Inter and Intraobserver Agreement of the IOOG SAMEO ATO Classification for Tympanomastoid Surgery.

INTRODUCTION

In 2018 the International Otology Outcome Group (IOOG) introduced the stage of surgery, approach, mastoidectomy, external ear canal reconstruction, obliteration of mastoid cavity, access to middle ear, tympanic membrane, ossicular chain (SAMEO ATO) categorization framework for tympanomastoid surgery to develop a classification system that encompasses all aspects of surgical technique that are likely to influence the outcome of tympanomastoid surgery. To date there is no study that examines inter or intraobserver reliability of this classification system.

OBJECTIVE

To assess inter and intraobserver reliability of the SAMEO ATO classification.

STUDY DESIGN AND

SETTING

Retrospective single center study.

INTERVENTION: Two observers independently categorized 167 tympanomastoid surgeries using the SAMEO-ATO system to allow for interobserver analysis. Categorization was performed retrospectively from operation notes. Intraobserver reliability was evaluated for one observer.

PATIENTS: One hundred sixty seven tympanomastoid surgeries performed by a single surgeon between 2018 and 2021.

MAIN OUTCOME MEASURE: Inter and intraobserver reliability calculated using Cohen's kappa.

RESULTS

Almost perfect interobserver agreement was seen for stage of surgery ( S ), approach ( A ), mastoidectomy ( M ), and ossicular chain ( O ) with kappa scores ranging from of 0.957 to 0.848.Almost perfect intraobserver agreement was seen for approach ( A ), mastoidectomy ( M ), external ear reconstruction ( E ), obliteration of mastoid cavity ( O ), access to middle ear ( A ), and ossicular chain ( O ) with kappa ranging from 0.929 to 08.21.

CONCLUSION

The SAMEO ATO classification is a reliable system for recording surgical procedures. Given the complexity of the SAMEO ATO classification it is vital that those using it have a thorough knowledge of the classification.