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Reliability of a complication classification system for orthopaedic surgery
Ernest L Sink1, Michael Leunig, Ira Zaltz
1Hospital for Special Surgery, New York, NY 10021, USA. sinke@hss.edu
Insights
A modified Clavien-Dindo classification for orthopaedic surgery shows high reliability in grading complications for hip preservation procedures. This standardized system improves the consistency and comparability of outcome studies in orthopaedic surgery.
Area of Science:
- Orthopaedic Surgery
- Surgical Complication Grading
- Health Services Research
Background:
- Standardized methods for grading surgical complications in orthopaedics are lacking.
- Objective and concurrent complication assessment is crucial for evaluating surgical outcomes.
- The Clavien-Dindo classification is a validated system used in general surgery.
Purpose of the Study:
- To assess the reliability of a modified Clavien-Dindo classification for orthopaedic surgery.
- Specifically, to determine the interobserver and intraobserver reliability of this adapted system in hip preservation surgery.
- To evaluate if the classification demonstrates high reliability when applied to a specific orthopaedic subspecialty.
Main Methods:
- Adapted the validated Clavien-Dindo complication classification system for orthopaedic surgery.
- Developed 44 complication scenarios from a prospective multicenter hip preservation database and literature.
- Ten hip surgeons from eight centers across three countries graded scenarios twice, with Fleiss' and Cohen's κ statistics used for reliability analysis.
Main Results:
- The adapted classification demonstrated high interobserver reliability with an overall Fleiss' κ of 0.887.
- Intraobserver reliability was also high, with a Cohen's κ of 0.891.
- Specific grade reliabilities ranged from 0.838 to 0.925, indicating consistent grading across different levels of severity.
Conclusions:
- The adapted Clavien-Dindo classification exhibits high interobserver and intraobserver reliability for grading complications in hip preservation surgery.
- This grading scheme offers a potential solution for standardizing complication reporting in orthopaedics.
- Implementation of this system can enhance the comparability and validity of outcome studies in orthopaedic surgery.
Background:
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.
Questions/Purposes:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
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