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Morbid obesity is considered to have a stronger association with complications after total knee arthroplasty (TKA). Although the impact of obesity coding errors has been previously reported, the extent of coding inaccuracies with respect to morbid obesity is unclear. Therefore, the purpose of this study was to assess (1) the utility of coding in identifying morbid obesity and (2) the effects of morbid obesity on 90-day complications after TKA when morbid obesity was defined by both body mass index (BMI) and International Classification of Diseases 9th edition (ICD-9) coding. A total of 18,030 primary TKAs performed at a single institution from 2004 to 2014 were identified. Patients were defined as morbidly obese based on ICD-9 codes or by BMI recorded in the electronic medical record (EMR). Patients were defined as obese (ICD-9 codes 278.0, 278.00, 278.01, 278.03, 649.10-14, 793.91, V85.30-39, V85.41-45, V85.54) or morbidly obese (278.01, V85.41-45) by ICD-9 codes. Patient EMRs were also reviewed to identify obese and morbidly obese patients (BMI cutoffs of 30 and 40 kg/m, respectively). Complications between the cohorts were compared. Sensitivity and specificity were also calculated. Among the 2,880 surgeries performed in morbidly obese patients, a code for obesity was present in 1,618 (56.2%) surgeries, but only 57.9% (937) of these patients had a code specific for morbid obesity, with the rest having a code not specifying morbid obesity. The sensitivity and specificity of obesity coding were 34.5 and 96.0%, while that of morbid obesity were 32.5 and 96.7%, respectively (area under curve: 0.65 vs. 0.65, = 0.214). A higher rate of complications was noted when patients were defined as morbidly obese by ICD-9 as when defined by EMR-reported BMI. Although morbidly obese patients are more likely to have a code for obesity compared with obese patients, these patients may not be correctly identified as morbidly obese due to a lack of specificity in the codes. These errors may lead to inadequate reimbursements, and may also overestimate the effect of morbid obesity on complications.
This article was published in the following journal.
Name: The journal of knee surgery
Although the impact of coding errors, with respect to obesity, has been previously reported, it is unclear whether morbid obesity is prone to similar coding inaccuracies. Therefore, the purpose of thi...
Although morbid obesity has been associated with early surgical complications after total knee arthroplasty (TKA), evidence of long-term outcomes is limited. We conducted a population-based study to d...
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The condition of weighing two, three, or more times the ideal weight, so called because it is associated with many serious and life-threatening disorders. In the BODY MASS INDEX, morbid obesity is defined as having a BMI greater than 40.0 kg/m2.
Surgical procedures aimed at producing major WEIGHT REDUCTION in patients with MORBID OBESITY.
A status with BODY WEIGHT that is grossly above the acceptable or desirable weight, usually due to accumulation of excess FATS in the body. The standards may vary with age, sex, genetic or cultural background. In the BODY MASS INDEX, a BMI greater than 30.0 kg/m2 is considered obese, and a BMI greater than 40.0 kg/m2 is considered morbidly obese (MORBID OBESITY).
Agents that increase energy expenditure and weight loss by neural and chemical regulation. Beta-adrenergic agents and serotoninergic drugs have been experimentally used in patients with non-insulin dependent diabetes mellitus (NIDDM) to treat obesity.
An instrument used to assess the results of rehabilitation from knee injuries, especially those requiring ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION. It measures recovery of knee joint function based on ACTIVITIES OF DAILY LIVING.
Obesity is the condition in which excess fat has accumulated in the body (mostly in subcutaneous tissues). clinical obesity is considered to be present when a person has a BMI of over 30 (Oxford Dictionary of Medicine). It is becoming increasing common i...
A joint is where two or more bones come together, like the knee, hip, elbow, or shoulder. Joints can be damaged by many types of injuries or diseases, including Arthritis - inflammation of a joint causes pain, stiffness, and swelling with ...
Arthroplasty is a surgical procedure to restore the integrity and function of a joint. A joint can be restored by resurfacing the bones. An artificial joint (called a prosthesis) may also be used. Various types of arthritis may affect the joints. Osteo...