Improving the identification of postoperative wound dehiscence missed by the Patient Safety Indicator algorithm.

Borzecki AM, Cevasco M, Mull H, Shin M, Itani K, Rosen AK. Improving the identification of postoperative wound dehiscence missed by the Patient Safety Indicator algorithm. American journal of surgery. 2013 Jun 1; 205(6):674-80.

Related HSR&D Project(s)

• SDR 07-002 – Validating the Patient Safety Indicators in the VA: A Multi-faceted Approach
• RCS 97-401 – Research Career Scientist Award

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Abstract:

BACKGROUND: The Patient Safety Indicator (PSI) Postoperative Wound Dehiscence (PWD) is an administrative data-based algorithm that flags cases using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 54.61 (abdominal wall disruption reclosure). We examined how often PWD missed events and explored ways to improve event identification. METHODS: We selected 125 high-risk unflagged cases based on predicted probability and the presence of clinically relevant codes. We determined the false-negative proportion and associated reasons through chart review and calculated likelihood ratios of associated codes. RESULTS: Thirty-two percent of cases were false negatives, 60% of which lacked any abdominal wall repair codes. All individual codes had low likelihood ratios; the combination of diagnosis code 998.3x (operative wound disruption) and particular abdominal wall repair procedure codes occurred exclusively in false-negative cases (representing 24% of false-negative cases). CONCLUSIONS: Among high-risk cases, the PWD algorithm frequently missed events. Coder training to clarify assignment of abdominal wall repair codes, plus adding specific code combinations to the algorithm, would improve event identification.