Specifications for identification of serious treatable complications after hip fracture surgery
| Complication* | Definition† |
| Shock/MI | Numerator: secondary diagnosis code for shock/MI‡ Denominator: surgical discharge, for patients aged ≥65 years with ICD-9-CM code for hip fracture surgery; and surgery within 4 days of admission or urgent admission type Exclude cases: principal diagnosis for shock, MI, haemorrhage, or GI haemorrhage; any listed procedure code for lung cancer resection; major diagnostic category 4 (diseases/disorder of respiratory system) or 5 (diseases/disorders of circulatory system); discharge disposition of transfer to acute care; or missing discharge disposition, age, or sex |
| Sepsis | Numerator: secondary diagnosis code for sepsis‡ Denominator: surgical discharge, for patients aged ≥65 years with ICD-9-CM code for hip fracture surgery; and surgery within 4 days of admission or emergency admission type Exclude cases: principal diagnosis for sepsis or infection; any listed diagnosis or procedure code for immunocompromised state; length of stay <4 days; or discharge disposition of transfer to acute care; or missing discharge disposition, age or sex |
| Pneumonia | Numerator: secondary diagnosis code for pneumonia‡ Denominator: surgical discharge, for patients aged≥65 years with ICD-9-CM code for hip fracture surgery; and surgery within 4 days of admission or emergency admission type Exclude cases: principal diagnosis for pneumonia or respiratory complications; any listed diagnosis code for viral pneumonia, influenza or immunocompromised state; any listed procedure code for lung cancer; major diagnostic category 4 (diseases/disorder of respiratory system) or discharge disposition of transfer to acute care; or missing discharge disposition, age or sex |
| DVT/PE | Numerator: secondary diagnosis code for DVT/PE‡ Denominator: surgical discharge, for patients aged ≥65 years with ICD-9-CM code for hip fracture surgery; and surgery within 4 days of admission or emergency admission type Exclude cases: principal diagnosis for DVT/PE; discharge disposition of transfer to acute care; missing discharge disposition, age or sex |
| GI haemorrhage/ acute ulcer | Numerator: secondary diagnosis code for GI haemorrhage/acute ulcer‡ Denominator: surgical discharge, for patients aged ≥65 years with ICD-9-CM code for hip fracture surgery; and surgery within 4 days of admission or emergency admission type Exclude cases: principal diagnosis for GI haemorrhage, acute ulcer, alcoholism, or anaemia; major diagnostic category 6 (diseases/disorder of digestive system) or 7 (diseases/disorders of hepatobiliary system and pancreas); discharge disposition of transfer to acute care; or missing discharge disposition, age, or sex |
* Identified from complications listed in AHRQ QI Research Version 5.0, Patient Safety Indicators 04, Technical Specifications.
† Modified from AHRQ QI Research Version 5.0, Patient Safety Indicators 04, Technical Specifications.
‡ Identified from secondary ICD-9-CM diagnosis codes listed in AHRQ QI Research Version 5.0, Patient Safety Indicators 04, Technical Specifications, Death Rate among Surgical Inpatients with Serious Treatable Complications.
DVT, deep venous thrombosis; GI, gastrointestinal; MI, myocardial infarction; PE, pulmonary embolism.