Abstract：
BACKGROUND: The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) uses Current Procedural Terminology (CPT) codes for risk-adjusted calculations. This study evaluates the inter-rater reliability of coding colorectal resections across Canada by ACS-NSQIP surgical clinical nurse reviewers (SCNR) and its impact on risk predictions.
METHODS: SCNRs in Canada were asked to code simulated operative reports. Percent agreement and free-marginal kappa correlation were calculated. The ACS-NSQIP risk calculator was utilized to illustrate its impact on risk prediction.
RESULTS: Responses from 44 of 150 (29.3 %) SCNRs revealed 3 to 6 different codes chosen per case, with agreement ranging from 6.7 % to 62.3 %. Free-marginal kappa correlation ranged from moderate agreement (0.53) to high disagreement (-0.17). ACS-NSQIP risk calculator predicted large absolute differences in risk for serious complications (0.2 %-13.7 %) and mortality (0.2 %-6.3 %).
CONCLUSIONS: This study demonstrated low inter-rater reliability in coding ACS-NSQIP colorectal procedures in Canada among SCNRs, impacting risk predictions.
METHODS: SCNRs in Canada were asked to code simulated operative reports. Percent agreement and free-marginal kappa correlation were calculated. The ACS-NSQIP risk calculator was utilized to illustrate its impact on risk prediction.
RESULTS: Responses from 44 of 150 (29.3 %) SCNRs revealed 3 to 6 different codes chosen per case, with agreement ranging from 6.7 % to 62.3 %. Free-marginal kappa correlation ranged from moderate agreement (0.53) to high disagreement (-0.17). ACS-NSQIP risk calculator predicted large absolute differences in risk for serious complications (0.2 %-13.7 %) and mortality (0.2 %-6.3 %).
CONCLUSIONS: This study demonstrated low inter-rater reliability in coding ACS-NSQIP colorectal procedures in Canada among SCNRs, impacting risk predictions.
摘要：
背景：美国外科医生学会国家外科质量改进项目（ACS-NSQIP）使用当前程序术语（CPT）代码进行风险调整计算。这项研究评估了ACS-NSQIP外科临床护士审查员（SCNR）在加拿大编码结直肠切除术的评估者间可靠性及其对风险预测的影响。
方法：加拿大的SCNR被要求编码模拟手术报告。计算了一致性百分比和自由边际kappa相关性。ACS-NSQIP风险计算器用于说明其对风险预测的影响。
结果：来自150个SCNR中的44个（29.3％）的响应显示，每个案例选择了3到6个不同的代码，协议范围从6.7%到62.3%。自由边际kappa相关性范围从中度一致(0.53)到高度不一致(-0.17)。ACS-NSQIP风险计算器预测严重并发症（0.2％-13.7％）和死亡率（0.2％-6.3％）的风险绝对差异很大。
结论：这项研究表明，加拿大在SCNR中编码ACS-NSQIP结直肠程序的评分者间可靠性较低，影响风险预测。
方法：加拿大的SCNR被要求编码模拟手术报告。计算了一致性百分比和自由边际kappa相关性。ACS-NSQIP风险计算器用于说明其对风险预测的影响。
结果：来自150个SCNR中的44个（29.3％）的响应显示，每个案例选择了3到6个不同的代码，协议范围从6.7%到62.3%。自由边际kappa相关性范围从中度一致(0.53)到高度不一致(-0.17)。ACS-NSQIP风险计算器预测严重并发症（0.2％-13.7％）和死亡率（0.2％-6.3％）的风险绝对差异很大。
结论：这项研究表明，加拿大在SCNR中编码ACS-NSQIP结直肠程序的评分者间可靠性较低，影响风险预测。
