Reliability of a Complication Classification System for Orthopaedic Surgery
- 594 Downloads
Quality of health care and safety have been emphasized by various professional and governmental groups. However, no standardized method exists for grading and reporting complications in orthopaedic surgery. Conclusions regarding outcomes are incomplete without a standardized, objective complication grading scheme applied concurrently. The general surgery literature has the Clavien-Dindo classification that meets the above criteria.
We asked whether a previously reported classification would show high intraobserver and interobserver reliabilities when modified for orthopaedic surgery specifically looking at hip preservation surgery. We therefore determined the interreader and intrareader reliabilities of the adapted classification scheme as applied to hip preservation surgery.
We adapted the validated Clavien-Dindo complication classification system and tested its reliability for orthopaedic surgery, specifically hip preservation surgery. There are five grades based on the treatment required to manage the complication and the potential for long-term morbidity. Forty-four complication scenarios were created from a prospective multicenter database of hip preservation procedures and from the literature. Ten readers who perform hip surgery at eight centers in three countries graded the scenarios at two different times. Fleiss’ and Cohen’s κ statistics were performed for interobserver and intraobserver reliabilities, respectively.
The overall Fleiss’ κ value for interobserver reliability was 0.887 (95% CI, 0.855–0.891). The weighted κ was 0.925 (95% CI, 0.894–0.956) for Grade I, 0.838 (95% CI, 0.807–0.869) for Grade II, 0.87 (95% CI, 0.835–0.866) for Grade III, and 0.898 (95% CI, 0.866–0.929) for Grade IV. The Cohen’s κ value for intraobserver reliability was 0.891 (95% CI, 0.857–0.925).
The adapted classification system shows high interobserver and intraobserver reliabilities for grading of complications when applied to orthopaedic surgery looking at complications of hip preservation surgery. This grading scheme may facilitate standardization of complication reporting and make outcome studies more comparable.
KeywordsIntensive Care Unit Admission Intraobserver Reliability Complication Classification Provide Quality Health Care Chance Adjust Agreement
We thank Amy Monreal BS, Joseph T. Nguyen MPH, and Pan Zhaoxing PhD for assistance with preparation of this manuscript.
- 3.Chun YS, Vauthey JN, Ribero D, Donadon M, Mullen JT, Eng C, Madoff DC, Chang DZ, Ho L, Kopetz S, Wei SH, Curley SA, Abdalla EK. Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg. 2007;11:1498–1504; discussion 1504–1505.PubMedCrossRefGoogle Scholar
- 4.Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250:187–196.PubMedCrossRefGoogle Scholar
- 22.Reddy SK, Morse MA, Hurwitz HI, Bendell JC, Gan TJ, Hill SE, Clary BM. Addition of bevacizumab to irinotecan-and oxaliplatin-based preoperative chemotherapy regimens does not increase morbidity after resection of colorectal liver metastases. J Am Coll Surg. 2008;206:96–106.PubMedCrossRefGoogle Scholar
- 23.Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, Assumpcao L, Barbas AS, Abdalla EK, Choti MA, Vauthey JN, Ludwig KA, Mantyh CR, Morse MA, Clary BM. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol. 2007; 14:3481–3491.PubMedCrossRefGoogle Scholar
- 25.Seda-Neto J, Godoy AL, Carone E, Pugliese V, Fonseca EA, Porta G, Pugliese R, Miura IK, Baggio V, Kondo M, Chapchap P. Left lateral segmentectomy for pediatic live-donor liver transplantation: special attention to segment IV complications. Transplantation. 2008; 86:697–701.PubMedCrossRefGoogle Scholar