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A new classification for surgical NEC during exploratory laparotomy: introduction and reproducibility assessment

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Abstract

Purpose

Variability in necrosis patterns and operative techniques in surgical necrotizing enterocolitis (NEC) necessitates a standardized classification system for consistent assessment and comparison. This study introduces a novel intraoperative reporting system for surgical NEC, focusing on reliability and reproducibility.

Methods

Analyzing surgical NEC cases from January 2018 to June 2023 at two tertiary neonatal and pediatric surgery units, a new classification system incorporating anatomical details and intestinal involvement extent was developed. Its reproducibility was quantified using kappa coefficients (κ) for interobserver and intraobserver reliability, assessed by four specialists. Furthermore, following surgery, the occurrence of mortality and enteric autonomy were evaluated on the basis of surgical decision-making of the novel intraoperative classification system for surgical NEC.

Results

In total, 95 patients with surgical NEC were included in this analysis. The mean κ value of the intra-observer reliability was 0.889 (range, 0.790−0.941) for the new classification, indicating excellent agreement and the inter-observer reliability was 0.806 (range, 0.718−0.883), indicating substantial agreement.

Conclusion

The introduced classification system for surgical NEC shows high reliability, deepening the understanding of NEC's intraoperative exploration aspects. It promises to indicate operative strategies, enhance prognosis prediction, and substantially facilitate scholarly communication in pediatric surgery. Importantly, it explores the potential for a standardized report and may represent a step forward in classifying surgical NEC, if pediatric surgeons are open to change.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

Abbreviations

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care units

NDI:

Neurodevelopmental impairment

IVH:

Intraventricular hemorrhage

PN:

Parenteral nutrition

CD:

Clip and drop

PD&W:

Patch drain and wait

PA:

Primary anastomosis

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Acknowledgements

We extend our appreciation to Dr. Ruiqian Yang, Director of the Medical Records Department, for her invaluable assistance during the process of collecting data for our study.

Funding

Not applicable.

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Authors and Affiliations

  1. Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China

    Shuai Shang, Yingchao Li, Lintao Liu, Na Geng, Weili Xu & Suolin Li

  2. Department of Pediatric Surgery, Maternity Hospital of Shijiazhuang City Affiliated to Hebei Medical University, Shijiazhuang, Hebei, China

    Shuai Shang, Ao Li, Chao Liang & Cuncun Shen

Authors
  1. Shuai Shang
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  2. Ao Li
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  3. Chao Liang
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  4. Cuncun Shen
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  5. Yingchao Li
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  6. Lintao Liu
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  7. Na Geng
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  8. Weili Xu
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  9. Suolin Li
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Contributions

Study design: SS and WLX. Data collection: SS, LTL, AL, CCS, and CL. Data analysis: SS and WLX. Manuscript writing: SS. Manuscript critical review: WLX, CCS, NG, YCL, and SLL. All authors read and approved the final copy of the manuscript.

Corresponding author

Correspondence to Weili Xu.

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Shang, S., Li, A., Liang, C. et al. A new classification for surgical NEC during exploratory laparotomy: introduction and reproducibility assessment. Pediatr Surg Int 40, 108 (2024). https://doi.org/10.1007/s00383-024-05685-1

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