Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 May-Jun;7(5-6):179-84.
doi: 10.5489/cuaj.505.

Clavien classification in urology: Is there concordance among post-graduate trainees and attending urologists?

Mohamed A Elkoushy  1 , Murilo A Luz, Tarik Benidir, Saad Aldousari, Armen G Aprikian, Sero Andonian
Affiliations

Clavien classification in urology: Is there concordance among post-graduate trainees and attending urologists?

Mohamed A Elkoushy et al. Can Urol Assoc J. 2013 May-Jun.

Abstract

Purpose: We assess the variations between post-graduate trainees (PGTs) and attending urologists in applying the Revised Clavien-Dindo Classification System (RCCS) to urological complications.

Methods: Twenty postoperative complications were selected from urology service Quality Assurance meeting minutes spanning 1 year at a tertiary care centre. The cases were from adult and pediatric sites and included minor and major complications. After a briefing session to review the RCCS, the survey was administered to 16 attending urologists and 16 PGTs. Concordance rates between the two groups were calculated for each case and for the whole survey. Inter-rater agreement was calculated by kappa statistics.

Results: There was good overall agreement rate of 81 % (range: 30-100) when both groups were compared. Thirteen of the 20 cases (65%) held an agreement rate above 80% (k = 0.753, p < 0.001) including 3 (15%) cases with 100% agreement. There were only 2 cases where the scores given by PGTs were significantly different from that given by attending urologists (p ≤ 0.03). There was no significant difference between both groups in terms of overall RCCS grades (p = 0.12). When all participants were compared as one group, there was good overall inter-rater agreement rate of 75% (k = 0.71). Although the percent of overall agreement rate among PGTs was higher than the attending urologists (82% [k = 0.79] vs. 69% [k = 0.64]), this was not significantly different (p = 0.68).

Conclusion: There was good overall agreement among PGTs and attending urologists in application of the RCCS in urology. Therefore, it is appropriate for PGTs to complete the Quality Assurance meeting reports.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Revised Clavien-Dindo Classification System Grading according to group (post-graduate trainnes vs. attending urologists); p = 0.36.
Fig. 2.
Fig. 2.
Inter-group differences between post-graduate trainees and attending urologists using the contracted Revised Clavien-Dindo Classification System; p = 0.09.
See this image and copyright information in PMC

Comment in

References

    1. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518–26. - PubMed
    1. Dindo D, Demartines N, Clavien PA. Classification of Surgical Complications. A New Proposal with Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg. 2004;240:205–13. doi: 10.1097/01.sla.0000133083.54934.ae. - DOI - PMC - PubMed
    1. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96. doi: 10.1097/SLA.0b013e3181b13ca2. - DOI - PubMed
    1. Donat SM, Shabsigh A, Savage C, et al. Potential impact of postoperative early complications on the timing of adjuvant chemotherapy in patients undergoing radical cystectomy: a high-volume Tertiary Cancer Center Experience. Eur Urol. 2009;55:177–85. doi: 10.1016/j.eururo.2008.07.018. - DOI - PubMed
    1. Constantinides CA, Tyritzis SI, Skolarikos A, et al. Short- and long-term complications of open radical prostatectomy according to the Clavien Classification system. BJU Int. 2009;103:336–40. doi: 10.1111/j.1464-410X.2008.08080.x. - DOI - PubMed

LinkOut - more resources