Small Animal Surgery Resident University of Wisconsin-Madison Middleton, Wisconsin
Comparison of Postoperative Complication Grading Systems Following the Performance of a Single Veterinary Orthopedic Surgical Procedure. Barrett FM1;2, Bleedorn JA1, Hutcheson KD2, Torres BT2, Fox DB2. 1University of Wisconsin-Madison, Madison, WI; 2University of Missouri, Veterinary Health Center, Columbia, MO.
A method of postoperative complication grading described by Cook is widely used in veterinary surgery despite lacking evidence of reliability. The purpose of this study was to adapt a validated technique from human surgery (Clavien-Dindo) and apply it to a population of dogs that experienced postoperative complications following the performance of the TightRope® procedure for joint instability. We hypothesized that the adapted Clavien-Dindo (aCD) method would demonstrate comparable reliability to the Cook system when used by different surgeons. Records of cases reporting complications following TightRope® were obtained and summarized as case scenarios which were graded by four ACVS board-certified veterinary surgeons at two institutions using the two systems. Because the aCD system distinguishes complications from situations more accurately defined by an outcome measure (sequelae and failure to cure), two data sets were created: one where scenarios possessing outcome measures were censored as non-complications (n = 67), and one where those scenarios were included (n = 76). Interobserver reliability assessment was performed using intraclass correlation coefficient (ICC) calculations. When comparing cases of true complications, the ICC for the aCD system was 0.975 demonstrating excellent reliability, whereas the ICC using the Cook system was 0.857 demonstrating good reliability. After reintroducing sequela and failure to cure scenarios to the data, the ICC worsened for the aCD system to 0.620 while remaining unchanged for the Cook system (ICC = 0.848). This study demonstrates the potential utility of an alternative system for grading complications but will be dependent on wider acceptance of novel terminology among surgeons to be reliably applied.