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. Author manuscript; available in PMC: 2015 Sep 2.
Published in final edited form as: Am J Surg. 2013 Nov 7;207(4):584–595. doi: 10.1016/j.amjsurg.2013.08.031

Table I.

Comparison of AHRQ PSI version 4.1a and VASQIP Data Dictionary AE Definitions

AHRQ PSI v4.1a
Numerator Criteria		 VASQIP 2007 Data Dictionary
Definition of Postoperative Complication
PSI#10 Postoperative Physiologic and Metabolic Derangement (PMD):

  1. Various diabetes codes in secondary diagnosis field

    OR

  2. Dialysis as a secondary procedure AND various necrosis/renal failure codes in any secondary diagnosis field

 VASQIP Acute Renal Failure (ARF):
In a patient who did not require dialysis preoperatively, worsening of renal dysfunction postoperatively requiring either

  • hemodialysis,

  • peritoneal dialysis,

  • hemofiltration,

  • hemodiafiltration or

  • ultrafiltration


If the patient refuses dialysis the answer is Yes to this variable, because he/she did require dialysis.
NOTE: Part 1 of the PSI algorithm does not align with the VASQIP AE
PSI#11 Postoperative Respiratory Failure:

  1. Acute respiratory failure code in any secondary diagnosis field

    OR

  2. Reintubation (96.04) or mechanical ventilation (96.70, 96.71, 96.72), codes in any secondary procedure field in the following time frame:

    • (96.04) one or more days after the major operating room procedure code

    • (96.70 or 96.71) two or more days after the major operating room procedure code

    • (96.72) zero or more days after the major operating room procedure code

  • VASQIP Failure to Wean (FW) OR On Ventilator > 48 hours:

    Total duration of ventilator-assisted respirations during postoperative hospitalization was >48 hours. This can occur at any time during the 30-day period postoperatively.

    This time assessment is CUMULATIVE, not necessarily consecutive. Ventilator-assisted respirations can be via endotracheal tube, nasotracheal tube, or tracheostomy tube.

  • VASQIP Reintubation OR Unplanned Intubation (R/UI) for Respiratory/Cardiac Failure:

    Patient required placement of an endotracheal tube and mechanical or assisted ventilation because of the onset of respiratory or cardiac failure manifested by severe respiratory distress, hypoxia, hypercarbia, or respiratory acidosis. In patients who were intubated for their surgery, unplanned intubation occurs after they have been extubated after surgery. In patients who were not intubated during surgery, intubation at any time after their surgery is considered unplanned.
NOTE: Part of the PSI#11 algorithm overlaps with part of the VASQIP AE definition for “Cardiac Arrest Requiring CPR”
PSI#12 Postoperative Pulmonary Embolism (PE)/Deep Vein Thrombosis (DVT):

  1. Code for pulmonary embolism in any secondary diagnosis field

    OR

  2. Codes for deep vein thrombosis in any secondary diagnosis field

  • VASQIP Pulmonary Embolism (PE):

    Definition: Lodging of a blood clot in a pulmonary artery with subsequent obstruction of blood supply to the lung parenchyma. The blood clots usually originate from the deep leg veins or the pelvic venous system. Enter “YES” if the patient has a V-Q scan interpreted as high probability of pulmonary embolism or a positive pulmonary arteriogram or positive CT angiogram or positive Spiral CT exam. Treatment usually consists of:

    • Initiation of anticoagulation therapy

    • Placement of mechanical interruption (e.g. Greenfield Filter), for patients in whom anticoagulation is contraindicated or already instituted.

  • VASQIP Deep Vein Thrombosis (DVT)/ Thrombophlebitis:

    Definition: the identification of a new blood clot or thrombus within the venous system, which may be coupled with inflammation. This diagnosis is confirmed by a duplex, venogram or CT scan. The patient must be treated with anticoagulation therapy, and/or placement of a vena cava filter or clipping of the vena cava.
PSI#13 Postoperative Sepsis:
Discharges with various sepsis codes in any secondary diagnosis field (i.e., strep septicemia, staph, pneumococcal septicemia, septicemia due to anaerobes, septic shock, postoperative shock, septicemia due to gram negative organism, hemophilus influenza, E. coli, or SIRs due to infectious process with or without organ dysfunction)		 VASQIP Systemic Sepsis (SS):

  1. Sepsis: Sepsis is the systemic response to infection. Report this variable if the patient has clinical signs and symptoms of Systemic Inflammatory Response Syndrome (SIRS). SIRS is a widespread inflammatory response to a variety of severe clinical insults. This syndrome is clinically recognized by the presence of two or more of the following:

    • Temp >38 degrees C or <36 degrees C

    • HR >90 bpm

    • RR >20 breaths/min or PaCO2 <32 mmHg(<4.3 kPa)

    • WBC >12,000 cell/mm3, <4000 cells/mm3, or >10% immature (band)forms

    • Anion gap acidosis: this is defined by either:

      • [Na + K] – [Cl + HCO3 (or serum CO2)]. If this number is greater than 16, then an anion gap acidosis is present.

      • Na – [Cl + HCO3 (or serum CO2)]. If this number is greater than 12, then an anion gap acidosis is present.

      And one of the following:

    • positive blood culture

    • clinical documentation of purulence or positive culture from any site thought to be causative

  2. Severe Sepsis/Septic Shock: Sepsis is considered severe when it is associated with organ and/or circulatory dysfunction. Report this variable if the patient has the clinical signs and symptoms of SIRS or sepsis AND documented organ and/or circulatory dysfunction. Examples of organ dysfunction include: oliguria, acute alteration in mental status, acute respiratory distress. Examples of circulatory dysfunction include: hypotension, requirement of inotropic or vasopressor agents.


From 2001- June, 2004 the VASQIP definition of sepsis was as follows:
 If the primary physician or the chart states that the patient had systemic sepsis within the 30 days postoperatively, choose from the following choices for sepsis. If neither is present, follow these definitions and choose the most applicable:

  1. Sepsis: Definitive evidence of infection, plus evidence of a systemic response to infection. This systemic response is manifested by two or more of the following conditions:

    1. Temp > 38 degrees C or < 36 degrees C

    2. HR > 90 bpm

    3. RR > 20 breaths/min or PaCO2 < 32 mmHg (<4.3 kPa)

    4. WBC > 12,000 cell/mm3, < 4000 cells/mm3, or >10% immature (band) forms

  2. Septic Shock: Sepsis with hypotension despite adequate fluid resuscitation combined with perfusion abnormalities that may include, but are not limited to, lactic acidosis, oliguria, or an acute alteration in mental status. Patients who are on inotropic or vasopressor agents may not be hypotensive at the time that perfusion abnormalities are measured.
PSI#14 Postoperative Wound Dehiscence (WD):
Discharges with code for reclosure of postoperative disruption of abdominal wall (54.61) in any procedure field

  • VASQIP Dehiscence:

    Separation of the layers of a surgical wound, which may be partial or complete, with disruption of the fascia.

NOTES:

The VASQIP data dictionary definitions were valid from 2002–2007 with the exception of sepsis, as described in the table.

PSI exclusion criteria are not presented;

PSI AEs are detected prior to discharge while VASQIP AEs can occur up to 30 days postoperatively, regardless of inpatient status.