Abstract
Background
Since it's establishment in 2007, the National Hip Fracture Database [NHFD] has been the key driving force in improving care for hip fracture patients across the UK. It has facilitated the setting of standards to which all musculoskeletal units are held, and guides service development to optimise outcomes in this group of patients. As with any audit, the ability to draw conclusions and make recommendations for changes in practise relies on the accuracy of data collection. This project aimed to scrutinise the data submitted to the NHFD from a Major Trauma Centre [MTC], focusing on procedure coding, and discuss the implications of any inaccuracies.
Method
The authors performed a retrospective analysis of all procedure coding data entered into the NHFD from July 2009 to July 2014 at Cambridge University Hospitals NHS Foundation Trust. We examined 1978 cases for discrepancies, comparing procedure codes entered into the NHFD with post-procedure imaging and operative notes.
Results
The procedure coding data submitted to the NHFD was highly inaccurate, with incorrect procedure codes in 24% of the 1978 cases reviewed. In particular, coding of cemented total arthroplasty and cemented bipolar hemiarthroplasty, with coding errors in registry data of 42% and 39% respectively. Of the 67 THRs performed only 52% were correctly coded for, and only 626 of the 915 hemiarthroplasties (68%). 16% of cannulated hip screws actually underwent primary arthroplasty.
Conclusions
This study highlights the inaccuracy of coding data entered into the NHFD from a Major Trauma Centre, with data on arthroplasty being particularly inadequate. The unreliability of procedure data leaves us unable to evaluate surgical treatment strategies using the NHFD. This has worrying implications for standard setting, service development and, consequently, patient care.
Level of evidence
2c
