Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

S15-13

(P)

THE CLAVIEN-DINDO CLASSIFICATION OF SURGICAL COMPLICATIONS IS NOT A

STATISTICALLY REPRODUCIBLE WAY TO GRADE MORBIDITY IN PEDIATRIC

UROLOGY

Moira DWYER

, Joseph DWYER

, Glenn CANNON, JR.

, Heidi STEPHANY

and Michael OST

1) Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Urology, Pittsburgh, USA - 2) De la

Torre Research, New York, USA

PURPOSE

Use of the Clavien-Dindo Classification of Surgical Complications is becoming more widespread in urology and has been

"highly recommended" by the European Association of Urology since 2012. The system was initially evaluated using a

cohort of 6,336 adult general surgery patients and we hypothesized that it is not well-suited to pediatric cases. We set

out to formally assess the grading system for use in pediatric urology.

MATERIAL AND METHODS

We modified the 14 adult surgical cases in the “Survey to Assess Acceptability and Reproducibility of the Classification”

to pediatric urology cases of similar Clavien-Dindo Classification grades. We used REDCap electronic data capture tool

to distribute the survey and preserve respondent anonymity.

RESULTS

There were 51 respondents and 40 complete responses. The Clavien-Dindo Classification was significantly less accurate

when applied to pediatric urology cases (75%, 410/550) than adult surgical cases (90%, 1816/2016; p<0.0001). The

mean intercoder reliability, bootstrapped, (alpha=0.461, CI 0.370-0.547) was below the minimum level of acceptable

agreement (alpha=0.667) even when the analysis excluded the disability suffix (alpha=0.617, CI 0.507-0.698). The

Clavien-Dindo Classification was not perceived to be as simple, logical, or useful as it had been with adult surgical cases

(p=0.001, 0.02, 0.001, respectively). While 89% of respondents (32/36) thought that the system is appropriate for the

adult population, only 49% thought that it is appropriate for pediatrics (17/35, p<0.001).

CONCLUSIONS

The accuracy of the Clavien-Dindo Classification of Surgical Complications is decreased in pediatric urologic cases. This

system is not a statistically reproducible way to grade morbidity in the pediatric urologic population and findings suggest

it should not be used for this purpose.