1st Department of Urology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Department of Surgery, Urology Clinic, University of Verona, Verona, Italy.
Eur Urol Focus. 2018 Jul;4(4):608-613. doi: 10.1016/j.euf.2017.02.014. Epub 2017 Mar 7.
Since 2012 uniformed reporting of complications after urological procedures has been advocated by the European Association of Urology (EAU) guidelines. The Clavien-Dindo grading system was recommended to report the outcomes of urologic procedures.
To validate the Clavien-Dindo grading system in urology.
DESIGN, SETTING, AND PARTICIPANTS: Members of the EAU working group compiled a list of case scenarios including those with minor and major complications. A survey was administered online via Survey Monkey to the members of EAU committees for the appropriate grading according to the Clavien-Dindo classification of surgical complications. Scenarios with intraoperative complications were intentionally included to assess respondents' awareness of the Clavien-Dindo applicability.
Survey data collected were used to calculate agreement rates and to estimate the overall inter-rater agreement on all cases using Fleiss' kappa (κ). Differences in agreement rates for each scenario among groups with different criteria about the system were estimated using the chi-square test.
Evaluable responses were received from 81 out of 174 invited raters (46.5%). Of them 56.9% believed that the Clavien-Dindo system was adequate for grading postoperative complications. The agreement rate was over a score of ≥80% in nine cases, 60-79% in 10 cases, 40-59% in 14 cases, and <40% in two cases. Interestingly, the agreement rate on the nonapplicability of the Clavien-Dindo system was quite low, ranging from 27.5% to 67.2% (κ=0.147). Being a resident rather than a specialist affected only the distribution of agreement rates in case 1 (ie, score IIIb: 83.3% vs 94.1%). Being an academic or having affiliation did not have any impact on the distribution of agreement rates in all cases but one.
The Clavien-Dindo classification is a standardised approach to grade and report postoperative complications in urology and should be used systematically. However, it does not apply for intraoperative complications, and there is a need for an additional tool.
A rigorous methodology is mandatory when surgeons report about complications after surgery. In this study, the European Association of Urology Guidelines Panel has validated the use of the Clavien-Dindo grading system in urology.
自 2012 年以来，欧洲泌尿外科学会（EAU）指南一直提倡对泌尿科手术后的并发症进行统一报告。推荐使用 Clavien-Dindo 分级系统来报告泌尿科手术的结果。
验证泌尿科的 Clavien-Dindo 分级系统。
设计、地点和参与者：EAU 工作组的成员编制了一份病例情况清单，包括轻微和严重并发症的病例。通过 Survey Monkey 在线向 EAU 委员会的成员进行了一项调查，根据手术并发症的 Clavien-Dindo 分类对这些病例进行适当的分级。故意纳入术中并发症的病例，以评估受访者对 Clavien-Dindo 适用性的认识。
收集的调查数据用于计算一致性比率，并使用 Fleiss' kappa（κ）估计所有病例的总体评分者间一致性。使用卡方检验估计不同系统标准组之间的每个病例的一致性比率差异。
在受邀的 174 名评分者中，有 81 名进行了评估。其中 56.9%的人认为 Clavien-Dindo 系统足以对术后并发症进行分级。在九个病例中，评分≥80%的一致性比率超过 90%，10 个病例中为 60-79%，14 个病例中为 40-59%，两个病例中<40%。有趣的是，Clavien-Dindo 系统不适用的一致性比率相当低，范围为 27.5%至 67.2%（κ=0.147）。作为住院医师而非专家仅影响病例 1（即评分 IIIb：83.3%对 94.1%）的一致性比率分布。学术背景或附属关系对所有病例但一个病例的评分者间一致性比率分布均无影响。
Clavien-Dindo 分级是一种标准化的方法，用于对泌尿科手术后的并发症进行分级和报告，应系统使用。然而，它不适用于术中并发症，因此需要额外的工具。
外科医生报告手术后的并发症时，必须采用严格的方法。在这项研究中，欧洲泌尿外科学会指南小组已经验证了在泌尿科中使用 Clavien-Dindo 分级系统的有效性。
Zotero 插件