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

Elisabeth Jacomine Lier; Barend A.W. van den Beukel; Larsa Gawria; Philip J. van der Wees; Leontine van den Hil; Nicole D. Bouvy; Ying Cheong; Rudy Leon de Wilde; 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; Jun Kumakiri; Harry van Goor; Martijn W.J. Stommel; Richard P.G. ten Broek; CLAS Collaboration

doi:10.1007/s00464-020-07621-5

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

Elisabeth Jacomine Lier^*, Barend A.W. van den Beukel, Larsa Gawria, Philip J. van der Wees, Leontine van den Hil, Nicole D. Bouvy, Ying Cheong, Rudy Leon de Wilde, 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 VergutsSalomone 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, Jun Kumakiri, Harry van Goor, Martijn W.J. Stommel, Richard P.G. ten Broek, CLAS Collaboration

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

16 Citations (Scopus)

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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.

Original language	English
Journal	Surgical Endoscopy
Volume	35
Issue number	5
Pages (from-to)	2159-2168
Number of pages	10
ISSN	0930-2794
DOIs	https://doi.org/10.1007/s00464-020-07621-5
Publication status	Published - May 2021

Bibliographical note

Publisher Copyright:
© 2020, The Author(s).

Keywords

Adhesion-related complications
Adhesions
Clinical adhesion score

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Clinical adhesion score (CLAS): development of a novel clinical score for adhesion‑related complications in abdominal and pelvic surgeryFinal published version, 621 KBLicence: CC BY

Cite this

Lier, E. J., van den Beukel, B. A. W., Gawria, L., van der Wees, P. J., van den Hil, L., Bouvy, N. D., Cheong, Y., de Wilde, R. L., Parker, M., Schreinemacher, M., van der Wal, J. B. C., Fleshman, J. W., Wilson, M., Bakkum, E., Lundorff, P., Diamond, M. P., Trew, G., Koninckx, P., Krämer, B., ... CLAS Collaboration (2021). Clinical adhesion score (CLAS): development of a novel clinical score for adhesion-related complications in abdominal and pelvic surgery. Surgical Endoscopy, 35(5), 2159-2168. https://doi.org/10.1007/s00464-020-07621-5

Clinical adhesion score (CLAS) : development of a novel clinical score for adhesion-related complications in abdominal and pelvic surgery. / Lier, Elisabeth Jacomine; van den Beukel, Barend A.W.; Gawria, Larsa; van der Wees, Philip J.; van den Hil, Leontine; Bouvy, Nicole D.; Cheong, Ying; de Wilde, Rudy Leon; Parker, Mike; Schreinemacher, Marc; van der Wal, Johannes B.C.; Fleshman, James W.; Wilson, Malcolm; Bakkum, Erica; Lundorff, Per; Diamond, Michael P.; Trew, Geoffrey; Koninckx, Phillipe; Krämer, Bernhard; Verguts, Jasper; Di Saverio, Salomone; Leppaniemi, Ari; Sugrue, Michael; Kluger, Yoram; Sallinen, Ville; Ouaissi, Mehdi; Ansaloni, Luca; Beck, David E.; Catena, Fausto; Wallwiener, Markus; Mais, Valerio; Hackethal, Andreas; Tulandi, Togas; Burcharth, Jakob; Gerner Rasmussen, Jonas; Song, Yong S.; Wiseman, David M.; Coccolini, Federico; Dupre, Aurélien; Kumakiri, Jun; van Goor, Harry; Stommel, Martijn W.J.; ten Broek, Richard P.G.; CLAS Collaboration.

In: Surgical Endoscopy, Vol. 35, No. 5, 05.2021, p. 2159-2168.

Research output: Contribution to journal › Journal article › Research › peer-review

Lier, EJ, van den Beukel, BAW, Gawria, L, van der Wees, PJ, van den Hil, L, Bouvy, ND, Cheong, Y, de Wilde, RL, Parker, M, Schreinemacher, M, van der Wal, JBC, Fleshman, JW, Wilson, M, Bakkum, E, Lundorff, P, Diamond, MP, Trew, G, Koninckx, P, Krämer, B, Verguts, J, Di Saverio, S, Leppaniemi, A, Sugrue, M, Kluger, Y, Sallinen, V, Ouaissi, M, Ansaloni, L, Beck, DE, Catena, F, Wallwiener, M, Mais, V, Hackethal, A, Tulandi, T, Burcharth, J, Gerner Rasmussen, J, Song, YS, Wiseman, DM, Coccolini, F, Dupre, A, Kumakiri, J, van Goor, H, Stommel, MWJ, ten Broek, RPG & CLAS Collaboration 2021, 'Clinical adhesion score (CLAS): development of a novel clinical score for adhesion-related complications in abdominal and pelvic surgery', Surgical Endoscopy, vol. 35, no. 5, pp. 2159-2168. https://doi.org/10.1007/s00464-020-07621-5

Lier, Elisabeth Jacomine ; van den Beukel, Barend A.W. ; Gawria, Larsa ; van der Wees, Philip J. ; van den Hil, Leontine ; Bouvy, Nicole D. ; Cheong, Ying ; de Wilde, Rudy Leon ; Parker, Mike ; Schreinemacher, Marc ; van der Wal, Johannes B.C. ; Fleshman, James W. ; Wilson, Malcolm ; Bakkum, Erica ; Lundorff, Per ; Diamond, Michael P. ; Trew, Geoffrey ; Koninckx, Phillipe ; Krämer, Bernhard ; Verguts, Jasper ; Di Saverio, Salomone ; Leppaniemi, Ari ; Sugrue, Michael ; Kluger, Yoram ; Sallinen, Ville ; Ouaissi, Mehdi ; Ansaloni, Luca ; Beck, David E. ; Catena, Fausto ; Wallwiener, Markus ; Mais, Valerio ; Hackethal, Andreas ; Tulandi, Togas ; Burcharth, Jakob ; Gerner Rasmussen, Jonas ; Song, Yong S. ; Wiseman, David M. ; Coccolini, Federico ; Dupre, Aurélien ; Kumakiri, Jun ; van Goor, Harry ; Stommel, Martijn W.J. ; ten Broek, Richard P.G. ; CLAS Collaboration. / Clinical adhesion score (CLAS) : development of a novel clinical score for adhesion-related complications in abdominal and pelvic surgery. In: Surgical Endoscopy. 2021 ; Vol. 35, No. 5. pp. 2159-2168.

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title = "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.",

keywords = "Adhesion-related complications, Adhesions, Clinical adhesion score",

author = "Lier, {Elisabeth Jacomine} and {van den Beukel}, {Barend A.W.} and Larsa Gawria and {van der Wees}, {Philip J.} and {van den Hil}, Leontine and Bouvy, {Nicole D.} and Ying Cheong and {de Wilde}, {Rudy Leon} and Mike Parker and Marc Schreinemacher and {van der Wal}, {Johannes B.C.} and Fleshman, {James W.} and Malcolm Wilson and Erica Bakkum and Per Lundorff and Diamond, {Michael P.} and Geoffrey Trew and Phillipe Koninckx and Bernhard Kr{\"a}mer and Jasper Verguts and {Di Saverio}, Salomone and Ari Leppaniemi and Michael Sugrue and Yoram Kluger and Ville Sallinen and Mehdi Ouaissi and Luca Ansaloni and Beck, {David E.} and Fausto Catena and Markus Wallwiener and Valerio Mais and Andreas Hackethal and Togas Tulandi and Jakob Burcharth and {Gerner Rasmussen}, Jonas and Song, {Yong S.} and Wiseman, {David M.} and Federico Coccolini and Aur{\'e}lien Dupre and Jun Kumakiri and {van Goor}, Harry and Stommel, {Martijn W.J.} and {ten Broek}, {Richard P.G.} and {CLAS Collaboration}",

note = "Publisher Copyright: {\textcopyright} 2020, The Author(s).",

year = "2021",

month = may,

doi = "10.1007/s00464-020-07621-5",

language = "English",

volume = "35",

pages = "2159--2168",

journal = "Surgical Endoscopy and Other Interventional Techniques",

issn = "0930-2794",

publisher = "Springer",

number = "5",

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TY - JOUR

T1 - Clinical adhesion score (CLAS)

T2 - development of a novel clinical score for adhesion-related complications in abdominal and pelvic surgery

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.

AU - CLAS Collaboration

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

U2 - 10.1007/s00464-020-07621-5

DO - 10.1007/s00464-020-07621-5

M3 - Journal article

C2 - 32410083

AN - SCOPUS:85084834680

VL - 35

SP - 2159

EP - 2168

JO - Surgical Endoscopy and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

SN - 0930-2794

IS - 5

ER -