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Tuesday, March 16, 2000

Coding not accurate to determine complication rate

Coding for perioperative complications does not accurately determine the true complication rate of total hip arthroplasty because length of hospital stay has been dramatically reduced and many complications have not happened at the time of patient discharge, according to a review of the records of 100 consecutive patients.

Researchers in a study presented in poster exhibit 12 conclude that complication rates at three months and six months are better predictors of morbidity and mortality of total hip arthroplasty.

Between Jan. 1, 1997 to Dec. 9, 1997, the researchers retrospectively reviewed 100 consecutive patients who had primary total hip arthroplasty performed by two experienced orthopaedic surgeons at one medical center. All inpatient and outpatient records were reviewed and complication rates perioperatively at three months, six months, and nine months were calculated. Complications were categorized as major or minor. Major complications included, but were not limited to reoperation, dislocation and stroke, while minor complications included pneumonia, wound infections and urinary tract infections, to name a few.

The major complication rates during the acute hospitalization, at three months, six months, and nine months were 2 percent, 3 percent, 4 percent, and 4 percent, respectively. By six months, there were two additional major complications in two patients, including peroneal nerve decompression and dislocation. Minor complication rates were 13 percent, 17 percent, 18 percent, and 21 percent for the hospitalization, three months, six months, and nine months, respectively. By nine months, there were additional eight complications in eight patients, including deep venous thrombosis and trochanteric bursitis.

Co-authors of the study, all of Johns Hopkins University, are Simon Mears, MD, orthopaedic resident; Michael A. Mont, MD, associate professor orthopaedic surgery; Pat Pietryak, RN, director of clinical studies, division of arthritis surgery; Lynne C. Jones, PhD, assistant professor, orthopaedic surgery; David S. Hungerford, MD, professor, orthopaedic surgery; and Annemarie Krackow, PhD, consultant, department of orthopaedic surgery, Good Samaritan Hospital, Baltimore, Md.; and and Maneesh Bawa, BA, medical student, Johns Hopkins School of Medicine.

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2000 Academy News March 16 Index C

Last modified 23/February/2000 by IS