Conclusions Are Speculative

Letter to the Editor: Mortality and Complications Following Visceral Surgery A Nationwide Analysis Based on the Diagnostic Categories Used in German Hospital Invoicing Data by Dr. med. Philip Baum, Dr. med. Johannes Diers, Dr. med. Sven Lichthardt, Dr. med. Carolin Kastner, Prof. Dr. med. Nicolas Schlegel, Prof. Dr. med. Christoph-Thomas Germer, and PD Dr. med. Armin Wiegering in issue 44/2019

Baum et al. in their article (1) report “valid data“ on mortality and complications after visceral surgery. From a clinical perspective this claim is not plausible. The authors provided a statistical work-up of invoiced procedures and diagnostic codes. They did not validate the data, they did not check for concordance between financial accounting and clinical reality, their conclusions remain speculative. In Germany, the only purpose of coding is to achieve an as high as possible diagnosis-related groups (DRG) code, on which funding from insurance companies depends directly. In order to defend their methods, the authors cited a US publication from 1994, which, by the way, did not validate its data either. Numerous different reports regarding the problem were not included (2, 3, 4).

From a surgical perspective, I also cannot understand the grouping that was undertaken. Procedures with different risks, such as hemicolectomy and rectal amputation, were evaluated within one group, similar to esophageal procedures without reconstruction of continuity and interposition grafts. The authors did not describe how they calculated the 48-hour threshold for ventilation, since obviously this procedure was not defined by using the German procedure classification (Operationen- und Prozedurenschlüssel, OPS) but ICD code J953 (International Classification of Diseases). For gastrointestinal bleeding, peritonitis, and blood transfusion it is not known whether these occurred before, during or after surgery. Furthermore, any checking mechanism as to whether the coded procedure was the one that was undertaken is lacking, as no pathological results were evaluated.

Without any doubt, clinically and practice oriented quality measures are needed in Germany. These require much time, labor, staff, and expense and cannot be replaced with any pseudo-reality gleaned from billing data. Not even the quality of restaurants is assessed by means of the names of meals and billing receipts—so why are we doing this to surgically treated patients?

DOI: 10.3238/arztebl.2020.0361a

Prof. Dr. med. Pawel Mroczkowski

Klinik für Allgemein-, Viszeral- und Endokrine Chirurgie

DRK-Kliniken Nordhessen,Kassel, [e-mail]

Conflict of interest statement

The author declares that no conflict of interest exists.

References

1. Baum P, Diers J, Lichthardt S, et al.: Mortality and complications following visceral surgery—a nationwide analysis based on the diagnostic categories used in German hospital invoicing data. Dtsch Arztebl Int 2019; 116: 739–46

2. Etzioni DA, Lessow CL, Lucas HD, et al.: Infectious surgical complications are not dichotomous: characterizing discordance between administrative data and registry data. Ann Surg 2018; 267: 81–7

3. Lawson EH, Louie R, Zingmond DS, et al.: A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications. Ann Surg 2012; 256: 973–81

4. Koch CG, Li L, Hixson E, Tang A, Phillips S, Henderson JM: What are the real rates of postoperative complications: elucidating inconsistencies between administrative and clinical data sources. J Am Coll Surg 2012; 214: 798–805