Supplementing quality assurance data with administrative billing records yielded a 30% increase in identified cases of perioperative aspiration, finding a total incidence of 5.5 per 10,000 anesthetics.
Observational (n=47,272)
No
Does the use of administrative billing data supplement quality assurance databases to better identify perioperative aspiration in children?
Using administrative billing data alongside quality assurance databases significantly improves the detection of rare perioperative complications like pulmonary aspiration in children.
BACKGROUND: Perioperative aspiration is a rare but potentially devastating complication, occurring in 1-10 per 10 000 anesthetics based on studies of quality assurance databases. Quality assurance reporting is known to underestimate the incidence of adverse outcomes, but few large studies use supplementary data sources. This study aims to identify the incidence of and risk factors for perioperative aspiration in children using quality assurance data supplemented by administrative billing records, and to examine the utility of billing data as a supplementary data source. METHODS: Aspiration events for children receiving anesthesia at a tertiary care pediatric hospital between 2008 and 2014 were identified using (i) a perioperative quality assurance database and (ii) hospital administrative billing records with International Classification of Diseases, Ninth Revision Clinical Modification coded diagnoses of aspiration. Records were subject to review by pediatric anesthesiologists. Following identification of all aspiration events, the incidence of perioperative aspiration was calculated and risk factors were assessed. RESULTS: 47 272 anesthetic cases were evaluated over 7 years. The quality assurance database identified 20 cases of perioperative aspiration occurring in surgical inpatients, same-day admissions, and outpatients. Using hospital administrative data (which excludes outpatients with shorter than a 24-hour stay), 9 cases of perioperative aspiration were identified of which 6 had not been found through quality assurance data. Overall, International Classification of Diseases, Ninth Revision coding demonstrated a positive predictive value of 94.5% for any aspiration event; however, positive predictive value was <4% for perioperative aspiration. A total incidence of 5.5 perioperative aspirations per 10 000 (95% CI: 3.7-8.0 per 10 000) anesthetics was found. CONCLUSION: Quality assurance data offer an efficient way to measure the incidence of rare events, but may underestimate perioperative complications. International Classification of Diseases, Ninth Revision codes for aspiration used as a secondary data source were nonspecific for perioperative aspiration, but when combined with record review yielded a 30% increase in identified cases of aspiration over quality assurance data alone. The use of administrative data therefore holds potential for supplementing quality assurance studies of rare complications.
Eisler et al. (Wed,) conducted a observational in Perioperative aspiration (n=47,272). Quality assurance database supplemented by administrative billing records vs. Quality assurance data alone was evaluated on Incidence of perioperative aspiration per 10,000 anesthetics (95% CI 3.7-8.0). Supplementing quality assurance data with administrative billing records yielded a 30% increase in identified cases of perioperative aspiration, finding a total incidence of 5.5 per 10,000 anesthetics.