Estimating anesthesia and surgical procedure times from medicare anesthesia claims

Background: Procedure times are important variables that often are included in studies of quality and efficiency. However, due to the need for costly chart review, most studies are limited to single-institution analyses. in this article, the authors describe how well the anesthesia claim from Medicare can estimate chart times. Methods: The authors abstracted information on time of induction and entrance to the recovery room (anesthesia chart time) from the charts of 1,931 patients who underwent general and orthopedic surgical procedures in Pennsylvania. The authors then merged the associated bills from claims data supplied from Medicare (Part B data) that included a variable denoting the time in minutes for the anesthesia service. The authors also investigated the time from incision to closure (surgical chart time) on a subset of 1,888 patients. Results: Anesthesia claim time from Medicare was highly predictive of anesthesia chart time (Kendall's rank correlation tau = 0.85, P < 0.0001, median absolute error = 5.1 min) but somewhat less predictive of surgical chart time (Kendall's tau = 0.73, P < 0.0001, median absolute error = 13.8 min). When predicting chart time from Medicare bills, variables reflecting procedure type, comorbidities, and hospital type did not significantly improve the prediction, suggesting that errors in predicting the chart time from the anesthesia bill time arc not related to these factors; however, the individual hospital did have some influence on these estimates. Conclusions: Anesthesia chart time can be well estimated using Medicare claims, thereby facilitating studies with vastly larger sample sizes and much lower costs of data collection.