国际手术操作分类系统在手术难度研究中的应用

Application of International Surgical Classification System in the Study of Surgery Difficulty

目的基于手术操作分类系统开展手术难度评估和研究。方法在对比国际上常用的ICD-9-CM-3、ICD-10-PCS、CPT、ICHI和CCHI 5套手术操作分类系统特点的基础上,比较和分析不同分类系统在手术难度研究中的应用路径。结果手术难度研究方法的科学性与其基于的分类系统特点紧密相关:对于CPT、CCHI这类源于项目穷举的系统,适合使用RBRVS的方法将项目列举与难度评估同步推进;对于ICD-9-CM-3必须结合逻辑进行合理的扩码工作后,实现"一术一码一级";对于ICD-10-PCS这类混合编码的系统,可考虑借助信息化手段和大数据技术进行赋值;而ICHI这类归类用途较强的分类系统,并不适合作为手术难度评估的载体。结论从不同的研究角度出发选择对应的分类系统,并完善研究前的基础工作,同时充分利用好分类系统间的对照映射关系,能够集中不同分类系统在手术难度研究中的优势,大大提高手术难度评估的科学性。

Objective To evaluate and research the surgical difficulty based on classification system of surgical operation. Methods On the basis of comparing characteristics of five commonly used classification systems of ICD-9-CM-3,ICD-10-PCS,CPT,ICHI and CCHI,comparing and analyzing the application paths of different classification systems in the study of surgery difficulty. Results The research method of surgery difficulty is closely related with characteristics of the classification system. For the project exhaustion systems,such as CPT and CCHI,it is suitable to use RBRVS method to evaluate surgical difficulty at the same time of enumerating items. For ICD-9-CM-3,they must be combined with logic to expand the codes reasonably to realize ＂one-projectone-code-one-difficulty＂. For the hybrid coding systems,such as ICD-10-PCS,they can be assigned by means of information technology and big data technology. For the classification system with strong classification function,such as ICHI,it is not suitable as a carrier for the evaluation of surgery difficulty. Conclusion The corresponding classification system is selected from different research perspectives. The basic work before research should be improved.Making good use of the contrast mapping relation among classification systems will take advantages of concentrating different classification systems in the study of surgery difficulty,which enhances the scientificness of the evaluation of operation difficulty significantly.