Charts versus Discharge ICD-10 Coding for Sternal Wound Infection Following Coronary Artery Bypass Grafting.

BACKGROUND: Sternal wound infection (SWI) in patients undergoing coronary artery bypass grafting (CABG) can carry a significant risk of morbidity and mortality. The objective of this work is to describe the methods used to identify cases of SWI in an administrative database and to demonstrate the effectiveness of using an International Classification of Diseases, Tenth Revision (ICD-10) coding algorithm for this purpose. METHODS: ICD-10 codes were used to identify cases of SWI within one year of CABG between April 2002 and November 2009. We randomly chose 200 charts for detailed chart review (100 from each of the groups coded as having SWI and not having SWI) to determine the utility of the ICD-10 coding algorithm. RESULTS: There were 2,820 patients undergoing CABG. Of these, 264 (9.4 percent) were coded as having SWI. Thirty-eight cases of SWI were identified by chart review. The ICD-10 coding algorithm of T81.3 or T81.4 was able to identify incident SWI with a positive predictive value of 35 percent and a negative predictive value of 97 percent. The agreement between the ICD-10 coding algorithm and presence of SWI remained fair, with an overall kappa coefficient of 0.32 (95 percent confidence interval, 0.22-0.43). The effectiveness of identifying deep SWI cases is also presented. CONCLUSIONS: This article describes an effective algorithm for identifying a cohort of patients with SWI following open sternotomy in large databases using ICD-10 coding. In addition, alternative search strategies are presented to suit researchers' needs.

Trends in postcoronary artery bypass graft sternal wound dehiscence in a provincial population.

BACKGROUND: It appears that the medical profile of patients undergoing coronary artery bypass graft (CABG) surgery has changed. The impact of this demographic shift on CABG outcomes, such as sternal wound dehiscence, is unclear. OBJECTIVES: To quantify the incidence and trends of sternal wound dehiscence, quantify the demographic shift of those undergoing CABG and identify patient factors predictive of disease. METHODS: A prospective analysis was performed on a historical cohort of consecutive patients who underwent CABG (without valve replacement) in Alberta between April 1, 2002 and November 30, 2009. The incidence and trends of sternal wound dehiscence were determined. In addition, the trend of the mean Charlson index score and European System for Cardiac Operative Risk Evaluation (EuroSCORE) (capturing patient comorbidities) was analyzed. Univariable analysis and multivariable models were performed to determine factors predictive of wound dehiscence. RESULTS: A total of 5815 patients underwent CABG during the study period. The incidence proportion of sternal wound dehiscence in Alberta was 1.86% and the incidence rate was 1.98 cases per 100 person-years. Although both the EuroSCORE and Charlson scores significantly increased over the study period, the incidence of sternal wound dehiscence did not change significantly. Factors predictive of sternal wound dehiscence were diabetes (OR 2.97 [95% CI 1.73 to 5.10]), obesity (OR 1.55 [95% CI 1.05 to 2.27]) and female sex (OR 1.90 [95% CI 1.26 to 2.87]). CONCLUSIONS: The incidence proportion of sternal wound dehiscence in Alberta was comparable with the incidence previously published in the literature. While patients undergoing CABG had worsening medical profiles, the incidence of sternal wound dehiscence did not appear to be increasing significantly.

HISTORIQUE: Il semble que le profil médical des patients qui subisent un pontage aortocoronarien (PAC) a changé. On ne connaît pas les effets de ce changement démographique sur les résultats des PAC, tels que la déhiscence sternale. OBJECTIF: Quantifier l'incidence et les tendances de déhiscence sternale, quantifier le changement démographique des personnes qui subissent un PAC et cerner les facteurs liés aux patients qui sont prédictifs de maladie. MÉTHODOLOGIE: Les chercheurs ont effectué une analyse prospective auprès d'une cohorte historique de patients consécutifs qui avaient subi un PAC (sans remplacement valvulaire) en Alberta entre le 1er avril 2002 et le 30 novembre 2009. Ils ont déterminé l'incidence et les tendances des déhiscences sternales. Ils ont analysé la tendance de l'indice moyen de Charlson et de l'EuroSCORE (European System for Cardiac Operative Risk Evaluation) (qui saisit les comorbidités des patients). Ils ont utilisé des analyses univariables et des modèles multivariables pour déterminer les facteurs prédictifs d'une déhiscence de la plaie. RÉSULTATS: Au total, 5 815 patients ont subi un PAC pendant la période de l'étude. La proportion de déhiscence sternale en Alberta était de 1,86 % et le taux d'incidence, de 1,98 cas sur 100 personnes-année. Même si l'EuroSCORE et l'indice de Charlson ont augmenté considérablement pendant la période de l'étude, l'incidence de déhiscence sternale n'a pas changé de manière significative. Le diabète (RC 2,97 [95 % IC 1,73 à 5,10]), l'obésité (RC 1,55 [95 % IC 1,05 à 2,27]) et le sexe féminin (RC 1,90 [95 % IC 1,26 à 2,87]) étaient les facteurs prédictifs de déhiscence sternale. CONCLUSIONS: La proportion de déhiscence sternale en Alberta était comparable à celle publiée par le passé. Le profil médical des patients qui subissent un PAC s'aggravait, mais l'incidence de déhiscence sternale ne semblait pas augmenter de manière significative.