Abstract
Background
Bleeding is an intraoperative and postoperative complication of liver surgery of concern,
and yet evidence to support utility and reproducibility of bleeding scales for liver
surgery is limited. We determined the reproducibility of the clinician-reported validated
intraoperative bleeding severity scale and its clinical value of implementation in
liver surgery.
Methods
In this descriptive and observational multicenter study, we assessed the performance
of liver surgeons instructed on the clinician-reported intraoperative bleeding severity
scale using training videos that covered all 5 grades of bleeding severity. Surgeons
were stratified according to years of surgical experience and number of surgeries
performed per year based on a median split in low and high values. Intraobserver and
interobserver agreement was assessed using Kendall’s coefficient of concordance (Kendall’s
W).
Results
Forty-seven surgeons from 10 hospitals in Spain participated in the study. The overall
intraobserver concordance was 0.985, and the overall interobserver concordance was
0.929. For “high experience” surgeons, the intraobserver and interobserver agreement
values were 0.990 and 0.941, respectively. For “low experience” surgeons, the intraobserver
and interobserver agreement was 0.981 and 0.922, respectively. Regarding the annual
number of surgeries, intraobserver and interobserver agreement values were 0.995 and
0.940, respectively, for surgeons performing >35 surgeries per year, with 0.979 and
0.923, respectively, for surgeons who perform ≤35 surgeries year.
Conclusion
The clinician-reported intraoperative bleeding severity scale shows high interobserver
and intraobserver concordance, suggesting it is a useful tool for assessing severity
of bleeding during liver surgery; years of surgical experience and number of annual
procedures performed did not affect the applicability of the clinician-reported intraoperative
bleeding severity scale.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: July 21, 2022
Accepted:
May 20,
2022
Footnotes
All authors met the ICMJE authorship criteria. Author contributions: conception and design: José Manuel Ramia-Ángel and Mario Serradilla-Martín; administrative support: all authors; provision of study materials or patients: all authors; collection and assembly of data: José Manuel Ramia-Ángel and Mario Serradilla-Martín; data analysis and interpretation: José Manuel Ramia-Ángel and Mario Serradilla-Martín; manuscript writing: José Manuel Ramia-Ángel; final approval of manuscript: all authors.
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