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Interobserver variability of Clavien-Dindo scoring in urology

Sławomir Poletajew1, Lukasz Zapała, Sebastian Piotrowicz

  • 1Department of General, Oncological and Functional Urology, Infant Jesus Clinical Hospital, Medical University of Warsaw, Warsaw, Poland.

International Journal of Urology : Official Journal of the Japanese Urological Association
|July 22, 2014
PubMed

Insights

Interobserver variability in Clavien-Dindo scoring for urological complications is significant, indicating a need for classification refinement and specialist training to improve its use in quality assessment.

Area of Science:

  • Urology
  • Surgical Outcomes Assessment
  • Medical Error Analysis

Background:

  • The Clavien-Dindo classification is a widely used system for grading surgical complications.
  • Standardized assessment of surgical outcomes is crucial for quality improvement in urology.
  • Interobserver agreement is essential for the reliable application of any grading system.

Purpose of the Study:

  • To evaluate the interobserver variability of the Clavien-Dindo classification among urologists.
  • To identify factors influencing the agreement in grading urological complications.
  • To assess the suitability of the Clavien-Dindo classification for quality assessment in urology.

Main Methods:

  • A thematic survey was conducted across nine Polish urological centers.
  • 171 urologists and urologists-in-training participated in the study.
  • Respondents graded nine typical urological complications using the Clavien-Dindo classification.

Main Results:

  • Moderate agreement (κ = 0.45) was observed among respondents for Clavien-Dindo grading.
  • Surgical approach and physician experience did not significantly impact agreement.
  • Discrepancies were most notable for local complications after transurethral surgery and severe general complications after Bricker operation.

Conclusions:

  • Significant variability exists in the application of Clavien-Dindo scoring within urology.
  • The Clavien-Dindo classification may require further detailing and specific training for consistent implementation.
  • Despite variability, its simplicity and logical structure offer potential for quality assessment in urology.
Abstract

Keywords:
classificationinterobserver variabilitypostoperative complicationsurological surgical procedures

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