Clinical adhesion score (CLAS): development of a novel clinical score for adhesion-related complications in abdominal and pelvic surgery

Abstract

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.

A left-sided inguinoscrotal hernia mimicking a right-sided hernia: a case report

“…To the best of our knowledge, there have been no other studies or case reports describing this condition. It has been described that the formation of adhesions after abdominal surgery is relatively common, and 63-97% of patients develop adhesions after abdominal or pelvic surgery; general surgery, gynaecological and urological surgery (4,5).…”

Surgical adhesions after laparoscopic myomectomy: methods of prevention

“…Other Authors [24] have developed a novel clinical score for adhesion-related complications in abdominal and pelvic surgery: Clinical adhesion score (CLAS). This score includes outcomes and weight factors, describing the morbidity or clinical consequences of each adhesion-related complication: small bowel obstruction, difficulties at reoperation, female infertility, and chronic abdominal pain.…”

Classification of intraoperative adverse events in visceral surgery

“…For example, some of the reported classifications include only surgeryrelated events or are even more specific (eg, anastomotic leak or adhesiolysis-related events). 7,23 However, in complex visceral surgery, anesthesia is a relevant part of the operative process and comprises human factors with the potential for safety threats. 24 The classification of visceral surgery developed by Kaafarani et al includes only surgical adverse events and found an incidence of 0.02% for intraoperative adverse events and 31% for postoperative adverse events in a large group of 9,000 patients who underwent abdominal surgery.…”