A group of researchers examined whether the claims-based algorithm for classifying surgical indications and operative features in lumbar surgery was effective and published their results in Spine.
The researchers examined administrative data for safety, outcomes and cost of care for spine surgery at a single institution in 2009. Patients with back pain, herniated disc, stenosis, spondylolisthesis or scoliosis were included in the study.
There were 477 patients in the study, with 52 percent undergoing fusion and 48 percent undergoing decompression. Here are five key notes from the study:
1. The sensitivity of the claims-based coding algorithm for classifying the procedure was:
• Degenerative disc disease: 71.9 percent
• Disc herniation: 81.9 percent
• Spinal stenosis: 32.7 percent
• Degenerative spondylolisthesis: 90.4 percent
• Scoliosis: 93.8 percent
2. Specificity for these procedures was:
• Degenerative disc disease: 87.9 percent
• Disc herniation: 85.6 percent
• Spinal stenosis: 90.7 percent
• Degenerative spondylolisthesis: 95 percent
• Scoliosis: 97.3 percent
3. The sensitivity for identifying the type of procedure for fusion cases was 97.6 percent. The specificity for identifying the type of procedure for fusion cases was higher, at 99.1 percent.
4. The sensitivity of claims data characterized key operative features for 81.7 percent in the use of instrumentation, 96.4 percent for combined surgical approach and 53 percent for three or more disc levels fused.
5. The specificity was 57.1 percent for instrumentation, 94.5 percent for combined approaches and 71.9 percent for three or more disc levels fused.
The study highlighted the potential and current limitations of claims-based analysis for spine surgery, and the study authors concluded, "Claims data accurately reflected certain diagnoses and type of procedures, but were less accurate at characterizing operative features other than the surgical approach."