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• W4231941702 abstract "Dr Hertzer has presented an insightful article demonstrating the shortcomings of administrative data research and the variation of current publications using the National Inpatient Sample (NIS). Unfortunately, incomplete or incorrect coding, which can bias findings, is a well-documented phenomenon in all administrative data studies.1Romano P.S. Roos L.L. Luft H.S. Jollis J.G. Doliszny K. A comparison of administrative versus clinical data: coronary artery bypass surgery as an example Ischemic Heart Disease Patient Outcomes Research Team.J Clin Epidemiol. 1994; 47: 249-260Abstract Full Text PDF PubMed Scopus (188) Google Scholar, 2Romano P.S. Asking too much of administrative data?.J Am Coll Surg. 2003; 196 (author reply 338-9): 337-338Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar The NIS is well suited for “hard” end points such as mortality rates, procedures, and discharge disposition, but the coding of comorbidities and complications is often variable. Administrative discharge data was originally designed for billing purposes, and subsequently, clinical information is limited by the code schemes of the International Classification of Diseases, 9th Clinical Modification. Definitions of coding can vary between institutions and hospital coders. Therefore, more subtle diagnoses, such as transient cerebral ischemia or amaurosis fugax, are often not appropriately captured in administrative data and lead to the low rates of symptomatic patients reported in all NIS studies. Other limitations of the NIS data include the lack of longitudinality, which does not allow for analysis of readmission rates and complications after hospital discharge. As well, administrative databases often lack information regarding diagnoses “present on admission” and present difficulty discerning between hospital-acquired complications and conditions patients had before admission. However, administrative data do allow for the analysis of large numbers of procedures and can reflect population-level trends and outcomes. Although randomized controlled trials evaluate predefined situations, administrative studies assess outcomes of interventions across all practitioners and institutions. Furthermore, administrative studies can be performed with substantially less time and cost, providing hypothesis-generating findings. Validation of specific codes and diagnoses contained within the NIS would be extremely useful but has not occurred due to cost and technical feasibility. Despite these limitations, the NIS data set can certainly be used to critically evaluate carotid interventions. Examination of stroke rates using expanded coding parameters in conjunction with strict exclusion criteria to ensure only elective cases are captured yields stroke rates in the NIS that are quite comparable (4.16% after carotid artery stenting and 2.66% after carotid endarterectomy) with the Carotid Revascularization Endarterectomy vs Stent Trial trial (4.1% after carotid artery stenting and 2.3% after carotid endarterectomy).3Vogel T.R. Dombrovskiy V.Y. Haser P.B. Scheirer J.C. Graham A.M. Outcomes of carotid artery stenting and endarterectomy in the United States.J Vasc Surg. 2009; 49 (discussion 330): 325-330Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Therefore, code selection and study design, accounting for the inherent limitations of the NIS, can yield comparable results. In the future, coding inconsistencies will become more significant to practitioners as readmission measures designed to reflect “the quality of care” are created using these same codes. This should reinforce the importance of physician involvement in outcome studies and analysis. In conclusion, NIS studies have consistently reported the global superiority of carotid endarterectomy in the United States population but certainly fall short in providing the refined clinical data provided from randomized controlled trials and clinical series. The Nationwide Inpatient Sample may contain inaccurate data for carotid endarterectomy and carotid stentingJournal of Vascular SurgeryVol. 55Issue 1PreviewThe Nationwide Inpatient Sample (NIS) contains information from discharge abstracts submitted by hundreds of community hospitals across the United States, and it frequently has been used as a resource for population-based research comparing the safety of carotid artery stenting (CAS) to that of carotid endarterectomy (CEA). However, at least two findings from the NIS dataset seem open to question. First, several NIS studies have indicated that more than 90% of CEAs and CAS procedures now are being done in asymptomatic patients, a figure that substantially exceeds the prevalence of asymptomatic patients that has been reported elsewhere. Full-Text PDF Open Archive" @default.
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• W4231941702 date "2012-01-01" @default.
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• W4231941702 title "Invited commentary" @default.
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• W4231941702 doi "https://doi.org/10.1016/j.jvs.2011.09.008" @default.
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