A new classification for surgical NEC during exploratory laparotomy: introduction and reproducibility assessment
link.springer.com shows its articles on its own site.
Read the article on link.springer.com ↗Article · Apr 2024 · 1 min read
In brief
In brief
This study introduces a standardized intraoperative classification system for surgical necrotizing enterocolitis (NEC) based on anatomical details and extent of intestinal involvement. Validated across 95 cases at two tertiary centers, the system demonstrated excellent intra-observer (κ=0.889) and substantial inter-observer (κ=0.806) reliability, offering a reproducible framework for operative decision-making and prognostic assessment in neonatal NEC surgery.
- New intraoperative classification system for surgical NEC demonstrates excellent intra-observer reliability (κ=0.889) and substantial inter-observer reliability (κ=0.806).
- Classification incorporates anatomical details and extent of intestinal involvement to standardize assessment across different necrosis patterns and operative techniques.
- System validated across 95 surgical NEC cases from two tertiary centers, showing potential to guide operative strategy and improve prognosis prediction.
- Standardized reporting may enhance scholarly communication and comparison of outcomes in pediatric surgery for necrotizing enterocolitis.
- High reproducibility suggests the classification can reliably inform surgical decision-making regarding resection extent and reconstruction approach.
Written by the GCMD Library team from the article.
Abstract
Purpose
Variability in necrosis patterns and operative techniques in surgical necrotizing enterocolitis (NEC) necessitates a standardized classification system for consistent assessment and comparison. This study introduces a novel intraoperative reporting system for surgical NEC, focusing on reliability and reproducibility.
Methods
Analyzing surgical NEC cases from January 2018 to June 2023 at two tertiary neonatal and pediatric surgery units, a new classification system incorporating anatomical details and intestinal involvement extent was developed. Its reproducibility was quantified using kappa coefficients (κ) for interobserver and intraobserver reliability, assessed by four specialists. Furthermore, following surgery, the occurrence of mortality and enteric autonomy were evaluated on the basis of surgical decision-making of the novel intraoperative classification system for surgical NEC.
Results
In total, 95 patients with surgical NEC were included in this analysis. The mean κ value of the intra-observer reliability was 0.889 (range, 0.790−0.941) for the new classification, indicating excellent agreement and the inter-observer reliability was 0.806 (range, 0.718−0.883), indicating substantial agreement.
Conclusion
The introduced classification system for surgical NEC shows high reliability, deepening the understanding of NEC's intraoperative exploration aspects. It promises to indicate operative strategies, enhance prognosis prediction, and substantially facilitate scholarly communication in pediatric surgery. Importantly, it explores the potential for a standardized report and may represent a step forward in classifying surgical NEC, if pediatric surgeons are open to change.