February 2, 2022
Using the Centers for Disease Control (CDC) classification for the stratification of surgical wounds based on contamination and risk of developing a surgical site infection, researchers from Mayo Clinic in Jacksonville, Florida, investigated the degree of interobserver reliability between orthopedic surgeons.
Their work, “A Comparison of Interobserver Reliability Between Orthopedic Surgeons Using the Centers for Disease Control Surgical Wound Class Definitions,” was published in the December 15, 2021 edition of the Journal of the American Academy of Orthopaedic Surgeons.
Assistant Professor and Senior Associate Consultant in the Department of Orthopedic Surgery at Mayo Clinic in Florida and study co-author, Benjamin Wilke, M.D., explained the hypothesis of the study to OTW, “Accurate reporting of surgical outcomes is paramount to improving quality of care. Currently all surgical procedures are labeled using a classification system that was developed in the 1960s, intended mainly for general surgical procedures. This classification system often does not pertain to surgical wounds for subspecialty procedures. We felt that this would lead to errors in reporting and was the driver for our research.”
In addition to not being specific to orthopedic procedures, the classification system also involves a higher degree of subjectivity. This typically makes consistency more challenging to achieve, even with the latest automation technology, such as what’s used in documentation services like automated scribing or new medical dictation software with AI.
To test to what extent the classification system might lead to errors, the team distributed questionnaires with 30 clinical vignettes to 39 orthopedic surgeons at their institution. Participants then determined the appropriate wound class based and the interobserver agreement was analyzed. The investigators also asked respondents how adequate the existing classification system was in describing orthopedic surgical wound class.
The researchers asked their physician colleagues to assign the appropriate CDC surgical wound class as:
“We hypothesized that there would be low agreement amongst orthopedic surgeons when assigning a surgical wound class to clinical vignettes,” stated Dr. Wilke to OTW. “We found that interobserver agreement was poor (66%), and that only 15% of orthopedic surgeons surveyed felt that the current wound classification adequately covered orthopedic procedures.”
Unlike the CDC's wound classification system, other types of medical documentation like coding lend themselves naturally to automation, which can be used by orthopedic practices to improve consistency among doctors and accuracy across the clinic.
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