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Potentially |
General information - overview Products - hospital costs Contact us: - contact us |
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Definition of the indicator |
Proportion of index
interventions (eligible population) followed by a potentially avoidable
reoperation (cases). |
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Cases |
Only reoperations occurring
during the same hospitalization as the index intervention are included. Reoperations are considered as potentially avoidable
if they are related to an anatomic site opened or
manipulated during the index intervention, unplanned at the time of the index
operation, and if they reflect a surgical failure or a complication due to
surgery rather than the worsening of the underlying disease. The algorithm (see below) classifies a reoperation as potentially
avoidable if the same organ group was involved in both the index operation
(step 1) and a complication related to surgery (steps 2 and 3) or an
unplanned reoperation (step 4). The following reoperations, although performed on an other organ
group, were also classified as potentially avoidable: internal organ
resection or limb amputation after a vascular procedure (step 5), reopening
of laparotomy or thoracotomy (step 6), control of hemorrhage (step 7),
revision of a surgical wound (step 8). |
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Eligible population |
All therapeutic surgical
interventions are eligible. An intervention was defined as a series of
procedures, each performed within an interval of less than two hours from the
previous one. A surgical intervention required at least a breaking of skin or
mucous membrane; punctures and injections were not considered surgical. A
therapeutic intervention included at least one non-diagnostic procedure; a
simple biopsy was therefore not included. Endoscopic and endovascular
treatments requiring a hospital stay are included. |
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Risk
adjustment |
The expected values are computed
by an adjustment logistic regression model based on following variables: SQLape®
categories, age, gender, elective admission and first day operation. SQLape® groups
are protected by copyright |
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Scientific validation |
The sensitivity and the
specificity of the screening algorithm were 75% and 72% (cross validation).
The area under the ROC curve of the prediction model was 0.76 in the
validation set, indicating fair discrimination (18’187 interventions in a More details on the scientific
validation of the tool are given in following paper: Halfon P,
Eggli Y, Matter M, Kallay C, van Melle G, Burnand B. Risk-adjusted
potentially avoidable reoperation rates computed from routine data help
hospitals identify quality problems. J Clin epidemiology 2007;60(1):56-67. |
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Implementation |
For more details about required
data and material, format, software package implementation, click on the
corresponding button (French or German version): Manuel technique (French) Technisches Handbuch (German) Documentazione technica (Italian) |
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Comments |
The rational of the rules used
to set the gold standard (table) is given in following paragraphs : Several practices have been
shown to reduce surgical infections; in addition simply informing the
surgeons of their infection rates subsequently decreased these rates [1-4],
Wide variations in clinical anastomosis leak after gastrointestinal surgery
were found between surgeons and are largely considered to reflect surgical
skills [5-7]. Hemorrhage occurring immediately after surgery usually
indicates inadequate operative hemostasis or a technical mishap such as a
slipped ligature or unrecognized trauma to a blood vessel; later hemorrhage
is often related to infection or an anastomotic dehiscence that has eroded
vessels at operative site [8,9]. Fascial disruptions (evisceration) are often
the results of technical shortcomings even though there are patient related
risk factors; common causes are suture
break, slipped knot, excessive stitch interval or a suture tearing through
the fascia [10,11]. Kennedy, as early as 1934, claimed for him and his master
Joseph Price not one wound disruption with evisceration in 56 years of
abdominal surgery due to their constant technique of closure [12]. In a
recent review on abdominal incision wound breakdown, Cliby wrote “it is
entirely within our ability to eliminate most early dehiscence with proper
attention to suture technique, stitch placement and proper surgical
technique” [10]. Similarly, optimal sternal closure has been shown to
preclude sternal dehiscence of sternotomy, the most common incision used by cardiothoracic
surgeons [13]. Incisional hernia is one of the most frequent complications of
open abdominal surgery requiring reoperation but this late complication was
never encountered in our study, which included only reoperation during the
same hospitalization. Obviously, organ injury or foreign body accidentally
left during the index procedure and early mechanical complications of a
material leading to reoperation can be viewed more as a consequence of
inadequate technique than as a consequence of a high risk patient. Based on
these findings, reoperations for complications 1) to 6) were judged avoidable
(Table). Post operative obstruction
requiring laparotomy is mostly due to adhesions which may develop in all
patients undergoing abdominal or pelvic surgery (including laparoscopy), even
if careful attention is paid to reducing tissue trauma and ensuring
haemostasis. No strategy has been shown to decrease incidence of bowel
obstruction, which remains fairly constant over time [14-16]. There is
currently no prophylaxis of compartment syndrome, a devastating complication
requiring an urgent fasciotomy, occurring after trauma, vascular surgery and
rarely other surgical procedures [17,18],. Based on these findings,
reoperations due to complications 10 and 11 were considered unavoidable. Surgical failure was considered
avoidable only if an incomplete initial procedure was the cause of the
revision (cause 12). A calculated conservative approach was considered as not
avoidable, because the risk of reoperation was evaluated at the moment of the
index intervention (cause 13). Similarly, the possible replacement of a
temporary device by a permanent one is always in mind of the operator (cause
15). The relapse or worsening of the underlying disease (cause 14) cannot be attributed
to the index intervention. Thus reoperations for causes 13-15 were considered
unavoidable. Reoperations for complications
7-9 and for surgical failure of undetermined origin (16) were considered of
undetermined preventability, because both technical skills and patients
characteristics might contribute to the outcome. Surgical techniques have
been shown to influence the incidence of most post operative fistulas: lymph
[19], bronchiopleural [20,21] pharyngocutaneous [22] , genital [23,24], etc.; but some patients are more likely to
develop such complications. Vascular site patency depends on many factors
including patient factors, lesion factors and procedural factors [25]. The
role of the surgeon on venous graft patency in coronary bypass has been highlighted
in numerous studies: atraumatic methods as a“no touch” technique aimed at
minimizing vascular damage during vessel harvesting reduce graft failure
[26-28]. Risks for developing anastomotic strictures in urologic surgery are
related to operative factors (like intra operative bleeding, tension free
anastomosis) as well as patient co morbidities (like diabetes or vascular
disease) [29-31]. References [1] Cruse PJ, Foord R. The epidemiology of
wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin
North Am 1980; 60:27-40. [2] Haley RW, Culver DH, White JW, Morgan WM,
Emori TG, Munn VP, Hooton TM. The efficacy of infection surveillance and
control programs in preventing nosocomial infections in US hospitals. Am J
Epidemiol 1985; 121:182-205. [3] Shojania KG, Duncan BW, McDonald KM,
Wachter RM. Safe but sound: patient safety meets evidence-based medicine.
JAMA 2002; 288:508-13. [4] EBM Reviews -
Cochrane Database of Systematic Reviews Edwards PS, Lipp A., Holmes A.
Preoperative skin antiseptics for preventing surgical wound infections after
clean surgery. [Protocol] Cochrane Wounds Group. Cochrane Database of
Systematic Reviews. Updated March, 2003. [5] Bruce J, Russell EM, Mollison J, Krukowski
ZH. The measurement and monitoring of
surgical adverse events. Health Technol Assess 2001; 5:1-194. [6] Collopy BT. Colorectal anastomotic leak
rates are measures of technical skill in surgery. ANZ J Surg 2001; 71:508-10. [7] Smedh K,
Olsson L, Johansson H, Aberg C, Andersson M. Reduction of postoperative
morbidity and mortality in patients with rectal cancer following the
introduction of a colorectal unit. Br J Surg
2001; 88:273-7. [8] Burkitt HG,
Quick CR. Essential surgery: problems, diagnosis and management.3rd
ed. [9] Rumstadt B,
Schwab M, Korth P, Samman M, Trede M. Hemorrhage after pancreatoduodenectomy.
Ann Surg 1998; 227:236-41. [10] Cliby WA.
Abdominal incision wound breakdown. : Clin Obstet Gynecol 2002; 45:507-17. [11] Carlson MA.
Acute wound failure. Surg Clin North Am 1997; 77:607-36. [12] Kennedy JW. Tragedies in the abdominal
incision. Am j Surg 1934; 25: 512. [13] Losanoff JE, Jones JW, Richman BW. Primary closure of median sternotomy: techniques and
principles. Cardiovasc Surg 2002; 10:102-10. [14] Ellis H. Moran BJ.
Thompson JN. Parker MC. Wilson MS. Menzies D.
McGuire A. Lower AM. Hawthorn RJ. O'Brien F. Buchan S. Crowe AM.
Adhesion-related hospital readmissions after abdominal and pelvic surgery: a
retrospective cohort study. Lancet 1999. 353:1476-80. [15] MacLean AR,
Cohen Z, MacRae HM, O'Connor BI, Mukraj D, Kennedy ED, Parkes R, McLeod RS.
Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann
Surg 2002; 235:200-6. [16] EBM Reviews -
Cochrane Database of Systematic Reviews. Watson A, Vandekerckhove P, Lilford,
R. Liquid and fluid agents for preventing adhesions after surgery for
subfertility. [Systematic Review] Cochrane Menstrual Disorders and
Subfertility Group Cochrane Database of Systematic Reviews. Updated March,
2003. [17] McQueen MM,
Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br 2000; 82:200-3. [18] Warner ME,
LaMaster LM, Thoeming AK, Marienau ME, Warner MA. Compartment syndrome in
surgical patients. Anesthesiology 2001; 94 :705-8. [19] Giovannacci
L, Renggli JC, Eugster T, Stierli P, Hess P, Gurke L. Reduction of groin
lymphatic complications by application of fibrin glue: preliminary results of
a randomized study. Ann Vasc Surg 2001;
15:182-5. [20] Sayeed-Shah
U, Strachan J, Elefteriades JA. Diaphragm flap for routine prophylactic
reinforcement of bronchial stump after pneumonectomy. Ann Thorac Surg
2001;71:2081-3. [21] Alexiou C,
Beggs D, [22] Ikiz AO, Uca
M, Guneri EA, Erdag TK, Sutay S. Pharyngocutaneous fistula and total
laryngectomy: possible predisposing factors, with emphasis on pharyngeal
myotomy. J Laryngol Otol 2000; 114:768-71. [23] Tancer ML.
Observations on prevention and management of vesicovaginal fistula after
total hysterectomy. Surg Gynecol Obstet 1992; 175:501-6. [24] Gerber GS, Schoenberg HW. Female urinary tract fistulas. J Urol 1993;
149:229-36. [25] Shuhaiber JH.
Evans AN. Massad MG. [26] Gottlob R.
The preservation of the venous endothelium by "dissection without
touching" and by an atraumatic technique of vascular anastomosis. The
importance for arterial and venous surgery. Minerva Chir 1977; 32:693-700. [27] Adcock OT Jr,
Adcock GL, Wheeler JR, Gregory RT, Snyder SO Jr, Gayle RG. Optimal techniques
for harvesting and preparation of reversed autogenous vein grafts for use as
arterial substitutes: a review. Surgery 1984; 96:886-94. [28] Tsui JC,
Souza DS, Filbey D, Bomfim V, Dashwood MR. Preserved endothelial integrity
and nitric oxide synthase in saphenous vein grafts harvested by a 'no-touch'
technique. Br J Surg 2001; 88:1209-15. [29] Surya BV,
Provet J, Johanson KE, Brown J. Anastomotic strictures following radical
prostatectomy: risk factors and management. J Urol 1990; 143:755-8. [30] Catalona WJ, Carvalhal GF, Mager DE, Smith
DS. Potency, continence and complication
rates in 1,870 consecutive radical retropubic prostatectomies. J Urol 1999;
162:433-8. [31] Borboroglu PG, Sands JP, Roberts JL, Amling CL. Risk factors for
vesicourethral anastomotic stricture after radical prostatectomy. Urology
2000; 56:96-100. |
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Causes of reoperations |
The gold standard against which the screening algorithm has been
tested, have been set by the review of routinely collected data and medical
records of 809 operation/reoperation pair in a random sample of 7370
interventions in a Swiss university hospital. One hundred and sixty nine
reoperations were unrelated to the initial surgical site; 331 reoperations
related to the initial surgical site were planned; 309 were unplanned at the
time of the index intervention and related to the initial surgical site. The causes of
those unplanned reoperations related to an index surgical site are as follows: |
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1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14 15 16. 17. 18. |
Complications of
index interventions Surgical wound infection Post operative hemorrhage or haematoma Organ injury, foreign object accidentally left in
body cavity Mechanical complication (migration, breakdown, wrong
position, dislocation, blockage) of implanted material (including drains) Anastomotic leak Fascial disruption, in absence of an overt infection
or hematoma Fistula, in absence of an overt organ injury Thrombosis, occlusion or stenosis of a vascular
surgical site Stenosis of a non vascular surgical site Post operative adhesive bowel occlusion Compartment syndrome Surgical failure Incomplete treatment Calculated risk of choosing a less invasive treatment option Relapse or worsening of underlying disease Implantation of a permanent device following a temporary device,
unscheduled at the time of the index intervention No ascertained cause Not categorized in the above causes No pathologic condition on reopening for clinical worsening Other causes |
Number 18 43 12 27 8 12 17 26 4 1 3 24 38 16 8 46 2 4 |
Avoidable yes yes yes yes yes yes unknown unknown
no no yes no no no unknown no no |
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Potentially avoidable reoperations comprise those judged avoidable and
of unknown preventability |
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Screening for potentially
avoidable reoperations Figure 1
shows the algorithm that is proposed to screen potentially avoidable
reoperations. Each bifurcation in the graph is called a step; steps are
numbered 1 through 8. Clinical judgment was used to allocate each ICD9-CM
procedure code and ICD 10 diagnosis code of surgery related complications to
30 organ groups (Appendix A, step 1). Some procedures were assigned to two
organ groups: for instance a repair of a fistula involving a urinary and a
digestive organ, an amputation of a limb segment which was also allocated to
the distal adjoining limb part. Reoperations were classified as potentially
avoidable if the same organ group was involved in both the index operation
and a complication related to surgery (steps 2 and 3) or an unplanned
reoperation (step 4). Some reoperations on an other organ group were also
classified as potentially avoidable if organ resection after a vascular
procedure (step 5), reopening of laparotomy or thoracotomy (step 6), control
of hemorrhage (step 7), revision of a surgical wound (step 8). The
sensitivity and the specificity of the method applied on the 406
operation/reoperation pairs of the test sample reach respectively 75% and
72%.
Internal Reope-
no no Revision
Diagnosis no no
no yes Skin no Details of algorithmic steps Step 1. List of operated organs All spinal canal structures. Bone or joint of unspecified site. Brain,
pituitary gland and skull. Chest wall, mediastinum and thymus*. Cranial and
peripheral nerves. Ear. Eyeball and orbit. Facial bones and nose. Finger.
Forearm and elbow. Hand and wrist. Heart, valves and coronary vessels*. Hip
and femur. Kidney, adrenal glands and urinary tract**. Knee. Larynx and
trachea. Leg, foot, toes, lower limb not otherwise specified. Liver, biliary
tract and pancreas**. Lung and pleura*. Nasal sinus. Oesophagus, stomach,
intestine, rectum, anus and peritoneum**. Oral cavity, pharynx, tonsils.
Ovary, uterus , vagina and vulva**. Penis. Schoulder and arm and upper limb
not otherwise classified. Skin, subcutaneous tissue, muscle and breast.
Spleen and lymphatic structures. Testes, scrotum, and spermatic structures.
Thyroid and parathyroid. Vessels. *organs considered as thoracic site. ** organ considered as abdominal
or pelvic site (see step 3). Step 2. Reoperation
procedures identifying a surgery related complication Reoperation procedures ICD-9-CM codes (reopening of a surgical site) : 0070, 0071, 0072, 0073, 0080, 0081, 0082, 0083, 0084, 0123, 0242,
0302, 0397, 0475, 0602, 1152, 1266, 1283, 156, 1662, 1663, 1664, 1666, 1921,
1929, 196, 2062, 2092, 2184, 2763, 3161, 3174, 3403, 3595, 3775, 3779, 3942,
3949, 445, 4640, 4641, 4643, 4693, 4694, 4975, 5194, 5412, 5461, 5492, 5652,
5662, 5672, 5722, 8153, 8155, 8159, 8197, 843, 8466, 8468, 8469, 8481, 8483,
8485, 8593, 8675. Reoperation procedures ICD-9-CM codes (surgery for post-surgical
hemorrhage or hematoma) : 287, 3941, 3998, 4443, 4449, 4995, 5793, 6094. Reoperation procedures ICD-9-CM codes (reoperation for surgery related
injury) : 2951, 3161, 3171, 3341, 3343, 3471, 3482, 4282, 4461, 4671, 4673,
4675, 4871, 4971, 5061, 5191, 5581, 5682, 5781, 5841, 6141, 6261, 6351, 6381,
6761, 6941. Reoperation procedures ICD-9-CM codes (closure of a fistula) : 1282, 2182, 2271, 2642, 2753, 2952, 2953, 3162, 3173, 3342, 3473,
3483, 4063, 4284, 4463, 4672, 4674, 4676, 4792, 4873, 4893, 4911, 4912, 4973,
5193, 5583, 5684, 5783, 5784, 5843, 6142, 6762, 6942, 7072, 7073, 7074, 7075,
7172. Reoperation procedures ICD-9-CM codes (amputation of lower limb) : 8400, 8401, 8402, 8403, 8404, 8405, 8406, 8407, 8408, 8409, 8410,
8411, 8412, 8413, 8414, 8415, 8416, 8417, 8418, 8419. Step3. ICD 10
diagnosis codes identifying a surgery related complications Complications related to surgical care E890, E891, E892, E893, E894, E895, E896, E898#, E899#, G970, G971,
G972, G978, G979, H590, H598, H599, H950, H951, H958, H959, I970, I971, I972,
I978, I979, J950, J951, J952, J953, J954, J955, J958, J959, K430, K431, K439,
K660, K910, K911, K912, K913, K914, K915, K918, K919, M020, M801, M803, M811,
M813, M840, M841, M960, M961, M963, M964, M966, M968, M969, N990, N991, N992,
N993, N994, N995, N998#, N999#, O357, T810#, T811#, T812#, T813#, T814#,
T815#, T816#, T817#, T818#, T819#, T820, T821, T822, T823, T824, T825, T826,
T827, T828, T829, T830, T831, T832, T833, T834, T835, T836#, T838#, T839#,
T840, T841, T842, T843, T844, T845, T846, T847, T848, T849, T850, T851, T852,
T853, T854, T855, T856#, T857#, T858#, T859#, T861, T862, T863#, T864, T865#,
T868#, T869#, T870, T871, T872#, T873, T874, T875, T876, T888#, T889#. Complication related to an abortion or a delivery O040, O041, O042, O043, O044, O045, O046, O047, O048, O050, O051,
O052, O053, O054, O055, O056, O057, O058, O070, O071, O072, O073, O074, O075,
O076, O077, O078, O079, O080, O081, O082, O083, O084, O085, O086, O087, O088,
O089, O700, O701, O702, O703, O709, O713, O714, O715, O716, O717, O718, O719,
O720, O721, O722, O751, O754, O85, O860, O861, O862, O863, O864, O868, O870,
O871, O873, O879, O880, O881, O882, O883, O888, O900, O901, O902, O95, O96,
O97, Some infections of a surgical site classified elsewhere J850, J851, J852, J853, J860, J869, M000, M001, M002, M008, M009, M462,
M463, M862, M863, M864, M866, M868, M869. Complications are retained if they affect a reoperated organ group or
if the damaged organ cannot be specified (codes indicated with #). Step 4. Planned reoperations Reoperation procedure ICD-9-CM codes (removal of a temporary device) 0122, 0207, 0243, 0295, 0394, 0398, 0493, 1192, 146, 1671, 1672, 3764,
3777, 3785, 3786, 3787, 3788, 3789, 3797, 3798, 3799, 3943, 4494, 5195, 5598,
5694, 5798, 6496, 6694, 7697, 7860, 7861, 7862, 7863, 7864, 7865, 7866, 7867,
7868, 7869, 8000, 8001, 8002, 8003, 8004, 8005, 8006, 8007, 8008, 8009, 8393,
8594, 8596, 9788. Reoperation procedure ICD-9-CM codes (temporary stomy closure) 3172, 3472, 4283, 4462, 4650, 4651, 4652, 4872, 5192, 5582, 5683,
5782, 5842. Reoperation procedure ICD-9-CM codes (anastomosis of two hollow organs
after a temporary stomy) 4251, 4252, 4254, 4255, 4256, 4258, 4259, 4261, 4262, 4263, 4264, 4265,
4266, 4268, 4269, 437, 4439, 4590, 4591, 4592, 4593, 4594, 4595, 4874, 5131,
5132, 5133, 5134, 5135, 5136, 5137, 5139, 5296, 5586, 5673, 5674, 5675, 5679,
5788, 5844, 6383, 6672, 6673, 6674, with one of the following index procedure
ICD-9CM codes : 022, 0981, 0982, 0983, 311, 3121, 3129, 3163, 3174, 4210,
4211, 4219, 4311, 4319, 4610, 4611, 4613, 4614, 4620, 4621, 4622, 4623, 4624,
4631, 4632, 4639, 4640, 4641, 4791, 481, 5103, 5502, 5503, 5504, 5512, 5651,
5652, 5661, 5662, 5717, 5718, 5721, 5722, 6602. Reoperation procedure ICD-9-CM codes
(tubal crushing, division or destruction) 6621, 6622, 6629, 6631, 6632, 6639. Reoperation procedure ICD-9-CM codes (Cholecystectomy or anastomosis
of biliary duct after relief of a biliary obstruction by endoscopy) : 5121, 5122, 5123, 5124, 5131, 5132, 5133, 5134, 5135, 5136, 5137,
5139, 5194, with one of the following index procedure ICD-9-CM codes: 5141,
5164, 5181, 5184, 5185, 5187, 5188, 5196, 5198, 5294. Reoperation procedure ICD-9-CM codes (Implantation of prothesis or
other devices) : 0045, 0046, 0047, 0048, 0050, 0051, 0053, 0054, 0055, 0056, 0057,
0063, 0064, 0065, 0066, 0067, 0205, 0293, 0294, 0296, 0393, 0492, 1173, 1370,
1371, 1372, 1391, 1441, 1631, 1661, 1662, 2095, 2096, 2097, 2098, 232, 233,
234, 235, 236, 2764, 3485, 3606, 3607, 3761, 3762, 3765, 3766, 3767, 3770,
3771, 3772, 3773, 3774, 3775, 3779, 3780, 3781, 3782, 3783, 3785, 3786, 3787,
3788, 3790, 3794, 3795, 3796, 3797, 3798, 3993, 4493, 1975, 4992, 5187, 5293,
5341, 5361, 5361, 5369, 5597, 5692, 5796, 5893, 627, 6395, 6494. 6495, 6497,
6693, 697, 7053, 7054, 7055, 7063, 7064, 7078, 7095, 7692, 7890, 7891, 7892,
7893, 7894, 7895, 7896, 7897, 7898, 7899, 7999, 8159, 8197, 8392, 8440, 8441,
8442, 8443, 8444, 8445, 8446, 8447, 8448, 8449, 8451, 8452, 8453, 8454, 8455,
8456, 8457, 8458. 8459, 8460, 8461, 8462, 8463, 8464, 8465, 8466, 8467, 8468,
8469, 8480, 8481, 8482, 8483, 8484, 8485, 8533, 8535, 8553, 8554, 8593, 8595,
8606, 8607, 8608, 8693, 8694, 8695, 8696, 8697, 8698. Reoperation procedure ICD-9-CM codes (Any neurosurgical intervention
after a ventricular or subarachnoid shunt) : 0122, 0131, 0132, 0139, 0141, 0142, 0151, 0152, 0153, 0159, 0211,
0212, 0214, 022, 0231, 0232, 0233, 0234, 0235, 0239, 0241, 0242, 0243, 0291,
0292, 0293, 0296, 0299, 0301, 031, 0321, 0329, 034, 0351, 0352, 0359, 036,
0371, 0372, 0379, 0393, 0394, 0396, 0397, 0398, 0399, 0752, 0753, 0754, 0759
with one of following index procedure ICD-9-CM codes : 0231, 0232, 0233,
0234, 0235, 0239, 0241, 0242, 0371, 0372, 0379, 0397. Reoperation and index procedure ICD-9-CM codes (two successive
catheter based repairs of vessels): 0045, 0046, 0047, 0048, 0055, 0056, 0063, 0064, 0065, 0066, 3606, 3607,
3609, 3966, 3990, 3993 without any of following exclusion secondary diagnoses
ICD-10 codes: I21.x, I22.x. Reoperation and index procedure ICD-9-CM codes (two endoscopic
procedures on digestive or urinary system) : 4201, 4232, 4233, 4281, 4283, 4291, 4292, 4311, 4341, 4422, 4432,
4438, 4443, 4462, 4493, 4494, 4495, 4496, 4497, 4498, 4530, 4542, 4543, 4643,
4685, 4695, 4696, 4831, 4832, 4833, 4834, 4835, 4836, 4841, 4874, 4911, 4931,
5221, 5293, 5294, 5298, 5502, 5503, 5504, 5512, 5534, 5582, 5594, 5597, 5598,
560, 5683, 5691, 5692, 5694, 5717, 5718, 5741, 5749, 5751, 5782, 5791, 5792,
5793, 5796, 5797, 5798, 580, 581, 5831, 5842, 585, 586, 5891, 5893, 6021,
6029, 6094, 6095, 6096, 6097. Reoperation procedure ICD-9-CM codes (graft, transplantation or
reconstructive surgery) : 0061, 0062, 0202, 0203, 0204, 0206, 0212,
0292, 0351, 0352, 0353, 0359, 045, 046, 0476, 0475, 0476, 0479, 0581, 0744,
0793, 0794, 0831, 0832, 0833, 0834, 0835, 0836, 0837, 0838, 0842, 0843, 0844,
0849, 0859, 0861, 0862, 0863, 0864, 0869, 0870, 0871, 0872, 0873, 0874, 0882,
0883, 0884, 0885, 0889, 0971, 0972, 0973, 1041, 1042, 1043, 1044, 1049, 106,
1131, 1132, 1152, 1153, 1159, 1160, 1161, 1162, 1163, 1164, 1169, 1171, 1172,
1174, 1176, 1179, 1235, 1239, 1274, 1285, 1286, 1287, 1288, 1435, 1439, 1449,
1451, 1459, 1511, 1512, 1519, 155, 157, 1663, 1665, 1681, 1682, 1689, 185,
186, 1871, 1879, 194, 1952, 1953, 1954, 1955, 196, 1999, 199, 2093, 2172,
2183, 2185, 2186, 2187, 2188, 2189, 2279, 242, 245, 2559, 2649, 2754, 2755,
2756, 2757, 2759, 2762, 2763, 2769, 2773, 294, 2959, 3164, 3169, 3175, 3179,
3221, 3334, 3348, 3349, 3350, 3351, 3352, 336, 3474, 3479, 3484, 3493, 3510,
3511, 3512, 3513, 3514, 3533, 3550, 3551, 3552, 3553, 3554, 3555, 3560, 3561,
3562, 3563, 3570, 3571, 3572, 3573, 3581, 3582, 3583, 3584, 3591, 3595, 3596,
3603, 3609, 3610, 3611, 3612, 3613, 3614, 3615, 3616, 3617, 3751, 3922, 3924,
3925, 3928, 3929, 3950, 3951, 3952, 3956, 3957, 3958, 3959, 3966, 3971, 3979,
3990, 4100, 4101, 4102, 4103, 4104, 4105, 4106, 4107, 4108, 4109, 4194, 4195,
4253, 4284, 4285, 4287, 4289, 4381, 4429, 4431, 4465, 4466, 4467, 4468, 4469,
4495, 4495, 4496, 4498, 4642, 4679, 4697, 4879, 4972, 4974, 4979, 5051, 5059,
5069, 5172, 5179, 5183, 5280, 8281, 5282, 5283, 5284, 5285, 5286, 5295, 5300,
5301, 5302, 5303, 5304, 5305, 5310, 5311, 5312, 5313, 5314, 5315, 5316, 5317,
5321, 5329, 5331, 5339, 537, 5380, 5381, 5382, 539, 5473, 5474, 5475, 5561,
5569, 5587, 5589, 5689, 5783, 5784, 5785, 5786, 5787, 5789, 5845, 5846, 5847,
5849, 593, 5979, 6093, 6149, 6269, 6359, 6382, 6389, 6443, 6444, 6449, 645,
6573, 6576, 6579, 6679, 6759, 6762, 6769, 6921, 6923, 6929, 6949, 7050, 7051,
7052, 7061, 7062, 7074, 7079, 7094, 7179, 7536, 7550, 7551, 7552, 7561, 7562,
7569, 7593, 7641, 7643, 7644, 7646, 765, 7661, 7662, 7663, 7665, 7666, 7667,
7668, 7669, 7670, 7672, 7674, 7676, 7677, 7679, 7691, 7694, 7751, 7752, 7753,
7754, 7756, 7757, 7758, 7800, 7801, 7802, 7803, 7804, 7805, 7806, 7807, 7808,
7809, 7820, 7822, 7823, 7824, 7825, 7827, 7828, 7829, 7830, 7831, 7832, 7833,
7834, 7835, 7837, 7838, 7839, 7840, 7841, 7842, 7843, 7844, 7845, 7846, 7847,
7848, 7849, 7850, 7851, 7852, 7853, 7854, 7855, 7856, 7857, 7858, 7859, 7870,
7871, 7872, 7873, 7874, 7875, 7876, 7877, 7878, 7879, 7910, 7911, 7912, 7913,
7914, 7915, 7916, 7917, 7918, 7919, 7930, 7931, 7932, 7933, 7934, 7935, 7936,
7937, 7938, 7939, 7950, 7951, 7952, 7955, 7956, 7959, 7960, 7961, 7962, 7963,
7964, 7965, 7966, 7967, 7968, 7969, 7980, 7981, 7982, 7983, 7984, 7985, 7986,
7987, 7988, 7989, 8140, 8142, 8143, 8145, 8146, 8147, 8149, 8165, 8166, 8171,
8172, 8174, 8175, 8179, 8182, 8183, 8185, 8196, 8232, 8234, 8251, 8252, 8256,
8257, 8258, 8259, 8261, 8269, 8271, 8272, 8279, 8282, 8283, 8284, 8286, 8289,
8363, 8371, 8375, 8376, 8377, 8379, 8381, 8382, 8383, 8385, 8386, 8387, 8388,
8389, 8492, 8493, 8531, 8532, 8550, 857, 8582, 8583, 8584, 8585, 8586, 8587,
8589, 8660, 8661, 8662, 8663, 8664, 8665, 8666, 8667, 8669, 8670, 8671, 8672,
8673, 8674, 8675, 8681, 8683, 8685, 8686, 8689. These procedures codes are not considered as
planned if they were preceded by an index procedure included in the above
list, except if ICD-10 diagnoses codes were : T20 to T32.9 or Z42.x. Reoperation procedure ICD-9-CM codes (Excision, incision , resection
or suture of skin or muscular tissue after excision, incision or resection of
skin or muscular tissue) : 540, 8302, 8303, 8311, 8312, 8313, 8314, 8331, 8332, 8341, 8342, 8343,
8344, 8345, 8349, 8384, 8520, 8522, 8523, 8524, 8534, 8536, 8541, 8542, 8543,
8544, 8545, 8546, 8547, 8548. Step 5. Internal
organ resection or limb amputation after vascular surgery Reoperation procedures ICD-9-CM codes (internal organ resection or
limb amputation) : 0125, 0152, 0153, 0302, 0405, 0406, 0522, 0523, 0524, 0525, 0529, 062,
0639, 064, 0650, 0651, 0652, 0681, 0689, 0722, 0729, 073, 0753, 0754, 0764,
0765, 0780, 1369, 1471, 1472, 1473, 1474, 1639, 1641, 1642, 1649, 1651, 1659,
1664, 2041, 2042, 2049, 2092, 252, 253, 254, 2630, 2632, 2933, 301, 3029,
303, 304, 321, 3222, 323, 324, 325, 329, 3534, 3731, 3735, 3810, 3811, 3812,
3813, 3814, 3815, 3816, 3818, 3830, 3831, 3832, 3833, 3834, 3835, 3836, 3837,
3838, 3839, 3845, 4040, 4041, 4042, 4050, 4051, 4052, 4053, 4054, 4059, 4143,
415, 4240, 4241, 4242, 435, 436, 4389, 4391, 4399, 4561, 4562, 4563, 4571,
4572, 4573, 4574, 4575, 4576, 4579, 458, 4602, 4604, 4701, 4709, 4711, 4719,
485, 4861, 4862, 4863, 4864, 4865, 4869, 4892, 4912, 5022, 503, 504, 5121,
5122, 5124, 5251, 5252, 5253, 5259, 526, 527, 554, 5551, 5552, 5553, 5554,
5640, 5641, 5642, 576, 5771, 5779, 603, 604, 605, 6062, 6069, 6522, 6524,
6531, 6539, 6541, 6549, 5551, 6552, 6553, 6554, 6561, 6562, 6563, 6564, 664,
6651, 6652, 6662, 6663, 6669, 6831 6839, 684, 6851, 6859, 686, 687, 688, 689,
715, 7161, 7162, 7631, 7639, 7642, 7645, 7780, 7781, 7782, 7783, 7784, 7785,
7787, 7788, 7789, 7790, 7791, 7792, 7793, 7794, 7795, 7797, 7798, 7799, 8070,
8071, 8072, 8073, 8074, 8075, 8076, 8077, 8078, 8079, 835, 8400, 8401, 8402,
8403, 8404, 8405, 8406, 8407, 8408, 8409, 8410, 8411, 8412, 8413, 8414, 8415,
8416, 8417, 8418, 8419. and index operation procedures ICD-9-CM codes (vascular surgery) : 0040, 0041, 0042, 0043, 0044, 0061, 0062, 0213, 0743, 3601, 3603,
3610, 3611, 3612, 3613, 3614, 3615, 3616, 3617, 3619, 362, 3631, 3632, 3639,
3691, 3699, 3800, 3801, 3802, 3803, 3804, 3805, 3806, 3807, 3808, 3809, 3810,
3811, 3812, 3813, 3814, 3815, 3816, 3818, 3823, 3830, 3831, 3832, 3833, 3834,
3835, 3836, 3837, 3838, 3839, 3840, 3841, 3842, 3843, 3844, 3845, 3846, 3847,
3848, 3849, 3851, 3852, 3855, 3857, 3860, 3861, 3862, 3863, 3864, 3865, 3866,
3867, 3868, 387, 3880, 3881, 3882, 3883, 3884, 3885, 3886, 3887, 3888, 3889,
3894, 390, 391, 3921, 3922, 3923, 3924, 3925, 3926, 3927, 3928, 3929, 3930,
3931, 3932, 3941, 3942, 3943, 3949, 3950, 3951, 3952, 3953, 3954, 3955, 3956,
3957, 3958, 3959, 398, 3991, 3998, 3999. Step 6. Laparo- and
thoracotomy or reclosure of disruption of abdominal wall Reoperation procedures ICD-9-CM codes: 3401, 3402, 3403, 3409, 341, 3473, 5411, 5412, 5419, 540, 5461, 5462,
5463, 5471, 5472, 5495 and one index procedure belonging to a thoracic,
abdominal or pelvic organ (see step 1). Step 7. Control of
hemorrhage Reoperation procedures ICD-9-CM code: 3998 Step 8. Skin
debridement after open surgery for wound complications Reoperation procedures ICD-9-CM code: 8302, 8303, 8309, 8311, 8312, 8313, 8314, 8331, 8332, 8339, 8341,
8342, 8343, 8344, 8345, 8349, 8384, 8603, 8604, 8605, 8609, 8621, 8622, 8623,
8625, 8627, 8628, 863, 864, 8682, 8691. and ICD-10 diagnoses codes : T815, T854, T874, T875, T876. |
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Last update: August 9, 2011