THE VALUE OF HOSPITAL DISCHARGE DATABASES

OBJECTIVES: The purpose of this study was to determine outcome and identify predictors of death after thoracoabdominal aortic aneurysm (TAA) repair, renal artery bypass (RAB), and revascularization for chronic mesenteric ischemia (CMI). Patients and Methods: In this retrospective analysis, data were obtained from the Nationwide Inpatient Sample, a 20% all-payer stratified sample of hospitals in the United States during 1993 to 1997. Patients were identified by the presence of a diagnostic or procedure code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The main outcomes we examined were death, ICD-9-CM -based complications, length of stay, hospital charges, and disposition. A multivariate model was constructed to predict death. RESULTS: A total of 2934 patients were identified (TAA, 540; RAB, 2058; CMI, 336) in the database. The mean age was comparable (TAA, 69 +/9 years; RAB, 66 +/12 years; CMI, 66 +/11 years), but the breakdown between the sexes varied by procedure (male: TAA, 53%; RAB, 55%; CMI, 24%). The mortality rate (TAA, 20.3%; RAB, 7.1%; CMI, 14.7%), complication rate (TAA, 62.2%; RAB, 37.4%; CMI, 44.6%), and the percentage of patients discharged to another institution (TAA, 21.2%; RAB, 9.3%; CMI, 12.0%) were clinically significant for all procedures. The mortality rate for RAB was greater when performed concomitant with an aortic reconstruction (4.4% vs 8.3%). All three procedures were resource intensive as reflected by the median length of stay (TAA, 14 days; RAB, 9 days; CMI, 14 days) and median hospital charges (TAA, $64,493; RAB, $36,830; CMI, $47,390). The multivariate model identified several variables for each procedure that had an impact on the predicted mortality rate (TAA, 14%-76%; RAB, 46%; CMI, and RAB are greater than commonly reported in the literature and mandate reexamining the treatment strategies for these complex vascular problems Notes: ID: 842; DA 20010703 IS 0741-5214 LA eng PT Journal Article SB IM; RP: NOT IN FILE Author Address/Affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, USA Links: PM:11436075; 2 User 1: DATABASE NAME: 1993-1997 Nationwide Inpatient Sample User 2: STATE/NATIONAL: 19 states User 3: DEPENDENT VARIABLES: In-hospital mortality, post-operative complications, LOS, charges, and discharge disposition User 4: TYPE OF APPLICATION: Outcomes of care. User 5: COMMENTS: Race data were not available for all states. The database contains only a limited amount of clinical information, which may be insufficient for risk adjustment or precise identification of procedures and conditions. Accuracy of data coding is unknown. Can examine only in-hospital mortality. Cannot track patients longitudinally; therefore do not know where patients who are discharged to another facility ultimately end up. The 3 procedures examined are relatively rare, so the volume of cases available for analysis is small, even using several years of this large database. Created: 7/28/2004 8:54:44 AM Last Modified: 11/15/2004 12:41:27 PM Appendix E. Sample Entries from Electronic Citation Database NORC at the University of Chicago National Association of Health Data Organizations 73 National Association of Health Data Organizations 83