Ann Surg Treat Res.  2023 Mar;104(3):170-175. 10.4174/astr.2023.104.3.170.

Validation of I71.3 code for ruptured abdominal aortic aneurysm in Korea: misplaced diagnosis in claims data

• Jo EA
• Seong S
• Ahn S
• Mo H
• Jung IM
• Kim HK
• Ko H
• Han A
• Min S
• Min SK

• KMID: 2539696
• DOI: http://doi.org/10.4174/astr.2023.104.3.170

Abstract

Purpose
Studies in western countries have shown a decline in the incidence of ruptured abdominal aortic aneurysm (rAAA) with advancements in endovascular repair and screening. However, according to health insurance data in Korea based on rAAA code (I71.3), overall rAAA has been increasing. This study aimed to validate the I71.3 code for rAAA and attempt to define the true incidence of rAAA in Korea.
Methods
A 20-year multicenter retrospective review of rAAA was undertaken from the period of January 1, 2000 to December 31, 2020. All patients were diagnosed with the rAAA code I71.3 in each of the 4 hospitals. The CT images and surgical records of these patients were reviewed to differentiate true rAAA and misdiagnosis. Further data on true rAAA patient outcomes including mortality and treatment success were also collected.
Results
A total of 305 rAAA (I71.3) codes were identified in the 4 centers. However, medical record review showed true rAAA in only 131 (43.0%). The remaining 174 cases (57.0%) were misdiagnosed. Impending ruptures were the most common misdiagnoses (37.9%). The total in-hospital mortality including deaths before treatment was 38.9% (n = 51), while mortality of treated patients was 24.4% (n = 15).
Conclusion
The analysis of I71.3 code for rAAA showed that only 43.0% were true rAAA and the remaining 57.0% were misdiagnosed. This indicates that the I71.3 code is overestimated in National Health Insurance-based data and that the true incidence of rAAA could be much lower.

Keyword

Aortic rupture; Diagnostic errors; Insurance claim review; International classification of diseases; Prevalence

Figure

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  Fig. 1 Total national incidence and region-specific incidence of ruptured abdominal aortic aneurysm identified using I71.3 from Health Insurance and Review Assessment data.

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  Fig. 2 National incidence of ruptured abdominal aortic aneurysms according to sex identified using I71.3 from Health Insurance and Review Assessment data.

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  Fig. 3 Flowchart of validation cohort patients. rAAA, ruptured abdominal aortic aneurysm; EVAR, endovascular aneurysm repair.

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  Fig. 4 Annual case number of true ruptured abdominal aortic aneurysm from multicenter data.

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  Fig. 5 Number of patients according to the diameter of true ruptured abdominal aortic aneurysm (AAA) from multicenter data.

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