Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

2.34 Percent of patients who had a hip joint replacement due to degenerative conditions with adverse events associated with the hip joint replacement, United States, 2002 and 2003.

Data Source

1. CMS, MPSMS, inpatient medical records: for abstracted data related to the index hospital stay.
2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality to distinguish between cases who had hip arthroplasty for a fracture and cases who had total hip replacements for degenerative conditions and to determine 30-day post-procedure readmission.

Denominator

All patients in the MPSMS sample who experienced a surgical procedure performed to replace a damaged hip joint.

Numerator

Subset of the denominator population that experienced at least 1 of the following:

• Postoperative infections
• Postoperative pneumonia
• Postoperative urinary tract infection
• Postoperative venous thromboembolic event meeting either of the following criteria:
• during hospital stay (per abstracted information from medical records), or
• readmission to the hospital post-index hospital stay for a pelvic embolism or deep vein thrombosis within 30 days of the surgical procedure (per Medicare administrative data ICD-9-CM diagnosis codes 415.11, 415.19, 451.1, 451.2, 451.81, 451.83, 451.84, 451.89, 453.1, 453.2, 453.8, 453.9)
• Dislocation
• Wound complications other than infection
• Nerve injury
• Postoperative bleeding requiring 4 or more blood transfusions
• Cardiovascular complications
• Same side revision during the index hospital stay
• Return to operating room for reasons other than same side revision during the index hospital stay
• Periprosthetic fracture (only applies to 2003 data)

Comments

Postoperative infections are determined by documentation of early prosthetic joint and/or wound infection or acute and early deep hip infection, excluding superficial infection. Wound complications other than infection include dehiscence, hematoma, and necrosis.

The definition of major bleeding/hematoma underwent revision between 2002 and 2003.

Postoperative pneumonia, postoperative urinary tract infection, postoperative venous thromboembolic event are all determined in the same fashion as those in other MPSMS measures.

Cardiovascular complications include myocardial infaction, congestive heart failure, and arrhythmia requiring treatment.

In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.