Interobserver Variability in the International Study Group for Pancreatic Surgery (ISGPS)-Defined Complications After Pancreatoduodenectomy: An International Cross-Sectional Multicenter Study.

IF 7.5 1区医学 Q1 SURGERY Annals of surgery Pub Date : 2024-11-01 Epub Date: 2024-08-01 DOI:10.1097/SLA.0000000000006473

Tessa E Hendriks, Alberto Balduzzi, Susan van Dieren, J Annelie Suurmeijer, Roberto Salvia, Thomas F Stoop, Marco Del Chiaro, Sven D Mieog, Mark Nielen, Sabino Zani, Daniel Nussbaum, Thilo Hackert, Jakob R Izbicki, Ammar A Javed, D Brock Hewitt, Bas Groot Koerkamp, Roeland F de Wilde, Yi Miao, Kuirong Jiang, Kohei Nakata, Masafumi Nakamura, Jin-Young Jang, Mirang Lee, Cristina R Ferrone, Shailesh V Shrikhande, Vikram A Chaudhari, Olivier R Busch, Ajith K Siriwardena, Oliver Strobel, Jens Werner, Bert A Bonsing, Giovanni Marchegiani, Marc G Besselink

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Abstract

Objective: To determine the interobserver variability for complications of pancreatoduodenectomy as defined by the International Study Group for Pancreatic Surgery (ISGPS) and others.

Background: Good interobserver variability for the definitions of surgical complications is of major importance in comparing surgical outcomes between and within centers. However, data on interobserver variability for pancreatoduodenectomy-specific complications are lacking.

Methods: International cross-sectional multicenter study including 52 raters from 13 high-volume pancreatic centers in 8 countries on 3 continents. Per center, 4 experienced raters scored 30 randomly selected patients after pancreatoduodenectomy. In addition, all raters scored 6 standardized case vignettes. This variability and the "within centers" variability were calculated for 2-fold scoring (no complication/grade A vs grade B/C) and 3-fold scoring (no complication/grade A vs grade B vs grade C) of postoperative pancreatic fistula, postpancreatoduodenectomy hemorrhage, chyle leak, bile leak, and delayed gastric emptying. Interobserver variability is presented with Gwet AC-1 measure for agreement.

Results: Overall, 390 patients after pancreatoduodenectomy were included. The overall agreement rate for the standardized cases vignettes for 2-fold scoring was 68% (95% CI: 55%-81%, AC1 score: moderate agreement), and for 3-fold scoring 55% (49%-62%, AC1 score: fair agreement). The mean "within centers" agreement for 2-fold scoring was 84% (80%-87%, AC1 score; substantial agreement).

Conclusions: The interobserver variability for the ISGPS-defined complications of pancreatoduodenectomy was too high even though the "within centers" agreement was acceptable. Since these findings will decrease the quality and validity of clinical studies, ISGPS has started efforts aimed at reducing the interobserver variability.

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国际胰腺外科研究小组（ISGPS）定义的胰十二指肠切除术后并发症的观察者间差异：一项国际多中心横断面研究。

目的确定国际胰腺外科研究小组（ISGPS）和其他机构定义的胰十二指肠切除术并发症的观察者间差异性：手术并发症定义的良好观察者间变异性对于比较中心之间和中心内部的手术结果至关重要。然而，关于胰十二指肠切除术特异性并发症的观察者间变异性的数据还很缺乏：国际横断面多中心研究，包括来自 3 大洲 8 个国家 13 个高容量胰腺中心的 52 名评分员。每个中心由 4 名经验丰富的评分员对随机抽取的 30 名胰十二指肠切除术后患者进行评分。此外，所有评分员还对 6 个标准化病例进行评分。对术后胰瘘 (POPF)、胰十二指肠切除术后出血 (PPH)、糜烂性渗漏 (CL)、胆汁渗漏 (BL) 和胃排空延迟 (DGE) 的两倍评分（无并发症/A 级 vs B/C 级）和三倍评分（无并发症/A 级 vs B 级 vs C 级）计算了这种变异性和 "中心内 "变异性。用 Gwet's AC-1 测量法显示观察者之间的一致性：结果：共纳入了 390 名胰十二指肠切除术后患者。标准化病例小节两倍评分的总体一致率为 68%（95%-CI：55%-81%，AC1 评分：中等一致），三倍评分的总体一致率为 55%（49%-62%，AC1 评分：一般一致）。两倍评分的平均 "中心内 "一致性为 84%（80%-87%，AC1 评分；基本一致）：结论：尽管 "中心内 "的一致性可以接受，但ISGPS定义的胰十二指肠切除术并发症的观察者间变异性过高。由于这些发现会降低临床研究的质量和有效性，ISGPS 已开始努力降低观察者之间的变异性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.