Department of Surgery, Hospital General Universitario de Alicante, ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
Department of Surgery, Hospital Universitario Miguel Servet, University of Zaragoza, Spain.
Surgery. 2022 Oct;172(4):1141-1146. doi: 10.1016/j.surg.2022.05.022. Epub 2022 Jul 22.
Bleeding is an intraoperative and postoperative complication of liver surgery of concern, and yet evidence to support utility and reproducibility of bleeding scales for liver surgery is limited. We determined the reproducibility of the clinician-reported validated intraoperative bleeding severity scale and its clinical value of implementation in liver surgery.
In this descriptive and observational multicenter study, we assessed the performance of liver surgeons instructed on the clinician-reported intraoperative bleeding severity scale using training videos that covered all 5 grades of bleeding severity. Surgeons were stratified according to years of surgical experience and number of surgeries performed per year based on a median split in low and high values. Intraobserver and interobserver agreement was assessed using Kendall's coefficient of concordance (Kendall's W).
Forty-seven surgeons from 10 hospitals in Spain participated in the study. The overall intraobserver concordance was 0.985, and the overall interobserver concordance was 0.929. For "high experience" surgeons, the intraobserver and interobserver agreement values were 0.990 and 0.941, respectively. For "low experience" surgeons, the intraobserver and interobserver agreement was 0.981 and 0.922, respectively. Regarding the annual number of surgeries, intraobserver and interobserver agreement values were 0.995 and 0.940, respectively, for surgeons performing >35 surgeries per year, with 0.979 and 0.923, respectively, for surgeons who perform ≤35 surgeries year.
The clinician-reported intraoperative bleeding severity scale shows high interobserver and intraobserver concordance, suggesting it is a useful tool for assessing severity of bleeding during liver surgery; years of surgical experience and number of annual procedures performed did not affect the applicability of the clinician-reported intraoperative bleeding severity scale.
术中及术后出血是肝脏手术的一个关注点，然而，支持肝脏手术出血评分的实用性和可重复性的证据有限。我们旨在确定经临床医生报告的术中出血严重程度评分的可重复性及其在肝脏手术中的临床应用价值。
在这项描述性和观察性多中心研究中，我们评估了经过培训视频指导的肝脏外科医生使用经临床医生报告的术中出血严重程度评分的表现，该培训视频涵盖了所有 5 级出血严重程度。根据中位分割值，将外科医生分为手术经验年限和每年手术次数低和高值两组。采用 Kendall 协调系数（Kendall's W）评估观察者内和观察者间的一致性。
来自西班牙 10 家医院的 47 名外科医生参与了这项研究。总体观察者内一致性为 0.985，总体观察者间一致性为 0.929。对于“高经验”外科医生，观察者内和观察者间的一致性分别为 0.990 和 0.941。对于“低经验”外科医生，观察者内和观察者间的一致性分别为 0.981 和 0.922。关于每年手术次数，每年进行>35 例手术的外科医生的观察者内和观察者间的一致性分别为 0.995 和 0.940，每年进行≤35 例手术的外科医生的观察者内和观察者间的一致性分别为 0.979 和 0.923。
经临床医生报告的术中出血严重程度评分具有较高的观察者间和观察者内一致性，表明其是评估肝脏手术中出血严重程度的有用工具；手术经验年限和每年手术次数并未影响经临床医生报告的术中出血严重程度评分的适用性。
