A pervasive problem: Surgical wound class miscoding in pediatric laparoscopic appendectomy

Purpose: Surgical wound classification (SWC) is one factor contributing to the likelihood of surgical site infection (SSIs). This results in SWC being an important prognostic factor for SSI, post-operative morbidity for patients, and hospital quality assessment and finance. This analysis aimed to investigate the prevalence of SWC miscoding in pediatric laparoscopic appendectomies in a national database. Methods: Data were extracted from the NSQIP-P registry (2017–2021) for pediatric laparoscopic appendectomies (CPT: 44970) associated with acute appendicitis diagnoses (ICD-10 codes K35–K37). Frequencies were calculated for all SWC, with clean (SWC 1) and clean/contaminated (SWC 2) considered as miscoded for all acute appendicitis cases given the presence of acute inflammation. Subgroup analysis distinguished between non-perforated (ICD-10 codes K35.30, K35.31, K35.890, K35.891) and perforated appendicitis (ICD-10 codes K35.21, K35.32, K35.33), with the correct wound classifications deemed contaminated (SWC 3) and dirty/infected (SWC 4), respectively. Results: Of the 71,374 laparoscopic appendectomies analyzed, a minimum miscoding rate of 22.5 % was identified. Specifically, 28.1 % of the 10,580 non-perforated acute appendicitis subgroup were miscoded and 49.9 % of the 4247 perforated appendicitis subgroup were miscoded. Conclusion: There is a concerning misclassification rate of surgical wounds in pediatric laparoscopic appendectomies for acute appendicitis, exceeding 20 %. This rate rises to 50 % in instances of perforated appendicitis. Further investigation and solutions are needed to improve wound class miscoding to ensure the accuracy of data being used for hospital metrics, risk calculators and research related to surgical site infections. Level of Evidence (I-V): Level III.