Benjamin D Roye1, Adam N Fano1, Theodore Quan2, Hiroko Matsumoto1,3, Sumeet Garg4, Michael J Heffernan5, Selina C Poon6, Michael P Glotzbecker7, Nicholas D Fletcher8, Peter F Sturm9, Norman Ramirez10, Michael G Vitale1, Jason B Anari11. 1. Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA. 2. Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA. teddyquan@gwu.edu. 3. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA. 4. Department of Orthopaedic Surgery, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO, 80045, USA. 5. Department of Orthopaedic Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA. 6. Department of Orthopaedic Surgery, Shriners Children's Southern California, 909 S Fair Oaks Ave, Pasadena, CA, 91105, USA. 7. Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA. 8. Department of Orthopedic Surgery, Children's Healthcare of Atlanta, 1400 Tullie Rd NE 2nd Floor, Atlanta, GA, 30329, USA. 9. Department of Orthopaedic Surgery, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. 10. Department of Orthopaedic Surgery, Hospital de la Concepción, CARR 2 KM 173, San Germán, PR, 00683, USA. 11. Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Abstract
PURPOSE: Appropriately measuring and classifying surgical complications is a critical component of research in vulnerable populations, including children with early-onset scoliosis (EOS). The purpose of this study was to assess the inter- and intra-rater reliability of a modified Clavien-Dindo-Sink system (CDS) classification system for EOS patients among a group of pediatric spinal deformity surgeons. METHODS: Thirty case scenarios were developed and presented to experienced surgeons in an international spine study group. For each case, surgeons were asked to select a level of severity based on the modified CDS system to assess inter-rater reliability. The survey was administered on two occasions to allow for assessment of intra-rater reliability. Weighted Kappa values were calculated, with 0.61 to 0.80 considered substantial agreement and 0.81 to 1.00 considered nearly perfect agreement. RESULTS: 11/12 (91.7%) surgeons completed the first-round survey and 8/12 (66.7%) completed the second. Inter-observer weighted kappa values for the first and second survey were 0.75 [95% CI 0.56-0.94], indicating substantial agreement, and 0.84 [95% CI 0.70-0.98], indicating nearly perfect agreement, respectively. Intra-observer reliability was 0.86 (range 0.74-0.95) between the first and second surveys, indicating nearly perfect agreement . CONCLUSION: The modified CDS classification system demonstrated substantial to nearly perfect agreement between and within observers for the evaluation of complications following the surgical treatment of EOS patients. Adoption of this reliable classification system as a standard for reporting complications in EOS patients can be a valuable tool for future research endeavors, as we seek to ultimately improve surgical practices and patient outcomes. LEVEL OF EVIDENCE: Level V.
PURPOSE: Appropriately measuring and classifying surgical complications is a critical component of research in vulnerable populations, including children with early-onset scoliosis (EOS). The purpose of this study was to assess the inter- and intra-rater reliability of a modified Clavien-Dindo-Sink system (CDS) classification system for EOS patients among a group of pediatric spinal deformity surgeons. METHODS: Thirty case scenarios were developed and presented to experienced surgeons in an international spine study group. For each case, surgeons were asked to select a level of severity based on the modified CDS system to assess inter-rater reliability. The survey was administered on two occasions to allow for assessment of intra-rater reliability. Weighted Kappa values were calculated, with 0.61 to 0.80 considered substantial agreement and 0.81 to 1.00 considered nearly perfect agreement. RESULTS: 11/12 (91.7%) surgeons completed the first-round survey and 8/12 (66.7%) completed the second. Inter-observer weighted kappa values for the first and second survey were 0.75 [95% CI 0.56-0.94], indicating substantial agreement, and 0.84 [95% CI 0.70-0.98], indicating nearly perfect agreement, respectively. Intra-observer reliability was 0.86 (range 0.74-0.95) between the first and second surveys, indicating nearly perfect agreement . CONCLUSION: The modified CDS classification system demonstrated substantial to nearly perfect agreement between and within observers for the evaluation of complications following the surgical treatment of EOS patients. Adoption of this reliable classification system as a standard for reporting complications in EOS patients can be a valuable tool for future research endeavors, as we seek to ultimately improve surgical practices and patient outcomes. LEVEL OF EVIDENCE: Level V.
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