankle fractures. Database research that relies on ICD-10 coding as a surrogate for primary clinical data should be interpreted with caution and institutions should make efforts to increase the accuracy of their coding.
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Affiliation(s)
- Ryan A Seltzer
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305-5101, United States of America.
| | - Noelle L Van Rysselberghe
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, United States of America
| | - Andrew T Fithian
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, United States of America
| | - Christopher M LaPrade
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, United States of America
| | - Jigyasa Sharma
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305-5101, United States of America
| | - Yousi A Oquendo
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305-5101, United States of America
| | - John B Michaud
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305-5101, United States of America
| | - Malcolm R DeBaun
- Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, 325 9th Avenue, Seattle, WA 98104, United States of America
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, United States of America
| | - Julius A Bishop
- Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, United States of America
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