The utility of claims data for infection surveillance following anterior cruciate ligament reconstruction

Infect Control Hosp Epidemiol. 2014 Jun;35(6):652-9. doi: 10.1086/676430. Epub 2014 Apr 22.


Objective: To explore the feasibility of identifying anterior cruciate ligament (ACL) allograft implantations and infections using claims.

Design: Retrospective cohort study.

Methods: We identified ACL reconstructions using procedure codes at 6 health plans from 2000 to 2008. We then identified potential infections using claims-based indicators of infection, including diagnoses, procedures, antibiotic dispensings, specialty consultations, emergency department visits, and hospitalizations. Patients' medical records were reviewed to determine graft type, validate infection status, and calculate sensitivity and positive predictive value (PPV) for indicators of ACL allografts and infections.

Results: A total of 11,778 patients with codes for ACL reconstruction were identified. After chart review, PPV for ACL reconstruction was 96% (95% confidence interval [CI], 94%-97%). Of the confirmed ACL reconstructions, 39% (95% CI, 35%-42%) used allograft tissues. The deep infection rate after ACL reconstruction was 1.0% (95% CI, 0.7%-1.4%). The odds ratio of infection for allografts versus autografts was 0.41 (95% CI, 0.19-0.78). Sensitivity of individual claims-based indicators for deep infection after ACL reconstruction ranged from 0% to 75% and PPV from 0% to 100%. Claims-based infection indicators could be combined to enhance sensitivity or PPV but not both.

Conclusions: While claims data accurately identify ACL reconstructions, they poorly distinguish between allografts and autografts and identify infections with variable accuracy. Claims data could be useful to monitor infection trends after ACL reconstruction, with different algorithms optimized for different surveillance goals.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anterior Cruciate Ligament Reconstruction / adverse effects*
  • Confidence Intervals
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control
  • Humans
  • Insurance Claim Review*
  • Medical Audit
  • Population Surveillance / methods*
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / prevention & control
  • Transplantation, Homologous / adverse effects
  • United States / epidemiology