Original articleAdapting a clinical comorbidity index for use with ICD-9-CM administrative databases
Abstract
Administrative databases are increasingly used for studying outcomes of medical care. Valid inferences from such data require the ability to account for disease severity and comorbid conditions. We adapted a clinical comorbidity index, designed for use with medical records, for research relying on International Classification of Diseases (ICD-9-CM) diagnosis and procedure codes. The association of this adapted index with health outcomes and resource use was then examined with a sample of Medicare beneficiaries who underwent lumbar spine surgery in 1985 (n = 27,111). The index was associated in the expected direction with postoperative complications, mortality, blood transfusion, discharge to nursing home, length of hospital stay,and hospital charges. These associations were observed whether the index incorporated data from multiple hospitalizations over a year's time, or just from the index surgical admission. They also persisted after controlling for patient age. We conclude that the adapted comorbidity index will be useful in studies of disease outcome and resource use employing administrative databases.
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Adjusted for potential confounders, the odds of RRT dependence at 90 days postdischarge among survivors of RRT for AKI was 30% lower for those treated first with CRRT vs. IHD, overall and in several sensitivity analyses.
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Association of Sociodemographic Factors with Surgical Management of Hepatoblastoma and Hepatocellular Carcinoma in Children
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Long-Term Effect of Systemic Comorbidity on Glaucoma Medication Adherence
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Cohort study.
Setting: Population-based.
Study population: All patients with confirmed newly diagnosed glaucoma in one or both eyes were identified using National Health Insurance (NHI) claims data from Taiwan.
Observation procedure: Individuals with newly diagnosed glaucoma were followed up for 5 years from onset. The study period was from January 1, 2011, to December, 31, 2020. Patient comorbidities were identified using the Deyo–Charlson Comorbidity Index. Adherence was measured using the medication possession ratio (MPR). The MPR was calculated by dividing the total number of days a patient had a supply of glaucoma medication by 365. Data for the MPR were extracted from NHI outpatient and drug records.
This study included a total of 50 408 patients. Compared with patients without comorbidity, patients with at least 1 comorbidity exhibited higher MPR in the first 2 years following glaucoma onset. However, their MPR decreased in the long term, specifically in the fourth and fifth years after onset. Additionally, the degree of nonadherence increased with the number of comorbidities. Patients with ≥4 comorbidities had significantly lower glaucoma medication adherence, with reductions of 6.4% (P = .033) and 11.8% (P < .001) in the fourth and fifth years after glaucoma onset, respectively.
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Short-term survival analysis of a risk-adjusted model for ovarian cancer care
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This was a retrospective population-based study of stage I-IV invasive epithelial ovarian cancer reported to California Cancer Registry 1996–2017. A fit logistic regression model, risk-adjusted for patient and disease characteristics, was used to calculate O/E for each hospital stratified by hospital annual case volume. Cox proportional hazards model was used for survival analyses at 3, 6, 12, 24 months and stratified according to sociodemographic characteristics.
The study population included 35,725 subjects treated at 443 hospitals:
Low-O/E – 26.4% of cases; Intermediate-O/E – 55.5% of cases; and High-O/E - 18.1% of cases. Overall median survival by hospital category was: High-O/E = 72.5 months (95% CI = 68.6–78.6 months), Intermediate-O/E = 68.6 months (95% CI = 65.9–71.6 months), Low-O/E = 47.0 months (95% CI = 44.2–49.2 months). Initial treatment at a High-O/E hospital (HR = 1.00) was a statistically significant and independent predictor of improved short-term survival compared to Low-O/E hospitals at 3 months (HR = 1.46, 95% CI = 1.29–1.65), 6 months (HR = 1.35, 95% CI = 1.22–1.50), 12 months (HR = 1.27, 95% CI = 1.17–1.38), and 24 months (HR = 1.19, 95% CI = 1.11–1.27). Significant and independent associations between improved sort-term survival and High/O/E care were observed for Whites, Hispanics, Asian/Pacific Islanders (A/PI), across SES strata, and among all payer categories.
Ovarian cancer care at a High-O/E hospital is an independent predictor of improved outcome and the survival advantage is disproportionately weighted toward the short-term time horizon following diagnosis.
Outcomes of Liver Transplant Recipients Hospitalized With COVID-19: A Nationwide Analysis From the United States
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Surgical management of ventrally located cervical epidural abscess: A comparative analysis between patients aged 18–64 years and ≥65 years
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Clinical and imaging data were retrospectively collected from the institutional database between September 2005 and December 2021.
A total of 35 and 26 patients aged 18–64 and ≥ 65 years, respectively who were diagnosed with ventrally located CSEA were included. The overall mean age was 63.9 ± 3.2 years, with a predominance of the male sex (n = 43/61, 70.5%). Patients aged ≥65 years presented with significantly higher rates of comorbidities (10.3 ± 2.8), as indicated by the CCI, than their younger counterparts (18–64 years: 6.2 ± 2.6; p < 0.001). No differences in the surgical approach or characteristics were observed among the groups. Notably, patients aged ≥65 years had a significantly longer intensive care unit as well as overall hospital stay. In-hospital and 90-day mortality were similar across both groups. Following both types of surgery, a significant improvement was observed in the blood infection parameters and neurological status at discharge compared with the baseline measurements. Older age, higher rates of comorbidities, and higher grades of disability were significant predictors for mortality.
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