Elisabeth Jacomine Lier1, Barend A W van den Beukel2, Larsa Gawria2, Philip J van der Wees3, Leontine van den Hil4, Nicole D Bouvy4,5, Ying Cheong6,7, Rudy-Leon de Wilde8, Harry van Goor2, Martijn W J Stommel2, Richard P G Ten Broek2. 1. Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. janienkelier@gmail.com. 2. Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. 3. IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands. 4. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. 5. Department of Surgery, Uniklinik RWTH, Aachen, Germany. 6. Faculty of Medicine, Human Development and Health, University of Southampton, Southampton, UK. 7. Complete Fertility, Princess Anne Hospital, Southampton, UK. 8. Department of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Oldenburg, Germany.
Abstract
BACKGROUND: Adhesions are a major cause of long-term postsurgical complications in abdominal and pelvic surgery. Existing adhesion scores primarily measure morphological characteristics of adhesions that do not necessarily correlate with morbidity. The aim of this study was to develop a clinical adhesion score (CLAS) measuring overall clinical morbidity of adhesion-related complications in abdominal and pelvic surgery. METHODS: An international Delphi study was performed to identify relevant score items for adhesion-related complications, including small bowel obstruction, female infertility, chronic abdominal or pelvic pain, and difficulties at reoperation. The CLAS includes clinical outcomes, related to morbidity of adhesions, and weight factors, to correct the outcome scores for the likelihood that symptoms are truly caused by adhesions. In a pilot study, two independent researchers retrospectively scored the CLAS in 51 patients to evaluate inter-observer reliability, by calculating the Intraclass correlation coefficient. During a feasibility assessment, we evaluated whether the CLAS completely covered different clinical scenarios of adhesion-related morbidity. RESULTS: Three Delphi rounds were performed. 43 experts agreed to participate, 38(88%) completed the first round, and 32 (74%) the third round. Consensus was reached on 83.4% of items. Inter-observer reliability for the CLAS was 0.95 (95% CI 0.91-0.97). During feasibility assessment, six items were included. As a result, the CLAS includes 22 outcomes and 23 weight factors. CONCLUSION: The CLAS represents a promising scoring system to measure and monitor the clinical morbidity of adhesion-related complications. Further studies are needed to confirm its utility in clinical practice.
BACKGROUND: Adhesions are a major cause of long-term postsurgical complications in abdominal and pelvic surgery. Existing adhesion scores primarily measure morphological characteristics of adhesions that do not necessarily correlate with morbidity. The aim of this study was to develop a clinical adhesion score (CLAS) measuring overall clinical morbidity of adhesion-related complications in abdominal and pelvic surgery. METHODS: An international Delphi study was performed to identify relevant score items for adhesion-related complications, including small bowel obstruction, female infertility, chronic abdominal or pelvic pain, and difficulties at reoperation. The CLAS includes clinical outcomes, related to morbidity of adhesions, and weight factors, to correct the outcome scores for the likelihood that symptoms are truly caused by adhesions. In a pilot study, two independent researchers retrospectively scored the CLAS in 51 patients to evaluate inter-observer reliability, by calculating the Intraclass correlation coefficient. During a feasibility assessment, we evaluated whether the CLAS completely covered different clinical scenarios of adhesion-related morbidity. RESULTS: Three Delphi rounds were performed. 43 experts agreed to participate, 38(88%) completed the first round, and 32 (74%) the third round. Consensus was reached on 83.4% of items. Inter-observer reliability for the CLAS was 0.95 (95% CI 0.91-0.97). During feasibility assessment, six items were included. As a result, the CLAS includes 22 outcomes and 23 weight factors. CONCLUSION: The CLAS represents a promising scoring system to measure and monitor the clinical morbidity of adhesion-related complications. Further studies are needed to confirm its utility in clinical practice.
Authors: Barend A van den Beukel; Roy de Ree; Suzanne van Leuven; Erica A Bakkum; Chema Strik; Harry van Goor; Richard P G Ten Broek Journal: Hum Reprod Update Date: 2017-05-01 Impact factor: 15.610
Authors: Rudy Leon De Wilde; Rajesh Devassy; Richard P G Ten Broek; Charles E Miller; Aizura Adlan; Prudence Aquino; Sven Becker; Ferry Darmawan; Marco Gergolet; Maria Antonia E Habana; Chong Kiat Khoo; Philippe R Koninckx; Matthias Korell; Harald Krentel; Olarik Musigavong; George Pistofidis; Shailesh Puntambekar; Ichnandy A Rachman; Fatih Sendag; Markus Wallwiener; Luz Angela Torres-de la Roche Journal: J Clin Med Date: 2022-03-08 Impact factor: 4.241