title: Infectious Surgical Complications are Not Dichotomous: Characterizing Discordance Between Administrative Data and Registry Data.
abstract: OBJECTIVE
  To characterize reasons for discordance between administrative data and registry data in the determination of postoperative infectious complications.
  
  
  BACKGROUND
  Data regarding the occurrence of postoperative surgical complications are identified through either administrative or registry data. Rates of complications vary significantly between these two types of data; the reasons for this are not well-understood.
  
  
  METHODS
  The occurrence of 30-day inpatient infectious complications (pneumonia, sepsis, surgical site infection, and urinary tract infection) was compared between the NSQIP and administrative mechanisms at 4 academic hospitals between 2012 and 2014. In each situation where the NSQIP and administrative data were discordant regarding the occurrence of a specific complication, a 2-clinician chart abstraction was performed to characterize the reasons for discordance as (i) administrative coding error, (ii) NSQIP coding error, (iii) "question of criteria", where the discordance was the result of differences in criteria, or (iv) "dually incorrect", where both data sources coded the complication incorrectly.
  
  
  RESULTS
  The cohort included 19,163 patients undergoing surgery in 4 different academic hospitals. Rates of infectious complications varied up to 5-fold between the two data sources. A total of 717 discordant complications were identified. Of these, the greatest portion (43%) was due to "question of criteria," followed by administrative coding error (37%), NSQIP error (15%), and dually incorrect (5%).
  
  
  CONCLUSIONS
  With a goal of improving existing mechanisms for measuring surgical quality, definitions for the occurrence of a postoperative complication need to be developed and applied consistently. Progress toward this goal will enable patients and payers to better take advantage of recent advances in healthcare data transparency.
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ.|Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Scottsdale, AZ.
authors.forename: David A
authors.initials: DA
authors.lastname: Etzioni
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ.|Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Scottsdale, AZ.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Lessow
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ.
authors.forename: Heather D
authors.initials: HD
authors.lastname: Lucas
authors.affiliation: Department of Surgery, Mayo Clinic, Jacksonville, FL.
authors.forename: Amit
authors.initials: A
authors.lastname: Merchea
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ.
authors.forename: James A
authors.initials: JA
authors.lastname: Madura
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ.
authors.forename: Raman
authors.initials: R
authors.lastname: Mahabir
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ.|Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Scottsdale, AZ.
authors.forename: Nitin
authors.initials: N
authors.lastname: Mishra
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ.|Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Scottsdale, AZ.
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ.|Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Scottsdale, AZ.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Mathur
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Scottsdale, AZ.
authors.forename: Yu-Hui H
authors.initials: YH
authors.lastname: Chang
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Scottsdale, AZ.|Department of Surgery, Mayo Clinic, Rochester, NY.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Scottsdale, AZ.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
mesh_terms: D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006753:Hospital Records; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology