TY - JOUR
T1 - Clinical adhesion score (CLAS)
T2 - development of a novel clinical score for adhesion-related complications in abdominal and pelvic surgery
AU - CLAS Collaboration
AU - Lier, Elisabeth Jacomine
AU - van den Beukel, Barend A.W.
AU - Gawria, Larsa
AU - van der Wees, Philip J.
AU - van den Hil, Leontine
AU - Bouvy, Nicole D.
AU - Cheong, Ying
AU - de Wilde, Rudy Leon
AU - Parker, Mike
AU - Schreinemacher, Marc
AU - van der Wal, Johannes B.C.
AU - Fleshman, James W.
AU - Wilson, Malcolm
AU - Bakkum, Erica
AU - Lundorff, Per
AU - Diamond, Michael P.
AU - Trew, Geoffrey
AU - Koninckx, Phillipe
AU - Krämer, Bernhard
AU - Verguts, Jasper
AU - Di Saverio, Salomone
AU - Leppaniemi, Ari
AU - Sugrue, Michael
AU - Kluger, Yoram
AU - Sallinen, Ville
AU - Ouaissi, Mehdi
AU - Ansaloni, Luca
AU - Beck, David E.
AU - Catena, Fausto
AU - Wallwiener, Markus
AU - Mais, Valerio
AU - Hackethal, Andreas
AU - Tulandi, Togas
AU - Burcharth, Jakob
AU - Gerner Rasmussen, Jonas
AU - Song, Yong S.
AU - Wiseman, David M.
AU - Coccolini, Federico
AU - Dupre, Aurélien
AU - Kumakiri, Jun
AU - van Goor, Harry
AU - Stommel, Martijn W.J.
AU - ten Broek, Richard P.G.
N1 - Funding Information:
The authors would like to thank CLAS collaboration Expert panel members Mike Parker, Marc Schreinemacher, Johannes B.C. van der Wal, James W. Fleshman, Malcolm Wilson, Erica Bakkum, Per Lundorff, Michael P. Diamond, Geoffrey Trew, Phillipe Koninckx, Bernhard Krämer, Jasper Verguts, Salomone Di Saverio, Ari Leppaniemi, Michael Sugrue, Yoram Kluger, Ville Sallinen, Mehdi Ouaissi, Luca Ansaloni, David E. Beck, Fausto Catena, Markus Wallwiener, Valerio Mais, Andreas Hackethal, Togas Tulandi, Jakob Burcharth, Jonas Gerner Rasmussen, Yong S. Song, David M. Wiseman, Federico Coccolini, Aurélien Dupre, and Jun Kumakiri.
Publisher Copyright:
© 2020, The Author(s).
PY - 2021/5
Y1 - 2021/5
N2 - Background: Adhesions are a major cause of long-term postsurgical complications in abdominal and pelvic surgery. Existing adhesion scores primarily measure morphological characteristics of adhesions that do not necessarily correlate with morbidity. The aim of this study was to develop a clinical adhesion score (CLAS) measuring overall clinical morbidity of adhesion-related complications in abdominal and pelvic surgery. Methods: An international Delphi study was performed to identify relevant score items for adhesion-related complications, including small bowel obstruction, female infertility, chronic abdominal or pelvic pain, and difficulties at reoperation. The CLAS includes clinical outcomes, related to morbidity of adhesions, and weight factors, to correct the outcome scores for the likelihood that symptoms are truly caused by adhesions. In a pilot study, two independent researchers retrospectively scored the CLAS in 51 patients to evaluate inter-observer reliability, by calculating the Intraclass correlation coefficient. During a feasibility assessment, we evaluated whether the CLAS completely covered different clinical scenarios of adhesion-related morbidity. Results: Three Delphi rounds were performed. 43 experts agreed to participate, 38(88%) completed the first round, and 32 (74%) the third round. Consensus was reached on 83.4% of items. Inter-observer reliability for the CLAS was 0.95 (95% CI 0.91–0.97). During feasibility assessment, six items were included. As a result, the CLAS includes 22 outcomes and 23 weight factors. Conclusion: The CLAS represents a promising scoring system to measure and monitor the clinical morbidity of adhesion-related complications. Further studies are needed to confirm its utility in clinical practice.
AB - Background: Adhesions are a major cause of long-term postsurgical complications in abdominal and pelvic surgery. Existing adhesion scores primarily measure morphological characteristics of adhesions that do not necessarily correlate with morbidity. The aim of this study was to develop a clinical adhesion score (CLAS) measuring overall clinical morbidity of adhesion-related complications in abdominal and pelvic surgery. Methods: An international Delphi study was performed to identify relevant score items for adhesion-related complications, including small bowel obstruction, female infertility, chronic abdominal or pelvic pain, and difficulties at reoperation. The CLAS includes clinical outcomes, related to morbidity of adhesions, and weight factors, to correct the outcome scores for the likelihood that symptoms are truly caused by adhesions. In a pilot study, two independent researchers retrospectively scored the CLAS in 51 patients to evaluate inter-observer reliability, by calculating the Intraclass correlation coefficient. During a feasibility assessment, we evaluated whether the CLAS completely covered different clinical scenarios of adhesion-related morbidity. Results: Three Delphi rounds were performed. 43 experts agreed to participate, 38(88%) completed the first round, and 32 (74%) the third round. Consensus was reached on 83.4% of items. Inter-observer reliability for the CLAS was 0.95 (95% CI 0.91–0.97). During feasibility assessment, six items were included. As a result, the CLAS includes 22 outcomes and 23 weight factors. Conclusion: The CLAS represents a promising scoring system to measure and monitor the clinical morbidity of adhesion-related complications. Further studies are needed to confirm its utility in clinical practice.
KW - Adhesion-related complications
KW - Adhesions
KW - Clinical adhesion score
UR - http://www.scopus.com/inward/record.url?scp=85084834680&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85084834680&partnerID=8YFLogxK
U2 - 10.1007/s00464-020-07621-5
DO - 10.1007/s00464-020-07621-5
M3 - Article
C2 - 32410083
AN - SCOPUS:85084834680
SN - 0930-2794
VL - 35
SP - 2159
EP - 2168
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 5
ER -