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Evaluating alternative risk-adjustment strategies for surgery



Evaluating alternative risk-adjustment strategies for surgery



American Journal of Surgery 188(5): 566-570



Comparison of institutional health care outcomes requires risk adjustment. Risk-adjustment methodology may influence the results of such comparisons. We compared 3 risk-adjustment methodologies used to assess the quality of surgical care. Nurse reviewers abstracted data from a continuous sample of 2,167 surgical patients at 3 academic institutions. One risk adjustor was based on medical record data (National Surgical Quality Improvement Program [NSQIP]) whereas the other 2, the DxCG and Charlson Comorbidity Index (CCI), primarily used International Classification of Disease-9 (ICD-9) codes. Risk-assessment scores from the 3 systems were compared with each other and with mortality. Substantial disagreement was found in the risk assessment calculated by the 3 methodologies. Although there was a weak association between the CCI and DxCG, neither correlated well with the NSQIP. The NSQIP was best able to predict mortality, followed by the DxCG and CCI. In surgical patients, different risk-adjustment methodologies afford divergent estimates of mortality risk.

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Accession: 048990506

Download citation: RISBibTeXText

PMID: 15546571

DOI: 10.1016/j.amjsurg.2004.07.032


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