International Centre for Surgical Safety, Keenan Centre for Biomedical Research, St., Michael's Hospital, Toronto, ON.
Department of Surgery, University of Toronto, Toronto, ON.
Ann Surg. 2020 Aug;272(2):220-226. doi: 10.1097/SLA.0000000000003897.
To develop and evaluate a novel instrument to measure SEVERE processes using video data.
Surgical video data can serve an important role in understanding the relationship between intraoperative events and postoperative outcomes. However, a standard tool to measure severity of intraoperative events is not yet available.
Items to be included in the instrument were identified through literature and video reviews. A committee of experts guided item reduction, including pilot tests and revisions, and determined weighted scores. Content validity was evaluated using a validated sensibility questionnaire. Inter-rater reliability was assessed by calculating intraclass correlation coefficient. Construct validity was evaluated on a sample of 120 patients who underwent laparoscopic Roux-en-Y gastric bypass procedure, in which comprehensive video data was obtained.
SEVERE index measures severity of 5 event types using ordinal scales. Each intraoperative event is given a weighted score out of 10. Inter-rater reliability was excellent [0.87 (95%-confidence interval, 0.77-0.92)]. In a sample of consecutive 120 patients undergoing gastric bypass procedures, a median of 12 events [interquartile range (IQR) 9-18] occurred per patient and bleeding was the most frequent type (median 10, IQR 7-14). The median SEVERE score per case was 11.3 (IQR 8.3-16.9). In risk-adjusted multivariable regression models, history of previous abdominal surgery (P = 0.02) and body mass index (P = 0.005) were associated with SEVERE scores, demonstrating construct validity evidence.
The SEVERE index may prove to be a useful instrument in identifying patients with high risk of developing postoperative complications.
开发和评估一种使用视频数据测量严重程度的新工具。
手术视频数据在理解术中事件与术后结果之间的关系方面可以发挥重要作用。然而，目前还没有一种标准的工具来测量术中事件的严重程度。
通过文献和视频回顾确定仪器中包含的项目。一个专家委员会指导项目减少，包括试点测试和修订，并确定加权分数。内容有效性通过使用验证的敏感性问卷进行评估。通过计算组内相关系数来评估评分者间的可靠性。通过对 120 例接受腹腔镜 Roux-en-Y 胃旁路手术的患者进行样本评估，其中获得了全面的视频数据，评估了结构有效性。
SEVERE 指数使用等级量表测量 5 种事件类型的严重程度。每个术中事件的加权得分为 10 分。评分者间的可靠性很高[0.87（95%置信区间，0.77-0.92)]。在连续 120 例接受胃旁路手术的患者中，中位数为 12 个事件[四分位间距（IQR）9-18]发生在每个患者中，出血是最常见的类型（中位数 10，IQR 7-14）。每个病例的 SEVERE 评分中位数为 11.3（IQR 8.3-16.9）。在风险调整后的多变量回归模型中，既往腹部手术史（P=0.02）和体重指数（P=0.005）与 SEVERE 评分相关，表明具有结构有效性证据。
SEVERE 指数可能成为识别术后并发症风险较高患者的有用工具。
