286 - Claims Data Analysis on the Incidence and Coding Practice of Reoperati...

#286 Claims Data Analysis on the Incidence and Coding Practice of Reoperations in Instrumental Spine Surgeries in Germany

Regulatory Issues: Coding, Reimbursement, Coverage

Poster Presented by: C. Jacob


C. Jacob (1)
E. Annoni (2)
A. Witthohn (2)
S. Braun (1)

(1) Herescon GmbH - Health Economic Research & Consulting, Hannover, Germany
(2) Medtronic International Trading Sàrl, Tolochenaz, Switzerland


Background: Occurring complications in instrumental spine surgeries (ISS) pose a considerable burden on patients. Resilient data on the natural frequency of complications is lacking for Germany. The aim of this study is to estimate the incidence of ISS and consecutive revision surgeries and to analyze the current coding practice in the German Statutory Health Insurance setting.

Method: We conducted a retrospective claims data analysis using the Health Risk Institute research database, which contains anonymized claims data of approx. 4.4 million individuals. The sample is representative for the German population in terms of age and gender. Patients have coverage for all health care services in Germany. Therefore, claims data provides an almost complete picture of the utilized services on a patient individual basis. The study period was from 01 January 2009 to 31 December 2011.

We used operation codes (OPS, German adaptation of the International Classification of Procedures in Medicine, WHO) to identify ISS and revision surgeries. ISS were defined as one of the following OPS codes: 5-834.* “Open reduction with internal fixation of the spine (osteosynthesis)”, 5-835.0-9 “Osteosynthesis and bone substitutes at the spine”, 5-836.3* “Spondylodesis (dorsal)”, or 5-836.4* “Spondylodesis (dorsal and ventral combined, inter-corporal)”.

Patients were defined as incident patients if they had an ISS in 2010 and no previous ISS in the 12 months before their primary ISS in 2010. Revision/re-surgeries were identified by OPS 5-839.5 “Revision of a spinal surgery” and 5-983 “Re-surgery”. Additionally, potential revisions were approximated by a sequence of access codes. Individuals were required to have the same OPS codes 5-031.0* “patient access thoracic” or 5-032.0* “patient access lumbar” at their initial surgery and at the second surgery. Revision rates were calculated for an individual period of 12 months after the primary ISS in 2010.

Furthermore, the use of 3D-imaging and navigation systems was investigated by checking for OPS 3-996 “Use of a 3D-Image converter” and OPS 5-988 “Use of a navigation system”.

Results: A total of 3,356 individuals had a primary ISS in 2010 and were included in the study. The revision rate is 6.26% (95% CI = 5.44% to 7.16%) for revision/re-surgery codes, a total of 210 cases. 113 patients were assumed to have a potential revision. Considering these additional patients the revision rate would result in 9.62% (95% CI = 8.60% to 10.73%).

On average, patients had their revision/re-surgery 79.2 days after the primary surgery. 42.38% of all revisions/re-surgeries took place within the initial hospital stay.

A navigation system was used at the initial surgery in 4 cases for patients undergoing revision/re-surgery. No 3D-Image converter use was reported for this group. The group of patients with potential revisions had records of 4 cases where a navigation system was used at the initial surgery. In one case, a 3D-Image converter was used at the initial surgery in this group.

Based on the German population in 2010, the estimated number of ISS cases for Germany is 61,909.

Conclusion: The present study provides reliable information on the incidence of ISS and related revision rates for Germany. Navigation systems and 3D-Image techniques are rarely documented. Further research is warranted to assess possible causes.