Does surgeon seniority affect adhesion assessment at cesarean delivery? A prospective study

Shai Ram; Ziv Shapira; Hila Shalev-Ram; Shira Alon; Roza B Shperling; Margaret J Lipinski; Yariv Yogev; Ariel Many

doi:10.1016/j.xagr.2023.100162

Does surgeon seniority affect adhesion assessment at cesarean delivery? A prospective study

AJOG Glob Rep. 2023 Jan 28;3(1):100162. doi: 10.1016/j.xagr.2023.100162. eCollection 2023 Feb.

Authors

Shai Ram^{1

2}, Ziv Shapira^{1

2}, Hila Shalev-Ram^{2

3}, Shira Alon⁴, Roza B Shperling^{1

2}, Margaret J Lipinski², Yariv Yogev^{1

2}, Ariel Many^{1

2}

Affiliations

¹ Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
² Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr S Ram, Dr Shapira, Dr H Ram, Dr Shperling, Dr Lipinski, Prof Yogev, and Prof Many).
³ Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel (Dr H Ram).
⁴ Department of Statistics and Data Science, Hebrew University of Jerusalem, Jerusalem, Israel (Mr Alon).

Abstract

Background: Intraabdominal adhesions may develop following cesarean delivery and are considered a major concern.

Objective: This study aimed to determine the effect of surgeon seniority in evaluating intraabdominal adhesions at cesarean delivery.

Study design: A prospective study to estimate interrater reliability between surgeons was conducted. Women who underwent cesarean delivery (January-July 2021) in a single tertiary university-affiliated medical center were included. Blinded questionnaires assessing adhesions were completed by the surgeons. Questions were limited to 4 main anatomic sites and 3 possible categories of adhesion (each site was scored between 0 and 2; the sum score range was 0-8). The surgeons were ranked by increasing seniority (1-4) as: (1) junior residents (less than half of residency completed), (2) senior residents (more than half of residency completed), (3) young attending physicians (attending physicians for <10 years), and (4) senior attendings (attending physicians for >10 years). The weighted percentage of agreement was calculated between the 2 surgeons assessing the same adhesions. Scoring differences between the 2 surgeons (senior vs less senior) were also calculated.

Results: A total of 96 pairs of surgeons were included in the study. The sum interrater reliability found in the weighted agreement tests between surgeons was 0.918 (confidence interval, 0.898-0.938). When scoring differences between surgeons (senior vs less senior) were calculated, nonsignificant difference was found (mean sum score difference of 0.09 with a standard deviation of 1.03 in favor of the more experienced surgeon).

Conclusion: Surgeon seniority does not affect subjective scoring of adhesion reports.

Keywords: interrater reliability; postoperative adhesions; post–cesarean delivery complication.