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Suitability of administrative claims databases for bariatric surgery research - is the glass half-full or half-empty?

Publication ,  Journal Article
Li, X; Lewis, KH; Callaway, K; Wharam, JF; Toh, S
Published in: BMC Med Res Methodol
September 7, 2020

BACKGROUND: Claims databases are generally considered inadequate for obesity research due to suboptimal capture of body mass index (BMI) measurements. This might not be true for bariatric surgery because of reimbursement requirements and changes in coding systems. We assessed the availability and validity of claims-based weight-related diagnosis codes among bariatric surgery patients. METHODS: We identified three nested retrospective cohorts of adult bariatric surgery patients who underwent adjusted gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy between January 1, 2011 and June 30, 2018 using different components of OptumLabs® Data Warehouse, which contains linked de-identified claims and electronic health records (EHRs). We measured the availability of claims-based weight-related diagnosis codes in the 6-month preoperative and 1-year postoperative periods in the main cohort identified in the claims data. We created two claims-based algorithms to classify the presence of severe obesity (a commonly used cohort selection criterion) and categorize BMI (a commonly used baseline confounder or postoperative outcome). We evaluated their performance by estimating sensitivity, specificity, positive predictive value, negative predictive value, and weighted kappa in two sub-cohorts using EHR-based BMI measurements as the reference. RESULTS: Among the 29,357 eligible patients identified using claims only, 28,828 (98.2%) had preoperative weight-related diagnosis codes, either granular indicating BMI ranges or nonspecific denoting obesity status. Among the 27,407 patients with granular preoperative codes, 12,346 (45.0%) had granular codes and 9355 (34.1%) had nonspecific codes in the 1-year postoperative period. Among the 3045 patients with both preoperative claims-based diagnosis codes and EHR-based BMI measurements, the severe obesity classification algorithm had a sensitivity 100%, specificity 71%, positive predictive value 100%, and negative predictive value 78%. The BMI categorization algorithm had good validity categorizing the last available preoperative or postoperative BMI measurements (weighted kappa [95% confidence interval]: preoperative 0.78, [0.76, 0.79]; postoperative 0.84, [0.80, 0.87]). CONCLUSIONS: Claims-based weight-related diagnosis codes had excellent validity before and after bariatric surgical operation but suboptimal availability after operation. Claims databases can be used for bariatric surgery studies of non-weight-related effectiveness and safety outcomes that are well-captured.

Duke Scholars

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Published In

BMC Med Res Methodol

DOI

EISSN

1471-2288

Publication Date

September 7, 2020

Volume

20

Issue

1

Start / End Page

225

Location

England

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Obesity, Morbid
  • Humans
  • General & Internal Medicine
  • Gastric Bypass
  • Gastrectomy
  • Body Mass Index
  • Bariatric Surgery
  • Adult
 

Citation

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Chicago
ICMJE
MLA
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Li, X., Lewis, K. H., Callaway, K., Wharam, J. F., & Toh, S. (2020). Suitability of administrative claims databases for bariatric surgery research - is the glass half-full or half-empty? BMC Med Res Methodol, 20(1), 225. https://doi.org/10.1186/s12874-020-01106-8
Li, Xiaojuan, Kristina H. Lewis, Katherine Callaway, J Frank Wharam, and Sengwee Toh. “Suitability of administrative claims databases for bariatric surgery research - is the glass half-full or half-empty?BMC Med Res Methodol 20, no. 1 (September 7, 2020): 225. https://doi.org/10.1186/s12874-020-01106-8.
Li X, Lewis KH, Callaway K, Wharam JF, Toh S. Suitability of administrative claims databases for bariatric surgery research - is the glass half-full or half-empty? BMC Med Res Methodol. 2020 Sep 7;20(1):225.
Li, Xiaojuan, et al. “Suitability of administrative claims databases for bariatric surgery research - is the glass half-full or half-empty?BMC Med Res Methodol, vol. 20, no. 1, Sept. 2020, p. 225. Pubmed, doi:10.1186/s12874-020-01106-8.
Li X, Lewis KH, Callaway K, Wharam JF, Toh S. Suitability of administrative claims databases for bariatric surgery research - is the glass half-full or half-empty? BMC Med Res Methodol. 2020 Sep 7;20(1):225.
Journal cover image

Published In

BMC Med Res Methodol

DOI

EISSN

1471-2288

Publication Date

September 7, 2020

Volume

20

Issue

1

Start / End Page

225

Location

England

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Obesity, Morbid
  • Humans
  • General & Internal Medicine
  • Gastric Bypass
  • Gastrectomy
  • Body Mass Index
  • Bariatric Surgery
  • Adult