Incision Classification Accuracy: Do Residents Know How to Classify Them?

Background: It is unclear whether surgical residents understand how to classify incisions, which may impact how closure is handled in the operating room. We hypothesized that surgical residents define incision class (IC) accurately compared with an attending NSQIP surgeon champion (SC).

Methods: We evaluated our NSQIP database from April 1, 2015, to December 31, 2016, including cases in which a resident was present and IC was documented. Cases in which the resident, circulator, or surgical clinical rater disagreed on the IC were then reviewed by a blinded SC.

Results: Residents were correct in 83.6% of the cases, with PGY 5 persons having the lowest accuracy. Class 3 incisions were most often misclassified (36%). A disproportionate number of misclassifications by PGY4 and PGY5-7 residents occurred in incision classes 2 and 3. Surgical site infections occurred in 7.4% of cases, ranging from 2.4% in IC 1 to 15.7% in IC 4 cases.

Conclusions: Although overall accuracy appears reasonable, it is of concern that incisions at higher risk of infection (contaminated) were least likely to be classified appropriately. Chief residents, who often are making the decisions on incision closure, were the least accurate in determining IC. This may have a deleterious impact on incision management, suggesting a need for directed resident education on IC and further investigation to determine its impact on site infection risk and patient outcomes.