Dehiscence, Infection, Seroma, Haematoma (DISH): Development and Validation of a New Classification of Surgical Site Outcomes

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ID: 325865
2026
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Abstract
BACKGROUND: Surgical site outcome (SSO) reporting lacks details of management, focuses on infection, and overlooks dehiscence, seroma and haematoma. An international, consensus-driven classification system applicable to a diverse range of surgical incisions and outcomes was developed to address this gap and standardise the reporting of SSOs. METHOD: Concept statements based on a targeted literature review were rated by pan-specialty global experts during a four-round modified Delphi study to create a comprehensive classification of SSOs. Reliability and language validation focused on inter-rater agreement and intra-rater reproducibility by experts applying the classification to case vignettes, created using generative artificial intelligence sampling. Cross-domain agreement was evaluated using a patient-level, double entry, interclass correlation coefficient (DE-ICC). RESULTS: Consensus was achieved on definitions of dehiscence, inflammation/infection, seroma and haematoma ('DISH') within a new classification, comprising five objectifiable grades of clinical intervention (0-4) and four grades of clinical presentation (a-d) for each domain. The DISH 'score' presents all domains collectively, e.g. D1a I2b S0 H0; a snapshot of management and presentation of an incision. Mean patient-level inter-rater DE-ICC was 0.93 (95% confidence interval [CI] 0.91-0.96; median 1.00; very high concordance). Intra-rater DE-ICC was similarly high (mean 0.95; 95% CI 0.93-0.96; median 1.00). CONCLUSION: The proposed cross-specialty, global DISH Classification facilitates more comprehensive surveillance and audit of SSOs in clinical practice and research, by standardising reporting of all relevant grades of clinical presentation and management of SSOs. Very high concordance when applied to case vignettes gives credibility to clinical validation and adoption.
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Authors Giles Bond‐Smith, Marja A. Boermeester, David Leaper, Philip L. Russo, Antonia F Chen, the SSO Working Group Authors, Walter Danker, Najmuddin Gunja, Anastasia Ermakova, Nikolaos Takatzoglou, Cindy Tong, A Pashley, Jessica Albutt, Alexandra Yoe, the SSO Validation Study Panel, Thomas Aubert, Toms Augustin, Emre Balık, Tomasz Banasiewicz, Jayme Bennetts, Mujahid Bukhari, Marco Catarci, Mírian de Freitas Dal Ben Corradi, Eva Deerenberg, Christian Eckmann, Dario E Garin, Jignesh Gandhi, Bijie Hu, HyungJin Kim, Hayato Kurihara, Suk-Hwan Lee, Varut Lohsiriwat, Christian Macutkiewicz, Najjia Mahmoud, Keita Morikane, Norikatsu Miyoshi, Manuel Novajas, Federico Nuñez, Ibrahim Obeid, Caroline E. Reinke, Christine H Rohde, Ines Rubio-Perez, Esther A Saguil, Mauro J Salles, Angela Tecson, Jason Wellen, Yinmo Yang, the SSO Validation Study Panel, Yalda Afshar, Nitin Agarwal, Derek Amanatullah, Yaniss Belaroussi, Elias Castel, Alejandro Bolio Cerdán, Chong-Bum Chang, Patrick Charlebois, Paul Deramo, Federico Gorganchian, Shiki Fujino, Raj Gajbhiye, Zoilo Madrazo Gonzalez, Peter Graves, Dariusz Grzelecki, Chang Guohao, Dudy Arman Hanafy, Jonathan Hong, Susan Khalil, Bob Kiaii, Navamol Lekskul, Kil Yeon Lee, Shih-Hsuan Mao, Youn Young Park, Ji Won Park, Bhaveshkumar Patel, Luís Fernando Perin, Carlos Porras, Thiers Soares Raymundo, Christopher Reid, Rosa Jimenez-Rodriguez, Pablo Sanz-Ruiz, Nana Sarpong, Sharona Czerniak, Shahul Hameed Mohamed Siraj, M.J. Spencer, Santosh Thorat, Jonathan Torres-Castro, Konstantinos Toutouzas, Thomas Tsai, Francesco Venneri, Padmapriya Vivek, Mohamed Zayed
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag112
URL
https://doi.org/10.1093/bjs/znag112
Keywords Keywords not found

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