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 PS54. Present on Admission Indicator Is Essential to Evaluate Symptom Status and Stroke Rate After CAS and CEA Using Administrative Data

Margriet Fokkema1, Rob Hurks2, Rodney P. Bensley1, Ruby C. Lo1, Thomas Curran1, Allen D. Hamdan1, Mark C. Wyers1, Frans L. Moll2, Marc L. Schermerhorn1
1Surgery, Beth Israel Deaconess Medical Center, Boston, MA; 2University Medical Center Utrecht, Utrecht, Netherlands.

OBJECTIVES: Outcome analysis for carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) using administrative data is hampered by difficulty in distinguishing pre-existing conditions (e.g., symptomatic carotid stenosis) from post-operative complications (e.g., stroke). We evaluated whether the introduction of the present on admission (POA) indicator improved the accuracy of administrative databases.
 
METHODS: State inpatient databases from CA, NY and NJ from 2005-2008 were used to identify patients undergoing CAS and CEA. Procedural complications were identified using ICD-9 complication codes (e.g., 997.02, postoperative stroke). Preoperative conditions were identified using ICD-9 diagnosis codes (e.g., 433.11, carotid stenosis with infarction). We first analyzed the data without, and then with the POA information.
 
RESULTS: We identified 36,002 patients who underwent CEA and 5,682 patients who underwent CAS. Without POA info, the complication code for stroke indicated a postoperative stroke rate of 1.1% for CEA and 1.9% for CAS. After applying the POA indicator, only 59% (CEA) and 50% (CAS) of these actually referred to perioperative strokes while the remainder were POA and thus represented pre-existing strokes. POA info highlighted inaccuracies in morbidity data for both complication and diagnosis codes (Table 1).
 
CONCLUSIONS: The assumption that complication codes following CAS or CEA refer to perioperative adverse events proved to be incorrect, as great proportions appear to have been POA. The reclassification of indications and complications raise concerns about the validity of administrative data.
 
AUTHOR DISCLOSURES: R. P. Bensley: Nothing to disclose; T. Curran: Nothing to disclose; M. Fokkema: Nothing to disclose; A. D. Hamdan: Endologix, Consulting fees or other remuneration (payment); R. Hurks: Nothing to disclose; R. C. Lo: Nothing to disclose; F. L. Moll: Nothing to disclose; M. L. Schermerhorn: Endologix, Consulting fees or other remuneration (payment); Medtronic, Consulting fees or other remuneration (payment); M. C. Wyers: Boston Scientific, Consulting fees or other remuneration (payment); Endologix, Consulting fees or other remuneration (payment).

 

 

CEA
CAS
Rate w/o POA info
% POA
Rate w/o POA info
% POA
Stroke complication code
1.1
41
1.9
50
Cardiac complication code
2.3
45
2.5
50
Stroke diagnosis codes
5.7
86
10.6
87
TIA diagnosis codes
1.9
92
2.5
83
Amaurosis fugax diagnosis codes
2.5
97
2.3
94

 

Posted April 2013

 

 

 

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