Does surgeon seniority affect adhesion assessment at cesarean delivery? A prospective study

BACKGROUND: Intraabdominal adhesions may develop following cesarean delivery and are considered a major concern. OBJECTIVE: This study aimed to determine the effect of surgeon seniority in evaluating intraabdominal adhesions at cesarean delivery. STUDY DESIGN: A prospective study to estimate interrater reliability between surgeons was conducted. Women who underwent cesarean delivery (January–July 2021) in a single tertiary university-affiliated medical center were included. Blinded questionnaires assessing adhesions were completed by the surgeons. Questions were limited to 4 main anatomic sites and 3 possible categories of adhesion (each site was scored between 0 and 2; the sum score range was 0–8). The surgeons were ranked by increasing seniority (1–4) as: (1) junior residents (less than half of residency completed), (2) senior residents (more than half of residency completed), (3) young attending physicians (attending physicians for <10 years), and (4) senior attendings (attending physicians for >10 years). The weighted percentage of agreement was calculated between the 2 surgeons assessing the same adhesions. Scoring differences between the 2 surgeons (senior vs less senior) were also calculated. RESULTS: A total of 96 pairs of surgeons were included in the study. The sum interrater reliability found in the weighted agreement tests between surgeons was 0.918 (confidence interval, 0.898–0.938). When scoring differences between surgeons (senior vs less senior) were calculated, nonsignificant difference was found (mean sum score difference of 0.09 with a standard deviation of 1.03 in favor of the more experienced surgeon). CONCLUSION: Surgeon seniority does not affect subjective scoring of adhesion reports.