J&J's standardized classification system may improve outcomes

Johnson & Johnson MedTech's Ottava in a mock OR

J&J MedTech’s Ottava in a mock OR [Photo courtesy of J&J]

Johnson & Johnson MedTech recently unveiled a new global standardization system to measure surgical site outcomes in The British Journal of Surgery.

The new DISH Classification System outlines a consistent method for identifying and grading four common surgical site outcomes: dehiscence, inflammation/infection, seroma and hematoma.

“A shared language for reporting and understanding surgical outcomes is foundational for the prevention of adverse outcomes,” Giles Bond-Smith, a corresponding author of the publication and committee chair for J&J’s Surgical Outcomes program, said in a news release. “By establishing the DISH Classification System … we now have consistent terms and an independent grading system for how a surgical site presents and how it’s managed. This makes it easier to document complications, compare clinical responses to complications across specialties, and ultimately use this data to improve patient care.”

DISH consists of five objective grades of clinical intervention ranging from zero to four, and four grades of clinical presentation ranging from ‘a’ to ‘d’ for each classification. The DISH score presents the data collectively (for example, D1a I2b S0 H0) for a clear profile of clinical management and presentation of the surgical incision.

A photo of Johnson & Johnson Surgical Site Outcomes program steering committee member Dr. Antonia Chen.

Orthopedic surgeon Dr. Antonia Chen is a member of the Johnson & Johnson Surgical Site Outcomes program steering committee. [Photo courtesy of UT Southwestern Medical Center]

“For too long, common surgical site complications have been measured differently across specialties and institutions,” said orthopedic surgeon Dr. Antonia Chen, a Johnson & Johnson Surgical Site Outcomes program steering committee member. “DISH provides a consistent framework that can help clinicians learn from outcomes, identify opportunities for improvement, and advance patient care. As more data is collected using a common approach, we will be better positioned to understand what drives better outcomes for patients.”

In a 2023 J&J-sponsored study, surgical site infections accounted for 20% to 31% of hospital-acquired infections in 51,448 patients. J&J identified how a lack of standardized surgical outcome measurements limited clinicians’ abilities to evaluate, compare and improve post-operative care, leading to wound-related complications as a leading cause of post-operative readmission.

Surgical experts were first introduced to DISH under the guidance of the Johnson & Johnson Surgical Outcomes program steering committee in 2024. Since then, the team has been working to advance the classification system.

The version of the system’s framework that debuted in 2026 was developed through a Delphi study, and its language was validated for inter- and intra-rater reliability across a multi-specialty group of over 60 physicians, the company said. DISH features independent scales for clinical management and presentation, allowing for documentation of surgical wound management and observations.

DISH could enable “more comprehensive surveillance and audit of surgical site outcomes in clinical practice and research, by standardising reporting of all relevant grades of clinical presentation and management of surgical site outcomes,” the journal publication said.

J&J anticipates that a unified classification system for wound outcomes could lead to consistent care, evidence-based treatment plans and improved patient outcomes.