Table 7.

Reasons for Discordance between Survey and Manual Chart Review (N = 54 Complications)

	General Theme	Specific Reason for Discordance	Frequency	Example
Survey positive; chart review negative	The patient accurately reports an event that occurred before surgery.	The patient accurately reports a chronic medical diagnosis.	9	55-yr-old male with a history of atrial fibrillation underwent radiofrequency ablation. He remained in sinus rhythm after the procedure. He reported “abnormal heart rhythm” on the survey.
		The patient accurately reports a complication of a previous surgery.	9	34-yr-old male underwent laparoscopic cholecystectomy. He had a history of deep venous thrombosis 3 yr previously after resection of a bone tumor. He reported “blood clot in your legs” on the survey.
		The patient accurately reports a past medical event that was unrelated to surgery.	4	76-yr-old male with a history of stroke many years before underwent radical cystoprostatectomy and sigmoid colectomy for bladder cancer. He reported “stroke” on the survey.
	The patient accurately reports a complication that occurred in the hospital after surgery.	The patient accurately reports a complication that occurred in the hospital after surgery. (The chart review misses a complication that did occur.)	2	72-yr-old female with a history of atrial fibrillation underwent radiofrequency ablation. She was treated postoperatively with vancomycin and cefepime for probable pneumonia. She reported “infection in your lungs” on the survey, but this was not detected during chart review.
	The patient accurately reports a complication that occurred after hospital discharge.	The patient accurately reports a complication that occurred at home after hospital discharge.	4	71-yr-old male underwent resection of a left temporal lobe mass. After discharge, he presented to his primary care physician with a cough. Workup revealed a pulmonary embolism, and he was prescribed warfarin. He reported “blood clot in your lungs” on the survey.
		The patient accurately reports a complication that occurred during a subsequent hospitalization.	3	63-yr-old male underwent Whipple procedure for gallbladder carcinoma. He was discharged with a surgical drain in place. He was readmitted a month later with nausea/vomiting. His surgical drain output became purulent and culture was positive. He reported “infection of the wound” on the survey.
	The patient inaccurately reports an event as a complication.	The patient misinterprets an event that happened before surgery.	2	54-yr-old male underwent colonoscopy. Five months previously, he was admitted to the hospital for chest pain. Cardiac biomarkers were negative, and stress test was negative. He reported “heart attack” on the survey. On the telephone, he confirmed this was the event he referenced on the survey.
		The patient misinterprets an event that happened during hospitalization.	3	30-yr-old female underwent laser retinopexy for retinal detachment. She was extubated at the end of the surgery and discharged home. She reported “respiratory failure” on the survey because she was placed on a ventilator while under general anesthesia.
		The patient misinterprets an event that happened after hospital discharge.	2	36-yr-old female underwent bilateral mastectomy for breast carcinoma. She was subsequently admitted for chest pain and fever. She underwent a pericardial window for a pericardial effusion. She reported this event as “abnormal heart rhythm” on the survey.
	The patient does not intend to report a complication.	The patient does not recall indicating a complication on the survey.	10	57-yr-old male underwent oropharyngeal cancer excision. He indicated “respiratory failure,” “infection in your lungs,” “kidney failure and you needed dialysis,” “nerve injury,” “internal bleeding,” and “stomach or intestinal ulcer” on the survey. On the telephone, he had no recall of these survey responses and indicated that he experienced no complications.
		There was a technical problem with the survey.	1	49-yr-old male with a history of end-stage renal disease underwent arteriovenous fistula creation for hemodialysis access. He marked “kidney failure and you needed dialysis” on the survey, but then he crossed out his answer. The computer still read this as a positive survey response.
Survey negative; chart review positive	The patient does not recall the event discovered on chart review.	The patient has no recall of the event discovered on chart review.	2	58-yr-old male underwent left and right ventricular assist device placement for heart failure. Postoperatively the patient experienced a gastrointestinal bleed. The medical record indicated the patient underwent upper endoscopy, during which a gastric ulcer was clipped. The patient reported “internal bleeding” on the survey but not “stomach or intestinal ulcer.” On the telephone, the patient denied having an ulcer even when specifically asked.
	The patient does recall the event discovered on chart review.	The patient recalls the event discovered on chart review only when specifically prompted.	1	65-yr-old male underwent esophagectomy for esophageal cancer. Postoperatively, he experienced a leak at the anastomosis and infection requiring antibiotics. The patient did not report “infection of the wound” on the survey. On the telephone, the patient did recall this event when specifically asked.
		The patient reports the event as one complication, and the chart review identifies the same event as a different complication.	1	70-yr-old male underwent right upper lobe sleeve resection for broncholithiasis. Postoperatively, he experienced a bronchial stump leak and empyema. He reported “infection in your lung (pneumonia)” on the survey, while the chart review reported “infection of the wound.”
		The patient reports the complication discovered on chart review occurred after discharge.	1	78-yr-old male underwent Maze procedure for atrial fibrillation. Chart review revealed shortness of breath and pulmonary edema requiring diuresis. The patient did not report “congestive heart failure” on the survey. On the telephone, he reported going to another hospital after discharge for treatment of shortness of breath.