{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:23:31Z","timestamp":1794324211524,"version":"4.9.0"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2014,12]]},"abstract":"\n Object<\/jats:title>\n The rates of lumbar spinal fusion operations have increased dramatically over the past 2 decades, and several studies based on administrative databases such as the Nationwide Inpatient Sample (NIS) have suggested that the greatest rise is in the general categories of degenerative disc disease and disc herniation, neither of which is a well-accepted indication for lumbar fusion. The administrative databases classify cases with the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM). The ICD-9-CM discharge codes are not generated by surgeons but rather are assigned by trained hospital medical coders. It is unclear how accurately they capture the surgeon's indication for fusion. The authors sought to compare the ICD-9-CM code(s) assigned by the medical coder to the surgeon's indication based on a review of the medical chart.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective review was undertaken of all lumbar fusions performed at our institution by the department of neurosurgery between 8\/1\/2011 and 8\/31\/2013. Based on the authors' review, the indication for fusion for each case was categorized as spondylolisthesis, deformity, tumor, infection, nonpathological fracture, pseudarthrosis, adjacent-level degeneration, stenosis, degenerative disc pathology, or disc herniation. These surgeon diagnoses were compared with the primary ICD-9-CM codes that were submitted to administrative databases.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n There were 178 lumbar fusion operations performed for 170 hospital admissions. There were 44 hospitalizations in which fusion was performed for tumor, infection, or nonpathological fracture; the remaining 126 were for degenerative diagnoses. For these degenerative cases, the primary ICD-9-CM diagnosis matched the surgeon's diagnosis in only 61 of 126 degenerative cases (48.4%). When both the primary and all secondary ICD-9-CM diagnoses were considered, the indication for fusion was identified in 100 of 126 cases (79.4%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Characterizing indications for fusion based solely on primary ICD-9-CM codes extracted from large administrative databases does not accurately reflect the surgeon's indication. While these databases may accurately describe national\n rates<\/jats:italic>\n of lumbar fusion surgery, the lack of fidelity in the source codes limits their role in accurately identifying\n indications<\/jats:italic>\n for surgery. Studying relationships among indications, complications, and outcomes stratified solely by ICD-9-CM codes is not well founded.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.8.spine131113","type":"journal-article","created":{"date-parts":[[2014,10,17]],"date-time":"2014-10-17T10:01:07Z","timestamp":1413540067000},"page":"984-993","source":"Crossref","is-referenced-by-count":48,"title":["The Nationwide Inpatient Sample database does not accurately reflect surgical indications for fusion"],"prefix":"10.3171","volume":"21","author":[{"given":"Yakov","family":"Gologorsky","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"Knightly","sequence":"additional","affiliation":[{"name":"Atlantic Neurosurgical Specialists, Atlantic Neuroscience Institute, Morristown, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John H.","family":"Chi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Groff","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine131113","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1212\/WNL.49.3.660","article-title":"Inaccuracy of the International Classification of Diseases (ICD-9-CM) in identifying the diagnosis of ischemic cerebrovascular disease","volume":"49","author":"Benesch","year":"1997"},{"key":"b2-spine131113","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E804","DOI":"10.1097\/BRS.0b013e318247821b","article-title":"SF-6D values stratified by specific diagnostic indication","volume":"37","author":"Carreon","year":"2012"},{"key":"b3-spine131113","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1097\/00007632-199207000-00015","article-title":"Use of the International Classification of Diseases (ICD-9-CM) to identify hospitalizations for mechanical low back problems in administrative databases","volume":"17","author":"Cherkin","year":"1992"},{"key":"b4-spine131113","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.1097\/01.brs.0000166503.37969.8a","article-title":"United States trends in lumbar fusion surgery for degenerative conditions","volume":"30","author":"Deyo","year":"2005"},{"key":"b5-spine131113","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1001\/jama.2010.338","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo","year":"2010"},{"key":"b6-spine131113","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1056\/NEJMsb031771","article-title":"Spinal-fusion surgery\u2014the case for restraint","volume":"350","author":"Deyo","year":"2004"},{"key":"b7-spine131113","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1097\/00007632-199706010-00023","article-title":"Spine update. 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