Technical Note: Hysterectomy Readmission

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Technical Note
Hysterectomy Readmission

Unit of Analysis:

The unit of analysis is an "Episode of care". An episode of care refers to all contiguous in-patient hospitalizations and same-day surgery visits. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. To construct an episode of care a transfer is assumed to have occurred if either of the following conditions is met:

  • Acute care hospitalization or same day surgery visit occurs within 6 hours of discharge from previous acute care hospitalization or same day surgery visit regardless of whether the transfer is coded;
  • Acute care hospitalization or same day surgery visit occurs within 6-12 hours of discharge from previous acute care hospitalization or same day surgery visit and at least one of the hospitalization or visit has coded the transfer.

Denominator (Index Episode)

Inclusion Criteria:

  1. Hysterectomy1 CCP codes of 80.3^, 80.4^, 80.5^, or 80.6^ or ICD-9-CM codes of 68.4^-68.7^, 68.9^ or CCI codes of 1.RM.89^^, 1.RM.91^^, or 1.RM.87.BA-GX, 1.RM.87.CA-GX, 1.RM.87.DA-GX, 1.RM.87.LA-GX with extent attribute coded as “SU”
  2. Discharge between April 1 and March 3 of the following year (period of case selection ends March 3 to allow for 28 days of follow-up)
  3. Age at admission between 15 and 84 years
  4. Gender recorded as female
  5. Admission to an acute care institution or same day surgery facility
  6. Canadian resident

Exclusion Criteria:

  1. Records with an invalid Health Card Number
  2. Records with an invalid date of birth
  3. Records with an invalid admission date or time
  4. Records with an invalid discharge date or time
  5. CCP codes of 80.3^, 80.4^, 80.5^, or 80.6^ in conjunction with 80.7^ (equivalent of CMG 575 for pelvic exenteration); or ICD-9-CM codes of 68.4^ - 68.7^, 68.9^ in conjunction with 68.8^; or CCI codes of 1.RM.89^^, 1.RM.91^^, or 1.RM.87.BA-GX, 1.RM.87.CA-GX, 1.RM.87.DA-GX, 1.RM.87.LA-GX with extent attribute coded as “SU” in conjunction 1.PM.91.LA^^; or Patient Service code of 51, 53 or 59 (equivalent of CMG 600 for major procedure in pregnancy or childbirth).
  6. Discharged as a death or self sign-out
  7. Any one of the following diagnoses recorded in any position:
    1. Cancer (ICD-9/ICD-9-CM: 140-208, V58.1, V58.0 or ICD-10-CA: C00-C26, C30-C44, C45-C97, Z51.0, Z51.1)
    2. HIV (ICD-9: 042, 043, 044, 795.8 or ICD-9-CM: 042, 043, 044, 795.71, V08 or ICD-10-CA: B24, Z21, R75)
    3. Trauma (ICD-9/ICD-9-CM: E800-848, E880-886, E888, E890-899, E900-910, E913-926, E928, E950-958, E960-968, E970-976, E990-998 or ICD-10-CA: V01-V99, W00-W23, X00-X09, W92-W94, X17, X30, X31, X51, X53, X54, X57, X20-X29, W50-W60, X33-X38, W30, W31, W44, W45, W64-W77, W81-W84, W25-W27, W33-W40, W85-W99, X10-X19, X60-X84, X85-Y09, Y35.0-Y35.4, Y35.6, Y35.7, Y36)

Numerator

Inclusion Criteria:

  1. Readmission within 7 or 28 days of discharge (condition-specific) after the index episode of care
  2. Emergent or urgent (non-elective) readmission to an acute care hospital
  3. Readmission for any one of the following most responsible diagnoses within the time period specified:
    1. Acute post-hemorrhagic anemia (ICD-9/ICD-9-CM: 285.1 or ICD-10-CA: D62) - 28 days
    2. Paralytic ileus (ICD-9/ICD-9-CM: 560.1 or ICD-10-CA: K56.0, K56.7) - 28 days
    3. Cardiac complications during or resulting from a procedure (ICD-9/ICD-9-CM: 997.1 or ICD-10-CA: I97.8, I97.9) - 28 days
    4. Respiratory complications resulting from a procedure (ICD-9: 997.3 or ICD-9-CM: 997.3, 512.1 or ICD-10-CA: J95.4, J95.8, J95.9) - 28 days
    5. Postoperative infection (ICD-9/ICD-9-CM: 998.5 or ICD-10-CA: T81.4) - 28 days
    6. Urinary tract infection, site not specified (ICD-9/ICD-9-CM: 599.0 or ICD-10-CA: N39.0) - 7 days
    7. Retention of urine (ICD-9/ICD-9-CM: 788.2 or ICD-10-CA: R33, R39.12) - 7 days

1Code may be recorded in any position. Procedures coded as cancelled, previous and “abandoned after onset” are excluded.