Εφαρμογή της διεθνούς στατιστικής ταξινόμησης νοσημάτων και συναφών προβλημάτων υγείας (ICD) στα περιστατικά της μεταπτυχιακής κλινικής Οδοντοφατνιακής Χειρουργικής, Χειρουργικής Εμφυτευματολογίας και Ακτινολογίας ΑΠΘ
Creators: name: Κουραμάς, Αργύρης-Δημήτριος Δημητρίου
Publisher: name: Aristotle University of Thessaloniki
Year: 2018
Subjects: Ταξινόμηση
Διάγνωση
Οδοντοφατνιακή
ICD-10
Diagnosis
Dentoalveolar

description: Η Διεθνής Στατιστική Ταξινόμηση Νόσων και Συναφών Προβλημάτων Υγείας (International Classification of Diseases- ICD) είναι μία ταξινόμηση νοσημάτων του Παγκόσμιου Οργανισμού Υγείας, της οποίας η αρχική μορφή διαμορφώθηκε το 1893 και πρωτοαναφέρθηκε ως ταξινόμηση του Bertillon. Η παρούσα εργασία αποτελεί μία αναδρομική κλινική μελέτη από το αρχείο της μεταπτυχιακής κλινικής Οδοντοφατνιακής Χειρουργικής ΑΠΘ. Πραγματοποιήθηκε ταξινόμηση των διαγνώσεων των ασθενών που προσήλθαν στη μεταπτυχιακή κλινική στο διάστημα μεταξύ Σεπτεμβρίου 2013 και Ιουλίου 2018, σύμφωνα με τη 10η αναθεώρηση της ICD (ICD-10) και πιο συγκεκριμένα με την ελληνική τροποποίησή της (ICD-10-GrM). Επίσης, πραγματοποιήθηκε καταγραφή των εξετάσεων, θεραπειών και επιπλοκών των ασθενών με συστήματα ταξινόμησης των ερευνητών, με σκοπό την καταγραφή των συνολικών πεπραγμένων της μεταπτυχιακής κλινικής (audit) κατά το διάστημα αυτό
description: Aim of the study: The aim of this thesis, is to evaluate the type of diagnoses and complications that were encountered, in the postgraduate clinic of Dentoalveolar Surgery, Surgical Implantology and Roentgenology AUTH (audit), during the time between 2013 and 2018. The types of examinations, as well as, the treatment protocols applied to patients, were also recorded. Materials and methods: This diploma thesis is a retrospective clinical study of archival material (patients’ clinical records). The study’s material comes from the Department of Dentoalveolar Surgery, Clinical Implantology and Roentgenology, School of Dentistry, Aristotle University of Thessaloniki. Initially, the International Classification of Diseases, 10th revision (ICD-10) was reviewed and the codes that could have possibly related to the postgraduate clinic’s cases, were isolated. All the patients’ records related to dentoalveolar surgery that were treated in the postgraduate clinic between 2013 and 2018, were assessed. Implantology cases were excluded from the study. The procedure of processing and recording the data took place at the postgraduate clinic’s facilities under the author’s responsibility. Patients’ demographic information were recorded and then, the diagnoses were classified according to the greek modification of ICD-10 (ICD-10-GrM). When available, the final diagnosis was set by histology. In order to serve the audit of the postgraduate clinic during this period, the types of examinations requested for either assistance in diagnosis, or for assessing other laboratory parameters, were recorded. There was also recording of the treatments received by each patient, as well as, of the complications that occurred either intraoperatively, or postoperatively. In order to record examinations, therapies and complications, classification systems were developed by the authors for the study’s needs. All data were processed and analyzed by the SPSS program. Results: In this study, the records of 2920 patients were included, 1313 were males (44,97%) and 1607 (55,03%) were females. During the academic year 2013-14, 600 patients were treated, constituting 20,55% of all patients recorded. In academic year 2014-15, 636 patients were treated (21,78%), in 2015-16 631 patients (21,60%), in 2016-17 598 patients (20,48%) and finally, during the academic year 2017-18 455 patients, constituting 15,58% of all patients treated. We can notice this decrease in the patients’ number during the academic year 2017-18, due to professors’ strike for one academic semester. One diagnosis was recorded in 1628 patients (55,7%), two diagnoses in 1197 patients (41%), three diagnoses in 87 patients (2,8%) and four diagnoses in 8 patients (0,3%). The most common ICD-10 diagnostic codes that were recorded, were K01.1 (impacted/semi-impacted teeth) with 33,21% of all the diagnoses recorded, K05.3 (chronic periodontitis, chronic pericoronitis) with 26,34% and K02 (caries) with 16,72%. It is important to mention, that 3 cases of malignant lesions were recorded (0,069%), 2 lymphomas and 1 squamous cell carcinoma (SCC). Furthermore, 9 cases of medication-related osteonecrosis of the jaws (MROJ) were recorded (0,21%). The most common radiographic examinations were panoramic x-ray (66,78%), periapical x-ray (21,65%) and CBCT (6,75%). From the laboratory examinations, hematologic examinations constitute 2,13% of all examinations requested and biochemical examinations 1,20%. 45 biopsies were taken, constituting 1,18% of all examinations. The most common intraoperative complication was oro-antral communication (15,30%), when the most common postoperative complications were alveolar osteitis (16,40%) and postsurgical infection (15,84%). In relation to nerve injuries, 23 paresthesias of the lingual nerve (12,57%) were mentioned and 15 paresthesias of inferior alveolar nerve (8,20%). Approximately 95% of therapies that the patients received, were procedures of dentoalveolar surgery, with the most common being the simple extractions (41,80%) and the surgical extractions (41,17%). The rest 5% included conservative-non surgical therapies (0,72%) and procedures of mucogingival surgery, like excision of small benign lesions (0,92%), closure of oro-antral communications (1,22%) and treatment of odontogenic infections (2,67%). Conclusions: According to our experience gained from this diploma thesis, ICD-10 can help significantly in health services, however, its application in the field of dentistry is complex. The presence of numerous teeth in patients’ oral cavity can lead to several different diagnostic codes for the same patient, making the procedure of recording the relevant information difficult. Another major disadvantage of this classification is, that its codes are lacking in clarity and as a result, either some diagnoses can not be classified at all, or are classified into wider and more general diagnoses. This makes it harder to store the "authentic information", thus making its storage and its retrieval impossible. Another problem is that several different pathologic conditions, belong to the same ICD-10 code. For example, both chronic periodontitis and chronic pericoronitis correspond to the same code (K05.3). According to the results, approximately one third of the cases are cases of surgical extractions, which have chronic pericoronitis as its main indication. We assume that for this specific clinic’s audit, this is a serious problem. From the results we can understand, that the percentages of both intraoperative and postoperative complications, are within the same ranges with similar percentages existing in the literature. The amount of usage of CBCT was also compatible with the available information in the literature. We assume, that the services that the postgraduate clinic of Dentoalveolar Surgery provide, are acceptable. Knowing the percentages of complications might be very useful, because we can use them also for other purposes, such as the writing of the informed consent that patients sign. Such an informed consent, describing the procedure to be performed to each patient and the possible complications, is necessary for a surgical clinic. Recognizing a concept of minimal risk in clinical practice, could mean that all complication rates exceeding a certain threshold, require a formal informed consent procedure between the patient and the clinician, that includes a detailed explanation of these specific complications. It is important to understand, that the failure of a clinician to provide the patient with all the relevant information, has moral and potential legal consequences