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Incision Classification Accuracy: Do Residents Know How to Classify Them?

Jessica Goodwin1, Pepper Womack2, Billy Moore3

  • 11 Baylor University Medical Center at Dallas , Dallas, Texas.

Surgical Infections
|October 27, 2017
PubMed
Summary

Surgical residents misclassified higher-risk incisions, impacting patient safety. Chief residents showed the lowest accuracy in determining incision class (IC), necessitating targeted education to improve surgical site infection outcomes.

Keywords:
NSQIPaccuracywound classification

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Area of Science:

  • Surgical Education
  • Patient Safety
  • Infection Control

Background:

  • Understanding surgical incision classification is crucial for appropriate wound management.
  • The accuracy of surgical residents in classifying incisions is not well-established.
  • This knowledge gap may affect surgical site closure and patient outcomes.

Purpose of the Study:

  • To assess surgical residents' accuracy in classifying incisions compared to expert surgical champions.
  • To identify specific resident levels and incision classes with the highest rates of misclassification.
  • To explore the correlation between incision classification accuracy and surgical site infection rates.

Main Methods:

  • Analysis of a surgical database (NSQIP) from April 2015 to December 2016.
  • Inclusion of cases with documented incision class (IC) and resident involvement.
  • Review of discrepancies by a blinded surgical champion (SC) to determine accurate IC.

Main Results:

  • Residents achieved 83.6% accuracy in classifying incisions.
  • Post-graduate year 5 (PGY5) residents demonstrated the lowest accuracy.
  • Class 3 incisions were most frequently misclassified (36%), particularly by senior residents (PGY4-7).
  • Surgical site infections occurred in 7.4% of cases, with higher rates for misclassified, higher-risk incisions.

Conclusions:

  • While overall resident accuracy is considerable, misclassification of high-risk incisions is a concern.
  • Chief residents exhibited the least accuracy in determining incision class, potentially impacting wound management.
  • There is a need for focused resident education on incision classification to mitigate surgical site infection risks.