In Reply We were pleased and interested to find that our article “Analysis of Variations in the Use of Intraoperative Nerve Monitoring in Thyroid Surgery” has stimulated a constructive critique prompted by Dr Megwalu in his letter “Identifying Intraoperative Nerve Monitoring in Thyroid Surgery Using Administrative Databases.”1
We agree and share the concerns that the coding of intraoperative nerve monitoring (IONM) in administrative databases is likely to be influenced by the setting in which it was performed and we have mentioned this in discussing our paper. Although administrative databases come with the convenience of a large sample size, they are not without major limitations and caveats.2 Analyses of these large databases, have produced controversial—and even contradictory—results. These analyses may influence national treatment guidelines; therefore, it is vital to understand their limitations. Evidently based on our results; the State Inpatient Database (SID) has an “undercoding” of IONM. However, by solely depending on our reported low percentages of IONM utilization, we cannot conclude that IONM coding was incorrect coding by surgeons or reported only when done by technicians. A critical question to be asked is whether IONM undercoding was differential or not, in other words whether undercoding is associated with certain types of settings. Unfortunately, this question cannot be addressed using a single data source, which prevents establishing the extent of our study generalizability. Of note, the analysis used International Classification of Disease, 9th Revision (ICD-9) for defining IONM utilization and not the Current Procedural Terminology which is usually used for billing purposes.
Al-Qurayshi Z, Randolph GW, Kandil E. Identifying Intraoperative Nerve Monitoring in Thyroid Surgery Using Administrative Databases—Reply. JAMA Otolaryngol Head Neck Surg. 2017;143(4):428. doi:10.1001/jamaoto.2016.3656
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