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Related Experiment Video

Updated: Apr 19, 2026

Murine Excisional Wound Healing Model and Histological Morphometric Wound Analysis
06:36

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Surgical wound misclassification: a multicenter evaluation.

Shauna M Levy1, Kevin P Lally1, Martin L Blakely2

  • 1Children's Memorial Hermann Hospital, University of Texas Medical School at Houston, Houston, TX.

Journal of the American College of Surgeons
|December 24, 2014
PubMed
Summary
This summary is machine-generated.

Surgical wound classification (SWC) reliability is low for comparing hospitals and patients. This study found significant variation in SWC accuracy, questioning its use in quality benchmarking.

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Area of Science:

  • Healthcare Quality
  • Surgical Outcomes Research
  • Patient Safety

Background:

  • Surgical wound classification (SWC) is crucial for stratifying surgical site infection risk.
  • Current SWC practices lack robust validation, impacting its reliability for inter-institutional comparisons.
  • This study aimed to assess the multicenter reliability of SWC.

Purpose of the Study:

  • To evaluate the concordance between electronic medical record (EMR) SWC and operative note review SWC.
  • To determine if SWC reliability varies by institution and surgical procedure.
  • To assess the hypothesis that concordance rates are low.

Main Methods:

  • Conducted a multicenter study involving 11 institutions.
  • Assessed SWC concordance for 8 common pediatric surgical operations.
  • Reviewed operative notes from 2,034 cases using a predetermined algorithm.

Main Results:

  • Overall SWC concordance was 56%, with institutional rates ranging from 47% to 66%.
  • Inguinal hernia repair showed high concordance (92%), while appendectomy had low concordance (12%).
  • Discrepancies between EMR and reviewer SWC reached up to 3 classes.

Conclusions:

  • SWC, as currently practiced, is an unreliable method for patient and institutional risk stratification.
  • SWC should not be used for quality benchmarking due to its inherent unreliability.
  • Institutions should independently verify their SWC assignment processes for accuracy.