Postoperative Myocardial Infarction in Administrative Data vs Clinical Registry: A Multi-Institutional Study

In Brief BACKGROUND: Previous studies have documented significant differences between administrative data and registry data in the determination of postoperative MI. The goal of this study was to characterize discordance between administrative and registry data in the determination of postoperative myocardial infarction (MI). STUDY DESIGN: This study was performed using data from the American College of Surgeons NSQIP merged with administrative data from 8 different hospitals, between 2013 and 2015. From each of these sources, the occurrence of a postoperative MI, as ascertained by administrative data and NSQIP data, were compared. In each situation in which the 2 sources disagreed (discordance), a 2-clinician chart review was performed to generate a “gold standard” determination as to the occurrence of postoperative MI. RESULTS: A total of 43,289 operations met our inclusion criteria for analysis. Within this cohort a total of 230 cases of MI were identified by administrative data and/or NSQIP data (administrative rate 0.41%, NSQIP rate 0.42%). A total of 89 discordant ascertainments were identified, of which 42 were admin+/NSQIP- and 47 were admin-/NSQIP+. Accuracy (99.9% for both) and concordance (kappa = 0.89 [95% CI 0.86 to 0.92] for administrative data, kappa = 0.87 [95% CI 0.84 to 0.91] for NSQIP data) of the 2 systems were similar when compared against our gold standard (chart review). The majority of errors were related to false negatives, with sensitivity rates of 81% in both data sources. CONCLUSIONS: In this multi-institutional study, administrative data and NSQIP demonstrated a similar ability to determine the occurrence of postoperative MI. These findings do not demonstrate an advantage of registry data over administrative data in the determination of postoperative MI. Administrative- and registry-based data differ significantly in the determination of postoperative myocardial infarction. This multi-institutional study characterizes this discordance and accuracy of these 2 systems against a 2-clinician chart review. The 2 systems were found to have comparable accuracy, including problems with missing approximately 19% of myocardial infarctions.