title: Conflicts in wound classification of neonatal operations.
abstract: OBJECTIVE
  This study sought to determine the reliability of wound classification guidelines when applied to neonatal operations.
  
  
  METHODS
  This study is a cross-sectional web-based survey of pediatric surgeons. From a random sample of 22 neonatal operations, participants classified each operation as "clean," "clean-contaminated," "contaminated," or "dirty or infected," and specified duration of perioperative antibiotics as "none," "single preoperative," "24 hours," or ">24 hours." Unweighted kappa score was calculated to estimate interrater reliability.
  
  
  RESULTS
  Overall interrater reliability for wound classification was poor (kappa = 0.30). The following operations were classified as clean: pyloromyotomy, resection of sequestration, resection of sacrococcygeal teratoma, oophorectomy, and immediate repair of omphalocele; as clean-contaminated: Ladd procedure, bowel resection for midgut volvulus and meconium peritonitis, fistula ligation of tracheoesophageal fistula, primary esophageal anastomosis of esophageal atresia, thoracic lobectomy, staged closure of gastroschisis, delayed repair and primary closure of omphalocele, perineal anoplasty and diverting colostomy for imperforate anus, anal pull-through for Hirschsprung disease, and colostomy closure; and as dirty: perforated necrotizing enterocolitis.
  
  
  CONCLUSIONS
  There is poor consensus on how neonatal operations are classified based on contamination. An improved classification system will provide more accurate risk assessment for development of surgical site infections and identify neonates who would benefit from antibiotic prophylaxis.
authors.affiliation: Department of Surgery, University of California, San Francisco, CA 94143-0570, USA.
authors.forename: Lan T
authors.initials: LT
authors.lastname: Vu
authors.forename: Kerilyn K
authors.initials: KK
authors.lastname: Nobuhara
authors.forename: Hanmin
authors.initials: H
authors.lastname: Lee
authors.forename: Diana L
authors.initials: DL
authors.lastname: Farmer
mesh_terms: D019072:Antibiotic Prophylaxis; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D020407:Internet; D015588:Observer Variation; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000145:classification*; D013530:Surgical Wound Infection / Q000209:etiology