Prof. Philip L Russo1,2,3, Prof Marja Boermeester4,9, Mr Giles Bond-Smith5, Prof Antonia Chen6, Prof David Leaper7,8
1Monash University, Clayton, Australia, 2Avondale University, Cooranbong, Australia, 3Cabrini Health, Malvern, Australia, 4Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands, 5Oxford University, Oxford, United Kingdom, 6University of Texas Southwestern, Dallas, USA, 7University of Newcastle, Newcastle, United Kingdom, 8University of Huddersfield, Huddersfield, United Kingdom, 9Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Amsterdam, The Netherlands
Biography:
Philip Russo is a past President of ACIPC and now Director of Research for Nursing and Midwifery at Monash University and Cabrini Health.
Abstract:
Introduction
Surgical site complications of infection, dehiscence, seroma, and hematoma are a substantial burden to healthcare economics. They are under-reported and miscategorized following inconsistent definitions and identification, resulting in inappropriate antimicrobial use and surgical management. This study aimed to establish a universal classification system including these four elements, graded by severity, enabling standardization of reporting and evaluation of postoperative outcomes.
Methods
A modified Delphi study was undertaken, comprising a five-member expert Steering Committee and a panel of 32 international surgeons, who participated in four rounds of voting. Likert-based statements sought ≥75% agreement/disagreement as consensus. Statements defined each element of the proposed system, with grades of severity for clinical management and presentation. Statements without consensus were revised for subsequent rounds, guided by free-text responses. A post-Round 3 symposium critiqued the proposed system prior to Round 4.
Results
Following Round 4, 35 consensus statements were generated. In Round 1, panellists agreed (91%) that dehiscence, inflammation/infection, seroma, hematoma encapsulated the key complications of any surgical incision, irrespective of incision site or procedure. The new classification system goes beyond infection-specific scores by describing clinical presentation of surgical site outcomes, independent of clinical management and for each of the four elements.
Conclusions
The panel reached consensus on a universal classification system including dehiscence, inflammation/infection, seroma, and hematoma, and the independent grading of the elements’ clinical management and clinical presentation. Further research is needed to test the robustness, validation and multi-specialty application of this Delphi derived system.