title: Use of routine hospital morbidity data together with weight and height of patients to predict  in-hospital complications following total joint replacement.
abstract: BACKGROUND
  Routinely collected data such as hospital morbidity data (HMD) are increasingly used in studying clinical outcomes among patients undergoing total joint replacement (TJR). These data are readily available and cover large populations. However, since these data were not originally collected for the purpose of health research, a rigorous assessment of their quality is required. We assessed the accuracy of the diagnosis of obesity in HMD and evaluated whether the augmentation of HMD with actual weight and height of patients could improve their ability to predict major in-hospital complications following total joint replacement in men.
  
  
  METHODS
  The electronic records of 857 participants in the Health In Men Study (HIMS) who had had TJR were linked with Western Australia HMD. HMD-recorded diagnosis of obesity was validated using the actual weight and height obtained from HIMS. In-hospital major complications were modelled using multivariable logistic regressions that either included the actual weight and height or HMD-recorded obesity. Model discrimination was calculated using area under ROC curve.
  
  
  RESULTS
  The HMD failed to detect 70% of the obese patients. Only 64 patients (7.5%) were recorded in HMD as obese although 216 (25%) were obese [BMI: ≥30kg/m2] (sensitivity: 0.2, positive predictive value: 0.7). Overall, 174 patients (20%) developed an in-hospital major complication which was significantly higher in the overweight and obese comparing with patients with normal weight. HMD-recorded obesity was not independently associated with major complications, whereas a dose-response relationship between weight and these complications was observed (P=0.004). Using the actual weight and height of the participants instead of HMD-recorded diagnosis of obesity improved model discrimination by 9%, with areas under ROC curve of: 0.69, 95% CI: 0.64-0.73 for the model with HMD-recorded obesity compared with 0.75, 95% CI: 0.70-0.79 for the model with actual weight and height, P<0.001.
  
  
  CONCLUSIONS
  Body weight is an important risk factor for in-hospital complications in patients undergoing TJR. HMD systems do not include weight and height as variables whose recording is mandatory. Augmenting HMD with patients' weight and height may improve prediction of major complications following TJR. Our study suggests making these variables mandatory in any hospital morbidity data system.
authors.affiliation: Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia. George.Mnatzaganian@acu.edu.au
authors.forename: George
authors.initials: G
authors.lastname: Mnatzaganian
authors.forename: Philip
authors.initials: P
authors.lastname: Ryan
authors.forename: Paul E
authors.initials: PE
authors.lastname: Norman
authors.forename: David C
authors.initials: DC
authors.lastname: Davidson
authors.forename: Janet E
authors.initials: JE
authors.lastname: Hiller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data; D012372:ROC Curve; D012307:Risk Factors; D014904:Western Australia / Q000453:epidemiology