Clavien classification in urology: Is there concordance among post-graduate trainees and attending urologists?

Abstract

We assess the variations between post-graduate trainees (PGTs) and attending urologists in applying the Revised Clavien-Dindo Classification System (RCCS) to urological complications. Twenty postoperative complications were selected from urology service Quality Assurance meeting minutes spanning 1 year at a tertiary care centre. The cases were from adult and pediatric sites and included minor and major complications. After a briefing session to review the RCCS, the survey was administered to 16 attending urologists and 16 PGTs. Concordance rates between the two groups were calculated for each case and for the whole survey. Inter-rater agreement was calculated by kappa statistics. There was good overall agreement rate of 81 % (range: 30-100) when both groups were compared. Thirteen of the 20 cases (65%) held an agreement rate above 80% (k = 0.753, p < 0.001) including 3 (15%) cases with 100% agreement. There were only 2 cases where the scores given by PGTs were significantly different from that given by attending urologists (p ≤ 0.03). There was no significant difference between both groups in terms of overall RCCS grades (p = 0.12). When all participants were compared as one group, there was good overall inter-rater agreement rate of 75% (k = 0.71). Although the percent of overall agreement rate among PGTs was higher than the attending urologists (82% [k = 0.79] vs. 69% [k = 0.64]), this was not significantly different (p = 0.68). There was good overall agreement among PGTs and attending urologists in application of the RCCS in urology. Therefore, it is appropriate for PGTs to complete the Quality Assurance meeting reports.