title: The utility of claims data for infection surveillance following anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  To explore the feasibility of identifying anterior cruciate ligament (ACL) allograft implantations and infections using claims.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  We identified ACL reconstructions using procedure codes at 6 health plans from 2000 to 2008. We then identified potential infections using claims-based indicators of infection, including diagnoses, procedures, antibiotic dispensings, specialty consultations, emergency department visits, and hospitalizations. Patients' medical records were reviewed to determine graft type, validate infection status, and calculate sensitivity and positive predictive value (PPV) for indicators of ACL allografts and infections.
  
  
  RESULTS
  A total of 11,778 patients with codes for ACL reconstruction were identified. After chart review, PPV for ACL reconstruction was 96% (95% confidence interval [CI], 94%-97%). Of the confirmed ACL reconstructions, 39% (95% CI, 35%-42%) used allograft tissues. The deep infection rate after ACL reconstruction was 1.0% (95% CI, 0.7%-1.4%). The odds ratio of infection for allografts versus autografts was 0.41 (95% CI, 0.19-0.78). Sensitivity of individual claims-based indicators for deep infection after ACL reconstruction ranged from 0% to 75% and PPV from 0% to 100%. Claims-based infection indicators could be combined to enhance sensitivity or PPV but not both.
  
  
  CONCLUSIONS
  While claims data accurately identify ACL reconstructions, they poorly distinguish between allografts and autografts and identify infections with variable accuracy. Claims data could be useful to monitor infection trends after ACL reconstruction, with different algorithms optimized for different surveillance goals.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Murphy
authors.forename: Dongyi Tony
authors.initials: DT
authors.lastname: Du
authors.forename: Wei
authors.initials: W
authors.lastname: Hua
authors.forename: Karoll J
authors.initials: KJ
authors.lastname: Cortez
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.forename: Robert L
authors.initials: RL
authors.lastname: Davis
authors.forename: Thomas
authors.initials: T
authors.lastname: DeCoster
authors.forename: Laura
authors.initials: L
authors.lastname: Johnson
authors.forename: Lingling
authors.initials: L
authors.lastname: Li
authors.forename: Cynthia
authors.initials: C
authors.lastname: Nakasato
authors.forename: James D
authors.initials: JD
authors.lastname: Nordin
authors.forename: Mayur
authors.initials: M
authors.lastname: Ramesh
authors.forename: Michael
authors.initials: M
authors.lastname: Schum
authors.forename: Ann
authors.initials: A
authors.lastname: Von Worley
authors.forename: Craig
authors.initials: C
authors.lastname: Zinderman
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
mesh_terms: D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects*; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007345:Insurance Claim Review; D008485:Medical Audit; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D014184:Transplantation, Homologous / Q000009:adverse effects; D014481:United States / Q000453:epidemiology