Conflicts in wound classification of neonatal operations

Lan T. Vu, Kerilyn K. Nobuhara, Hanmin Lee, Diana L Farmer

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

Background/Purpose: This study sought to determine the reliability of wound classification guidelines when applied to neonatal operations. Methods: This study is a cross-sectional web-based survey of pediatric surgeons. From a random sample of 22 neonatal operations, participants classified each operation as "clean," "clean-contaminated," "contaminated," or "dirty or infected," and specified duration of perioperative antibiotics as "none," "single preoperative," "24 hours," or ">24 hours." Unweighted κ score was calculated to estimate interrater reliability. Results: Overall interrater reliability for wound classification was poor (κ = 0.30). The following operations were classified as clean: pyloromyotomy, resection of sequestration, resection of sacrococcygeal teratoma, oophorectomy, and immediate repair of omphalocele; as clean-contaminated: Ladd procedure, bowel resection for midgut volvulus and meconium peritonitis, fistula ligation of tracheoesophageal fistula, primary esophageal anastomosis of esophageal atresia, thoracic lobectomy, staged closure of gastroschisis, delayed repair and primary closure of omphalocele, perineal anoplasty and diverting colostomy for imperforate anus, anal pull-through for Hirschsprung disease, and colostomy closure; and as dirty: perforated necrotizing enterocolitis. Conclusions: There is poor consensus on how neonatal operations are classified based on contamination. An improved classification system will provide more accurate risk assessment for development of surgical site infections and identify neonates who would benefit from antibiotic prophylaxis.

Original languageEnglish (US)
Pages (from-to)1206-1211
Number of pages6
JournalJournal of Pediatric Surgery
Volume44
Issue number6
DOIs
StatePublished - Jun 2009

Keywords

  • Antibiotics
  • Neonatal surgery
  • Pediatrics
  • Risk assessment
  • Surgical site infections
  • Wound classification

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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