title: A systematic review of validated methods for identifying orthopedic implant removal and revision using administrative data.
abstract: OBJECTIVE
  To identify studies that have validated administrative and claims database algorithms for identifying patients with orthopedic device revision or removal.
  
  
  METHODS
  As a part of the Food and Drug Administration's Mini-Sentinel pilot program, we performed a systematic review to identify algorithms for orthopedic implant removal/revision in administrative and claims databases in the USA or Canada.
  
  
  RESULTS
  Five studies examined the validity of database algorithms against a gold standard of documentation in medical records (n = 3) or codes/documentation in another database (n = 2). The positive predictive values (PPV) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and/or the Current Procedural Terminology codes for revision total hip arthroplasty (THA) in the US Medicare population compared with medical record review were 92%and 91%, respectively. In another study of the US Medicare population, multiple ICD-9 codes for revision total knee arthroplasty were compared with newly available single ICD-9-CM codes for revision knee arthroplasty; sensitivity was 87% and specificity was 99% (PPV not provided). The fourth study validated the ICD-9-CM codes for revision total knee arthroplasty against Ontario health insurance physician fee service claims as the gold standard and found a PPV of 32%. In the last study in Medicare population, the accuracy of the attribution of revision THA to the same side as the earlier index primary THA was examined; PPV for same laterality of revision THA was 71% (using ICD-9-CM codes).
  
  
  CONCLUSIONS
  Validation data, with regard to the ICD-9-CM or the Current Procedural Terminology code algorithms for revision THA in the Medicare population, exist. More validation studies are needed to confirm these findings and examine other large databases.
authors.affiliation: Medicine Service and Center for Surgical Medical Acute Care Research and Transitions, Birmingham VA Medical Center, Birmingham, AL, USA. Jasvinder.md@gmail.com
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kundukulam
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000465:Algorithms; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data*; D002170:Canada / Q000453:epidemiology; D016208:Databases, Factual / Q000706:statistics & numerical data; D020878:Device Removal / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D010865:Pilot Projects; D019736:Prostheses and Implants / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration; D054928:Validation Studies as Topic