title: The validity of hospital discharge data for autologous breast reconstruction research.
abstract: BACKGROUND
  Specific International Classification of Diseases, Ninth Revision codes for different methods of autologous breast reconstruction have been introduced recently, prompting investigators to use discharge databases to evaluate outcomes of autologous breast reconstruction. The accuracy and validity of these data sources have not been evaluated.
  
  
  METHODS
  All patients who underwent autologous breast reconstruction in a single center from October of 2008 to April of 2013 were retrospectively included. Patient medical records were used as the criterion standard to identify specific autologous procedure performed and any perioperative reoperations. These findings were compared against procedure codes documented in the coded discharge data obtained from hospital billing.
  
  
  RESULTS
  A total of 163 autologous procedures were performed in 115 patients, including 40 pedicled and 37 free transverse rectus abdominis musculocutaneous, 74 deep inferior epigastric perforator, five superficial inferior epigastric artery, four transverse upper gracilis, and three superior gluteal artery perforator flaps. Only 126 of 163 flaps (77 percent) were coded correctly. Twenty-two of 48 bilateral procedures had coding for only one flap. An additional 16 cases were either incorrectly coded as another type of reconstruction or not coded at all. Only 19 of 21 reoperations (90 percent) could be captured by review of the coding alone.
  
  
  CONCLUSIONS
  Using International Classification of Diseases, Ninth Revision, codes alone to evaluate autologous breast reconstructions could result in an incomplete and inaccurate data set, with exclusion of many bilateral flaps. Reoperations during the same hospital stay may also be missed if identified only by a discharge code, thus limiting the evaluation of acute complications.
  
  
  METHODS
  Diagnostic, II.
authors: Ann Arbor, Mich. From the Section of Plastic Surgery, University of Michigan Medical School.
authors: Jordan
authors: J
authors: Talia
authors: Shailesh
authors: S
authors: Agarwal
authors: Adeyiza O
authors: AO
authors: Momoh
authors: Edwin G
authors: EG
authors: Wilkins
authors: Jeffrey H
authors: JH
authors: Kozlow
mesh_terms: D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D016462:Mammaplasty / Q000379:methods / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012086:Reoperation / Q000706:statistics & numerical data; D012107:Research Design; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013524:Surgical Flaps / Q000145:classification / Q000706:statistics & numerical data*
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