L. Gawria1,2, N. Gomes3, P. Kirchhoff4, H. Van Goor1, R. Rosenthal5, S. Dell-Kuster2,3,5 1Radboud University Medical Center,Surgery,Nijmegen, GELDERLAND, Netherlands 2Basel Institute for Clinical Epidemiology and Biostatistics,University Of Basel,Basel, BASEL, Switzerland 3University Hospital Basel,Anesthesiology,Basel, BASEL, Switzerland 4University Hospital Basel,Surgery,Basel, BASEL, Switzerland 5University of Basel,Basel, BASEL, Switzerland
Introduction: Prevention of intraoperative complications has received growing attention over the past decade. A clear definition and classification of intraoperative complications is required to capture the burden and achieve consistency in reporting. In a Delphi process, involving international interdisciplinary experts, such a definition and classification of intraoperative complications (CLASSIC) has been developed and retrospectively validated. Recently, an international multicenter cohort study has been conducted to prospectively validate an updated version of CLASSIC [NCT03009929]. The updated classification defines complications as any surgery- or anesthesia-related deviation from the ideal intraoperative course between skin incision and skin closure. It foresees five grades depending on the need for treatment and the severity of the symptoms. A survey including fictitious case scenarios describing intraoperative complications was used as an additional part of the prospective validation to evaluate the reliability and practicability of CLASSIC. This part of the validation is published on behalf of the CLASSIC study group.
Methods: From each of the 18 participating centers, 5 to 10 surgeons and anesthesiologists were invited via email to participate in a web-based survey. The online survey was created using SurveyMonkey® (www.surveymonkey.com) to allow respondents to complete it anonymously. The survey consisted of 10 fictitious case scenarios describing intraoperative complications. The respondents were asked to assign the corresponding severity grade of CLASSIC. The correct CLASSIC grade for each fictitious case scenario was previously determined by consensus among the investigators using objective interpretation of the definitions. The fictitious case scenarios were intentionally designed to display a wide range of severity grades and medical specialties. To assess reliability the average raw agreement across all 10 case scenarios and the intra-class correlation coefficient were determined. In addition, practicability was evaluated on a 9-point numeric scale with end-anchors "Not practical at all" and "Very practical".
Results: In total, 131 out of 163 physicians, from 18 centers and 12 countries, completed the survey (80% response rate). The physicians consisted of 50 anesthesiologists (38%), 61 abdominal surgeons (47%), and of 20 surgeons from other specialties (15%). The survey showed an intra-class correlation coefficient of 0.75 (95% CI 0.59 to 0.91) and a raw agreement of 61% (IQR 43%-70%). Practicability of CLASSIC was rated as 6 (IQR 5 -7), with 65% of the experts rating 6 or higher.
Conclusion: The survey showed a good reliability and practicability of the updated CLASSIC. We expect this to further increase when physicians become more familiar with the classification. This will eventually contribute to standardized reporting in surgical and perioperative practice and research.