Computerized assessment of complications after colorectal surgery - Is it valid?

PURPOSE: Historically, complication rates after colorectal surgery have bee n stratified by disease process, type of operation, or anesthesia risk deri ved after an intensive review of the medical record. Newer computer applica tions purport to shorten this process and predict the probability of postop erative complications by distinguishing them from comorbidities that are co mmingled on uniform discharge codes. We analyzed CaduCIS(TM) software, whic h uses discharge codes, to determine whether its predictions of comorbidity and complications were comparable to what was interpreted on the medical r ecord. METHODS: Two-hundred seventy patients were analyzed according to the principal and secondary diagnoses coded on discharge. Coding inaccuracies of clinical occurrences were identified by physician review of each medical record. The actual incidences of 17 common preoperative comorbidities and 11 postoperative complications were compared with those predicted by CaduCI S(TM). RESULTS: The CaduCIS(TM)-predicted distribution of comorbidities was similar to the actual occurrences in 15 of 17 categories. The overall inci dence of complications obtained by physician (actual) review was 47 percent , compared with 46 percent predicted by CaduCIS(TM). However, there was a s tatistical difference between the CaduCIS(TM)-predicted and the actual comp lication rates in 5 of the 11 categories. The most common preoperative como rbidity and complication was cardiopulmonary (47 percent and 28 percent, re spectively). CONCLUSION: The overall complication rate interpreted from the medical record (47 percent) was accurately predicted by CaduCIS(TM) (46 pe rcent). Predictions of 5 of 11 individual complications were underestimated because of charting and coding inaccuracies, not because of computerized e rrors. Because uniform discharge coding of commingled comorbidity and compl ications is increasingly used to rapidly compute surgical outcomes, colon a nd rectal surgeons need to ensure compatibility of the actual and coded med ical records.