Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Smile Train, New York, NY.
J Craniofac Surg. 2020 Sep;31(6):e580-e584. doi: 10.1097/SCS.0000000000006603.
When determining whether a cleft lip repair outcome is acceptable, the severity of a patient's cleft at initial presentation must be considered. Currently, there is not a widely agreed upon scale for grading the pre-operative severity or post-operative surgical outcome for patients with unilateral and/or bilateral cleft lip. The aim of this study is to validate the Hubli grading system as a reliable and reproducible system for characterizing cleft lip repair outcomes.
Craniofacial surgeon graders independently evaluated 2489 patients from 56 different countries undergoing both unilateral and bilateral cleft lip repair from April 2004 to December 2018. Preoperative severity and postoperative surgical results were assessed, and these grades were combined to determine surgical outcome acceptability based on initial cleft severity. Intrarater and interrater reliability were calculated as percentages of agreement.
Intrarater and interrater acceptability scores had an agreement of 94.50% and 87.04%, respectively. These results indicate that using the Hubli grading system, independent raters are able to reliably and reproducibly measure the acceptability of a cleft lip repair.
This study validates the use of the Hubli grading system to evaluate the acceptability of unilateral and bilateral cleft lip repairs. This is the largest study to date to evaluate cleft lip severity and repair outcomes, and the Hubli grading system is the only scale to determine the acceptability of surgical outcomes based on initial cleft severity. This system is designed to identify surgeons with sub-optimal outcomes in order to implement timely, individualized training on a global scale.
在确定唇裂修复结果是否可接受时，必须考虑患者初始表现时的唇裂严重程度。目前，尚无广泛认可的分级标准来评估单侧和/或双侧唇裂患者的术前严重程度或术后手术结果。本研究旨在验证 Hubli 分级系统作为一种可靠且可重复的方法来描述唇裂修复结果。
颅面外科医生评估员独立评估了 2004 年 4 月至 2018 年 12 月期间来自 56 个不同国家的 2489 名单侧和双侧唇裂修复患者。评估了术前严重程度和术后手术结果，并将这些等级结合起来，根据初始唇裂严重程度确定手术结果的可接受性。计算了组内和组间的可靠性作为一致性的百分比。
组内和组间的可接受性评分的一致性分别为 94.50%和 87.04%。这些结果表明，使用 Hubli 分级系统，独立评估员能够可靠且可重复地测量唇裂修复的可接受性。
本研究验证了 Hubli 分级系统用于评估单侧和双侧唇裂修复的可接受性。这是迄今为止评估唇裂严重程度和修复结果的最大研究，Hubli 分级系统是唯一一种根据初始唇裂严重程度确定手术结果可接受性的标准。该系统旨在识别手术结果不理想的外科医生，以便在全球范围内及时实施个体化培训。
