Evaluating the Reliability and Reproducibility of the Ottawa Thoracic Morbidity and Mortality Classification System
Evaluating the Reliability and Reproducibility of the Ottawa Thoracic Morbidity and Mortality Classification System
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DOI：
10.1016/j.athoracsur.2010.10.035
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发表时间：
2011-02-01
影响因子：
4.6
通讯作者：
Seely, Andrew J. E.
中科院分区：
文献类型：
--
作者：
Ivanovic, Jelena;Al-Hussaini, Ahmed;Seely, Andrew J. E.
背景。将术后不良事件最小化被广泛认为是质量的重要指标；然而，对于如何规范手术后不良事件的报告，尚未达成共识。我们的目的是建立一个标准化的分类系统来监测胸外科发病率和死亡率的存在和严重程度，并评估其在全国胸外科医生队列中的可靠性和可重复性。为了评估胸椎发病率和死亡率分类系统（基于Clavien-Dindo不良事件分类），于2009年8月向加拿大胸外科医师协会的所有成员发送了一份31项的问卷，包括胸椎发病率和死亡率严重等级的一般描述，20个基于病例的术后不良事件分类问题，以及关于个人判断的问题。我们使用加权Kappa统计得出描述性和定量信息。52名胸外科医生（54.7%）完成问卷调查；41人（78.8%）隶属于学术型教学医院。对所有不同的评分者对总共计算了1326个加权Kappa统计，其中1152个（87%）大于0.81，这个范围被解释为“几乎完全一致”。另有174个（13%）在0.61和0.8之间，被解释为“基本一致”。所有结果均有统计学意义（p < 0.0001）。该分类系统被认为是直接的（98%的回答者）、可重复的（94%）、合乎逻辑的（92%）和有用的（98%）。修改后的分类系统似乎提供了客观、可靠和可重复的胸外科发病率和死亡率报告，因此可能有助于胸外科手术质量的持续提高。（Ann Thorac surgery 2011; 91: 387-93） (C) 2011年由胸外科学会出版
Background. Minimizing adverse events after surgery is widely recognized as an important indicator of quality; yet no consensus has been reached on how to standardize the reporting of adverse events after surgical procedures. Our objectives were to develop a standardized classification system to monitor both the presence and severity of thoracic morbidity and mortality, and to evaluate its reliability and reproducibility among a national cohort of thoracic surgeons.Methods. To assess the Thoracic Morbidity and Mortality classification system (based on the Clavien-Dindo classification of adverse events), a 31-item questionnaire was sent to all members of the Canadian Association of Thoracic Surgeons in August 2009, consisting of a general description of the Thoracic Morbidity and Mortality severity grades, 20 case-based questions of postoperative adverse events to be classified, and questions regarding personal judgments. We derived descriptive and quantitative information using weighted Kappa statistics.Results. Fifty-two (54.7%) thoracic surgeons completed the questionnaire; 41 (78.8%) of the respondents were affiliated with an academic teaching hospital. A total of 1,326 individual weighted Kappa statistics were calculated for all distinct pairs of raters, of which 1,152 (87%) were greater than 0.81, a range that is interpreted as "almost perfect agreement." A further 174 (13%) were in the range between 0.61 and 0.8, interpreted as "substantial agreement." All results were statistically significant (p < 0.0001). The classification system was regarded as straightforward (98% of the respondents), reproducible (94%), logical (92%), and useful (98%).Conclusions. The modified classification system appears to offer objective, reliable, and reproducible reporting of thoracic morbidity and mortality, and thus may assist continuous quality improvement in thoracic surgery. (Ann Thorac Surg 2011; 91: 387-93) (C) 2011 by The Society of Thoracic Surgeons