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Validation of Living Donor Nephrectomy Codes.

ABSTRACT: Background:Use of administrative data for outcomes assessment in living kidney donors is increasing given the rarity of complications and challenges with loss to follow-up. Objective:To assess the validity of living donor nephrectomy in health care administrative databases compared with the reference standard of manual chart review. Design:Retrospective cohort study. Setting:5 major transplant centers in Ontario, Canada. Patients:Living kidney donors between 2003 and 2010. Measurements:Sensitivity and positive predictive value (PPV). Methods:Using administrative databases, we conducted a retrospective study to determine the validity of diagnostic and procedural codes for living donor nephrectomies. The reference standard was living donor nephrectomies identified through the province's tissue and organ procurement agency, with verification by manual chart review. Operating characteristics (sensitivity and PPV) of various algorithms using diagnostic, procedural, and physician billing codes were calculated. Results:During the study period, there were a total of 1199 living donor nephrectomies. Overall, the best algorithm for identifying living kidney donors was the presence of 1 diagnostic code for kidney donor (ICD-10 Z52.4) and 1 procedural code for kidney procurement/excision (1PC58, 1PC89, 1PC91). Compared with the reference standard, this algorithm had a sensitivity of 97% and a PPV of 90%. The diagnostic and procedural codes performed better than the physician billing codes (sensitivity 60%, PPV 78%). Limitations:The donor chart review and validation study was performed in Ontario and may not be generalizable to other regions. Conclusions:An algorithm consisting of 1 diagnostic and 1 procedural code can be reliably used to conduct health services research that requires the accurate determination of living kidney donors at the population level.

SUBMITTER: Lam NN

PROVIDER: S-EPMC5896849 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Validation of Living Donor Nephrectomy Codes.

Lam Ngan N NN Lentine Krista L KL Klarenbach Scott S Sood Manish M MM Kuwornu Paul J PJ Naylor Kyla L KL Knoll Gregory A GA Kim S Joseph SJ Young Ann A Garg Amit X AX

Canadian journal of kidney health and disease 20180409

<h4>Background</h4>Use of administrative data for outcomes assessment in living kidney donors is increasing given the rarity of complications and challenges with loss to follow-up.<h4>Objective</h4>To assess the validity of living donor nephrectomy in health care administrative databases compared with the reference standard of manual chart review.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>5 major transplant centers in Ontario, Canada.<h4>Patients</h4>Living kidney donors between 2 ...[more]

PMID: 29662679

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Project description:BackgroundWhile living kidney donation is considered safe in healthy individuals, perioperative complications can occur due to several factors.ObjectiveWe explored associations between the incidence of perioperative complications and donor characteristics, surgical technique, and surgeon's experience in a large contemporary cohort of living kidney donors.DesignLiving kidney donors enrolled prospectively in a multicenter cohort study with some data collected retrospectively after enrollment was complete (eg, surgeon characteristics).SettingLiving kidney donor centers in Canada (n = 12) and Australia (n = 5).PatientsLiving kidney donors who donated between 2004 and 2014 and the surgeons who performed the living kidney donor nephrectomies.MeasurementsOperative and hospital discharge medical notes were collected prospectively, with data on perioperative (intraoperative and postoperative) information abstracted from notes after enrollment was complete. Complications were graded using the Clavien-Dindo system and further classified into minor and major. In 2016, surgeons who performed the nephrectomies were invited to fill an online survey on their training and experience.MethodsMultivariable logistic regression models with generalized estimating equations were used to compare perioperative complication rates between different groups of donors. The effect of surgeon characteristics on the complication rate was explored using a similar approach. Poisson regression was used to test rates of overall perioperative complications between high- and low-volume centers.ResultsOf the 1421 living kidney donor candidates, 1042 individuals proceeded with donation, where 134 (13% [95% confidence interval (CI): 11%-15%]) experienced 142 perioperative complications (55 intraoperative; 87 postoperative). The most common intraoperative complication was organ injury and the most common postoperative complication was ileus. No donors died in the perioperative period. Most complications were minor (90% of 142 complications [95% CI: 86%-96%]); however, 12 donors (1% of 1042 [95% CI: 1%-2%]) experienced a major complication. No statistically significant differences were observed between donor groups and the rate of complications. A total of 43 of 48 eligible surgeons (90%) completed the online survey. Perioperative complication rates did not vary significantly by surgeon characteristics or by high- versus low-volume centers.LimitationsOperative and discharge reporting is not standardized and varies among surgeons. It is possible that some complications were missed. The online survey for surgeons was completed retrospectively, was based on self-report, and has not been validated. We had adequate statistical power only to detect large effects for factors associated with a higher risk of perioperative complications.ConclusionsThis study confirms the safety of living kidney donation as evidenced by the low rate of major perioperative complications. We did not identify any donor or surgeon characteristics associated with a higher risk of perioperative complications.Trial registrationsNCT00319579: A Prospective Study of Living Kidney Donation (https://clinicaltrials.gov/ct2/show/NCT00319579)NCT00936078: Living Kidney Donor Study (https://clinicaltrials.gov/ct2/show/NCT00936078).

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Validation of Living Donor Nephrectomy Codes.

Publications

Validation of Living Donor Nephrectomy Codes.

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