SURGICAL RESEARCH
Development and Evaluation of a Novel Instrument to Measure Severity of Intraoperative Events
Published on
August 1, 2020
Annals of Surgery
Overview
This study describes the development and validation of the SEVERE (Severity of Events Related to Intraoperative Video Evaluation) index, a novel instrument designed to measure the severity of intraoperative events using surgical video data. The researchers created the index through a rigorous process involving literature review, expert consultation, and pilot testing. The SEVERE index evaluates five types of intraoperative events using weighted ordinal scales, with each event scored out of 10.
The instrument demonstrated excellent inter-rater reliability and showed evidence of construct validity when tested on 120 laparoscopic Roux-en-Y gastric bypass procedures. The study found that patients had a median of 12 intraoperative events per procedure, with bleeding being the most common. Factors such as previous abdominal surgery and body mass index were associated with higher SEVERE scores. The researchers conclude that the SEVERE index could be a valuable tool for identifying patients at higher risk of postoperative complications, potentially improving surgical outcomes and patient care.
Results
SEVERE index measures severity of 5 event types using ordinal scales. Each intraoperative event is given a weighted score out of 10. Inter-rater reliability was excellent [0.87 (95%-confidence interval, 0.77-0.92)]. In a sample of consecutive 120 patients undergoing gastric bypass procedures, a median of 12 events [interquartile range (IQR) 9-18] occurred per patient and bleeding was the most frequent type (median 10, IQR 7-14). The median SEVERE score per case was 11.3 (IQR 8.3-16.9). In risk-adjusted multivariable regression models, history of previous abdominal surgery (P = 0.02) and body mass index (P = 0.005) were associated with SEVERE scores, demonstrating construct validity evidence.
