An algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data: a diagnostic accuracy study using the Danish National Patient Register
Background and purpose: Disease- or procedure-specific registers offer valuable information but are costly and often inaccurate regarding outcome measures. Alternatively, automatically collected data from administrative systems could be a solution, given their high completeness. Our primary aim was...
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| Format: | Article |
| Language: | English |
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Medical Journals Sweden
2025-01-01
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| Series: | Acta Orthopaedica |
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| Online Access: | https://actaorthop.org/actao/article/view/42633 |
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| author | Signe S Jensen Anders B Rønnegaard Per H Gundtoft Søren Kold Bjarke Viberg |
| author_facet | Signe S Jensen Anders B Rønnegaard Per H Gundtoft Søren Kold Bjarke Viberg |
| author_sort | Signe S Jensen |
| collection | DOAJ |
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Background and purpose: Disease- or procedure-specific registers offer valuable information but are costly and often inaccurate regarding outcome measures. Alternatively, automatically collected data from administrative systems could be a solution, given their high completeness. Our primary aim was to validate a method for identifying secondary surgical procedures (reoperations) in the Danish National Patient Register (DNPR) within the first year following primary fracture surgery. The secondary aim was to evaluate the accuracy of the diagnosis and procedure codes used to determine the causes of these reoperations. Finally, we developed algorithms to enhance precision in identifying the reasons for reoperations.
Methods: In a national cohort of 11,551 patients with primary fracture surgery, reoperations were identified through subsequent surgical procedure codes in the DNPR. Each patient record was reviewed to confirm the reoperations and causes. To improve accuracy, a stepwise algorithm was developed for each cause.
Results: We identified 2,347 possible reoperations; 2,212 were validated as true reoperations by review of patient record, i.e., a 94% positive predictive value (PPV). However, the coding for the causes of these reoperations was inaccurate. Our algorithm identified major reoperations with a sensitivity/PPV of 89/77%, minor reoperations 99%/89%, infections 77/85%, nonunion 82/56%, early re-osteosynthesis 90/75%, and secondary arthroplasties 95/87%.
Conclusion: While the overall reported reoperations in the DNPR had a high PPV, the predefined diagnosis and procedure codes alone were not sufficient to accurately determine the causes of these reoperations. An algorithm was developed for this purpose, yielding acceptable results for all causes except nonunion.
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| format | Article |
| id | doaj-art-888b203886d84c64bf1c59e5b08c08b3 |
| institution | Kabale University |
| issn | 1745-3674 1745-3682 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Orthopaedica |
| spelling | doaj-art-888b203886d84c64bf1c59e5b08c08b32025-01-13T16:45:33ZengMedical Journals SwedenActa Orthopaedica1745-36741745-36822025-01-019610.2340/17453674.2024.42633An algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data: a diagnostic accuracy study using the Danish National Patient RegisterSigne S Jensen0https://orcid.org/0000-0003-1563-3778Anders B Rønnegaard1https://orcid.org/0000-0002-8037-5114Per H Gundtoft2https://orcid.org/0000-0002-3688-6865Søren Kold3Bjarke Viberg4https://orcid.org/0000-0001-5169-4282Department of Orthopedic Surgery and Traumatology, Kolding Hospital; Department of Clinical Research, University of Southern Denmark, DenmarkDepartment of Orthopedic Surgery and Traumatology, Kolding Hospital; Department of Clinical Research, University of Southern Denmark, DenmarkDepartment of Orthopedic Surgery and Traumatology, Aarhus University Hospital. DenmarkDepartment of Orthopedic Surgery, Aalborg University Hospital, DenmarkDepartment of Orthopedic Surgery and Traumatology, Kolding Hospital; Department of Clinical Research, University of Southern Denmark; Institute of Regional Health Research, University of Southern Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark Background and purpose: Disease- or procedure-specific registers offer valuable information but are costly and often inaccurate regarding outcome measures. Alternatively, automatically collected data from administrative systems could be a solution, given their high completeness. Our primary aim was to validate a method for identifying secondary surgical procedures (reoperations) in the Danish National Patient Register (DNPR) within the first year following primary fracture surgery. The secondary aim was to evaluate the accuracy of the diagnosis and procedure codes used to determine the causes of these reoperations. Finally, we developed algorithms to enhance precision in identifying the reasons for reoperations. Methods: In a national cohort of 11,551 patients with primary fracture surgery, reoperations were identified through subsequent surgical procedure codes in the DNPR. Each patient record was reviewed to confirm the reoperations and causes. To improve accuracy, a stepwise algorithm was developed for each cause. Results: We identified 2,347 possible reoperations; 2,212 were validated as true reoperations by review of patient record, i.e., a 94% positive predictive value (PPV). However, the coding for the causes of these reoperations was inaccurate. Our algorithm identified major reoperations with a sensitivity/PPV of 89/77%, minor reoperations 99%/89%, infections 77/85%, nonunion 82/56%, early re-osteosynthesis 90/75%, and secondary arthroplasties 95/87%. Conclusion: While the overall reported reoperations in the DNPR had a high PPV, the predefined diagnosis and procedure codes alone were not sufficient to accurately determine the causes of these reoperations. An algorithm was developed for this purpose, yielding acceptable results for all causes except nonunion. https://actaorthop.org/actao/article/view/42633FracturesInfectionNonunionValidation |
| spellingShingle | Signe S Jensen Anders B Rønnegaard Per H Gundtoft Søren Kold Bjarke Viberg An algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data: a diagnostic accuracy study using the Danish National Patient Register Acta Orthopaedica Fractures Infection Nonunion Validation |
| title | An algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data: a diagnostic accuracy study using the Danish National Patient Register |
| title_full | An algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data: a diagnostic accuracy study using the Danish National Patient Register |
| title_fullStr | An algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data: a diagnostic accuracy study using the Danish National Patient Register |
| title_full_unstemmed | An algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data: a diagnostic accuracy study using the Danish National Patient Register |
| title_short | An algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data: a diagnostic accuracy study using the Danish National Patient Register |
| title_sort | algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data a diagnostic accuracy study using the danish national patient register |
| topic | Fractures Infection Nonunion Validation |
| url | https://actaorthop.org/actao/article/view/42633 |
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