Development and Evaluation of a Novel Instrument to Measure Severity of Intraoperative Events Using Video Data

Ann Surg. 2020 Aug;272(2):220-226. doi: 10.1097/SLA.0000000000003897.


Objective: To develop and evaluate a novel instrument to measure SEVERE processes using video data.

Background: Surgical video data can serve an important role in understanding the relationship between intraoperative events and postoperative outcomes. However, a standard tool to measure severity of intraoperative events is not yet available.

Methods: Items to be included in the instrument were identified through literature and video reviews. A committee of experts guided item reduction, including pilot tests and revisions, and determined weighted scores. Content validity was evaluated using a validated sensibility questionnaire. Inter-rater reliability was assessed by calculating intraclass correlation coefficient. Construct validity was evaluated on a sample of 120 patients who underwent laparoscopic Roux-en-Y gastric bypass procedure, in which comprehensive video data was obtained.

Results: SEVERE index measures severity of 5 event types using ordinal scales. Each intraoperative event is given a weighted score out of 10. Inter-rater reliability was excellent [0.87 (95%-confidence interval, 0.77-0.92)]. In a sample of consecutive 120 patients undergoing gastric bypass procedures, a median of 12 events [interquartile range (IQR) 9-18] occurred per patient and bleeding was the most frequent type (median 10, IQR 7-14). The median SEVERE score per case was 11.3 (IQR 8.3-16.9). In risk-adjusted multivariable regression models, history of previous abdominal surgery (P = 0.02) and body mass index (P = 0.005) were associated with SEVERE scores, demonstrating construct validity evidence.

Conclusion: The SEVERE index may prove to be a useful instrument in identifying patients with high risk of developing postoperative complications.

MeSH terms

  • Academic Medical Centers
  • Adult
  • Anastomosis, Surgical / adverse effects
  • Anastomosis, Surgical / methods
  • Blood Loss, Surgical / prevention & control
  • Cohort Studies
  • Digestive System Surgical Procedures / adverse effects
  • Digestive System Surgical Procedures / methods*
  • Endoscopy, Gastrointestinal / adverse effects
  • Endoscopy, Gastrointestinal / methods*
  • Female
  • Humans
  • Intraoperative Complications / diagnosis*
  • Intraoperative Complications / prevention & control
  • Linear Models
  • Male
  • Middle Aged
  • Monitoring, Intraoperative / methods*
  • Multivariate Analysis
  • Observer Variation
  • Ontario
  • Pilot Projects
  • Postoperative Complications / epidemiology
  • Postoperative Complications / physiopathology
  • Postoperative Complications / prevention & control*
  • Prognosis
  • Prospective Studies
  • Reproducibility of Results
  • Risk Assessment
  • Treatment Outcome
  • Video Recording*