Identifying and Codifying Complications after Radical Cystectomy: Comparison of Administrative Diagnostic and Procedure Codes, and Clinical Chart Review.
PURPOSE
To our knowledge the reliability of administrative claims codes to report postoperative radical cystectomy complications has not been examined. We compared complications identified by claims data to those abstracted from clinical chart review following radical cystectomy.


METHODS
We manually reviewed the charts of 268 patients treated with radical cystectomy between 2014 and 2016 for 30-day complications and queried administrative complication coding using 805 ICD-9/10 codes. Complications were categorized. Using Cohen κ statistics we assessed agreement between the 2 methods of complication reporting for 1 or more postoperative complications overall, categorical complications and complications stratified by the top quartile length of hospital stay and patients who were readmitted.


RESULTS
At least 1 or more complications were recorded in 122 patients (45.5%) through manual chart review and 80 (29.9%) were recorded via claim coding data with a concordance rate of κ=0.16, indicating weak agreement. Concordance was generally weak for categorical complication rates (range 0.05 to 0.36). However, when examining only the top length of stay quartile, 1 or more complications were reported in 32 patients (65%) by the manual chart review and in 12 (25%) via coding data with a concordance rate of κ=-0.2. Agreement was weak, similar to the total cohort.


CONCLUSIONS
Manual chart review and claim code identification of complications are not highly concordant even when stratified by patients with an extended length of stay, who are known to have more frequent complications. Researchers and administrators should be aware of these differences and exercise caution when interpreting complication reports.
['Peyton|Charles C|CC|', 'Reich|Richard R|RR|', 'Tang|Dominic|D|', 'Alford|Brandon|B|', 'Azizi|Mounsif|M|', 'Li|Roger|R|', 'Sexton|Wade J|WJ|', 'Poch|Michael|M|', 'Gilbert|Scott M|SM|']
D000368:Aged D015653:Cystectomy D005260:Female D005500:Follow-Up Studies D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D011183:Postoperative Complications D012372:ROC Curve D012189:Retrospective Studies D012307:Risk Factors D065287:Robotic Surgical Procedures D015996:Survival Rate D014481:United States D001749:Urinary Bladder Neoplasms
cystectomy postoperative complications International Classification of Diseases clinical coding urinary bladder