BACKGROUND: There is currently no systematic approach to evaluating the severity of intraoperative adverse events (iAEs). STUDY DESIGN: A 3-phase project was designed to develop and validate a novel severity classification scheme for iAEs. Phase 1 created the severity classification using a modified Delphi process. Phase 2 measured the classification's internal consistency by calculating inter-rater reliability among 91 surgeons using standardized iAEs scenarios. Phase 3 measured the classification's construct validity by testing whether major iAEs (severity class ≥3) correlated with worse 30-day postoperative outcomes compared with minor iAEs (severity class <3). This was achieved by creating a matched database using American College of Surgeons NSQIP and administrative data, querying for iAEs using the Patient Safety Indicator #15 (Accidental Puncture/Laceration), and iAE confirmation by chart review. RESULTS: Phase 1 resulted in a 6-point severity classification scheme. Phase 2 revealed an inter-rater reliability of 0.882. Of 9,292 patients, phase 3 included 181 confirmed with iAEs. All preoperative/intraoperative variables, including demographics, comorbidities, type of surgery performed, and operative length, were similar between patients with minor (n = 110) vs major iAEs (n = 71). In multivariable logistic analysis, severe iAEs correlated with higher risks of any postoperative complication (odds ratio [OR] = 3.8; 95% CI, 1.9-7.4; p < 0.001), surgical site infections (OR = 3.7; 95% CI, 1.7-8.2; p = 0.001), systemic sepsis (OR = 6.0; 95% CI, 2.1-17.2; p = 0.001), failure to wean off the ventilator (OR = 3.2; 95% CI, 1.2-8.9; p = 0.022), and postoperative length of stay ≥7 days (OR = 3.0; 95% CI, 1.5-5.9; p = 0.002). Thirty-day mortalities were similar (4.5% vs 7.1%; p = 0.46). CONCLUSIONS: We propose a novel iAE severity classification system with high internal consistency and solid construct validity. Our classification scheme might prove essential for benchmarking quality of intraoperative care across hospitals and/or individual surgeons.
BACKGROUND: There is currently no systematic approach to evaluating the severity of intraoperative adverse events (iAEs). STUDY DESIGN: A 3-phase project was designed to develop and validate a novel severity classification scheme for iAEs. Phase 1 created the severity classification using a modified Delphi process. Phase 2 measured the classification's internal consistency by calculating inter-rater reliability among 91 surgeons using standardized iAEs scenarios. Phase 3 measured the classification's construct validity by testing whether major iAEs (severity class ≥3) correlated with worse 30-day postoperative outcomes compared with minor iAEs (severity class <3). This was achieved by creating a matched database using American College of Surgeons NSQIP and administrative data, querying for iAEs using the Patient Safety Indicator #15 (Accidental Puncture/Laceration), and iAE confirmation by chart review. RESULTS: Phase 1 resulted in a 6-point severity classification scheme. Phase 2 revealed an inter-rater reliability of 0.882. Of 9,292 patients, phase 3 included 181 confirmed with iAEs. All preoperative/intraoperative variables, including demographics, comorbidities, type of surgery performed, and operative length, were similar between patients with minor (n = 110) vs major iAEs (n = 71). In multivariable logistic analysis, severe iAEs correlated with higher risks of any postoperative complication (odds ratio [OR] = 3.8; 95% CI, 1.9-7.4; p < 0.001), surgical site infections (OR = 3.7; 95% CI, 1.7-8.2; p = 0.001), systemic sepsis (OR = 6.0; 95% CI, 2.1-17.2; p = 0.001), failure to wean off the ventilator (OR = 3.2; 95% CI, 1.2-8.9; p = 0.022), and postoperative length of stay ≥7 days (OR = 3.0; 95% CI, 1.5-5.9; p = 0.002). Thirty-day mortalities were similar (4.5% vs 7.1%; p = 0.46). CONCLUSIONS: We propose a novel iAE severity classification system with high internal consistency and solid construct validity. Our classification scheme might prove essential for benchmarking quality of intraoperative care across hospitals and/or individual surgeons.
Authors: Ruchika Goel; Cassandra D Josephson; Eshan U Patel; Molly R Petersen; Sarah Makhani; Steven M Frank; Paul M Ness; Evan M Bloch; Eric A Gehrie; Parvez M Lokhandwala; Marianne M Nellis; Oliver Karam; Beth H Shaz; Ravi M Patel; Aaron A R Tobian Journal: Pediatrics Date: 2020-03-20 Impact factor: 7.124
Authors: Eric C Umbreit; Andrew G McIntosh; Chalairat Suk-Ouichai; Luis A Segarra; Levi C Holland; Bryan M Fellman; Stephen B Williams; Arun Z Thomas; Shi-Ming Tu; Curtis A Pettaway; Louis L Pisters; John F Ward; Christopher G Wood; Jose A Karam Journal: Cancer Date: 2020-09-17 Impact factor: 6.921
Authors: Alessia Ferrarese; Valentina Gentile; Marco Bindi; Matteo Rivelli; Jacopo Cumbo; Mario Solej; Stefano Enrico; Valter Martino Journal: Open Med (Wars) Date: 2016-11-26
Authors: Salome Dell-Kuster; Nuno V Gomes; Larsa Gawria; Soheila Aghlmandi; Maame Aduse-Poku; Ian Bissett; Catherine Blanc; Christian Brandt; Richard B Ten Broek; Heinz R Bruppacher; Cillian Clancy; Paolo Delrio; Eloy Espin; Konstantinos Galanos-Demiris; I Ethem Gecim; Shahbaz Ghaffari; Olivier Gié; Barbara Goebel; Dieter Hahnloser; Friedrich Herbst; Ioannidis Orestis; Sonja Joller; Soojin Kang; Rocio Martín; Johannes Mayr; Sonja Meier; Jothi Murugesan; Deirdre Nally; Menekse Ozcelik; Ugo Pace; Michael Passeri; Simone Rabanser; Barbara Ranter; Daniela Rega; Paul F Ridgway; Camiel Rosman; Roger Schmid; Philippe Schumacher; Alejandro Solis-Pena; Laura Villarino; Dionisios Vrochides; Alexander Engel; Greg O'Grady; Benjamin Loveday; Luzius A Steiner; Harry Van Goor; Heiner C Bucher; Pierre-Alain Clavien; Philipp Kirchhoff; Rachel Rosenthal Journal: BMJ Date: 2020-08-25
Authors: Daniel Dante Yeh; Gabrielle E Hatton; Claudia Pedroza; Gerd Pust; Alejandro Mantero; Nicholas Namias; Lillian S Kao Journal: Trauma Surg Acute Care Open Date: 2022-09-16
Authors: Ruchika Goel; Eshan U Patel; Melissa M Cushing; Steven M Frank; Paul M Ness; Clifford M Takemoto; Ljiljana V Vasovic; Sujit Sheth; Marianne E Nellis; Beth Shaz; Aaron A R Tobian Journal: JAMA Surg Date: 2018-09-01 Impact factor: 14.766