Johnson & Johnson Announces New Global Classification System for Surgical Outcomes

Johnson & Johnson today is introducing the DISH Classification System, a new global consensus framework developed and validated through a clinician-led initiative to standardize the way surgical site outcomes are measured and reported and help bring greater visibility to underreported surgical site infections and other wound complications. Published in The British Journal of Surgery, the DISH framework provides a consistent method for identifying and grading four of the most common surgical site outcomes: dehiscence, inflammation/infection, seroma, and hematoma.

Key takeaways

• The DISH Classification System creates a shared language for four common surgical site outcomes: dehiscence, inflammation/infection, seroma, and hematoma.
• The framework was developed through a Delphi Study and validated by clinicians globally representing more than 30 countries and 14 specialties.
• Grading scales support consistent documentation of management and clinical presentation.
• A common language for wound outcomes enables consistent care, evidence-based treatment, and improved patient outcomes.

Wound-related complications are among the leading causes of postoperative readmission, yet a lack of standardized outcome measurement limits the ability to consistently evaluate, compare, and improve care. DISH was developed to address this gap by providing a common language for assessing surgical site outcomes beyond infection alone. Through standardized reporting and data collection, DISH creates the foundation for benchmarking outcomes, identifying best practices, and advancing evidence-based standards of care to improve patient outcomes.

“A shared language for reporting and understanding surgical outcomes is foundational for the prevention of adverse outcomes,” said Giles Bond-Smith,* corresponding author, consultant emergency surgeon, and clinical lead for the surgical emergency unit at Oxford University Hospitals, NHS Foundations Trust, London, and steering committee chair for Johnson & Johnson’s Surgical Outcomes Program. “By establishing the DISH Classification System—which classifies and standardizes the definition of dehiscence, inflammation/infection, seromas, and hematomas—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.”

The DISH classification system first reached a broader community of surgical experts in 2024 under the guidance of the Johnson & Johnson Surgical Outcomes Program Steering Committee, which includes Giles Bond-Smith, FRCS¹; Marja A. Boermeester, M.D.,^2,3; David J Leaper, DSc^4,5; Philip L. Russo, Ph.D.,^6,7,8; and Antonia F. Chen, M.D.⁹ Bringing together leaders across surgical specialties and healthcare disciplines, the committee sought diverse perspectives and clinical expertise globally to advance the single, standardized framework.

“For too long, common surgical site complications have been measured differently across specialties and institutions,” said Dr. Chen,** an orthopedic surgeon and steering committee member for Johnson & Johnson’s Surgical Site Outcomes Program. “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.”

The framework was refined using a modified Delphi process and the language was validated for inter and intra rater reliability across a multi-specialty cohort of more than 60 clinicians. The final system includes independent scales for clinical management and clinical presentation, allowing care teams to document both how a wound was managed and what was observed without prescribing treatment pathways.

“Surgeons and care teams have asked for a clear, practical system to classify surgery-related complications and patient outcomes,” said Nisha Johnson, global president, Wound Closure & Healing, MedTech, Johnson & Johnson. “The publication of these consensus-driven findings in The British Journal of Surgery and Johnson & Johnson’s leadership in convening this Delphi Panel of global experts reflects our commitment to advancing meaningful innovation in the OR and beyond by listening to clinicians and partnering to improve patient outcomes.”

For more than a century, Johnson & Johnson has helped advance surgical care through its portfolio across wound closure, adjunctive hemostats, surgical stapling and instruments, robotics, and digital solutions. Together, with clinicians and healthcare experts around the world, the company is progressing surgerical innovations to better solve patient needs in metabolic and cardiovascular disease, cancer, and aesthetics and reconstruction.

Johnson & Johnson aims to prevent, treat, and cure complex diseases and develop treatments that are smarter and less invasive, with personal solutions. Through its expertise in cardiovascular, orthopedics, surgery, and vision solutions, the company strives to deliver medical breakthroughs and impact health for humanity.

* Dr. Bond-Smith is a paid consultant for Johnson & Johnson.

** Dr. Chen is a paid consultant for Johnson & Johnson.

References
¹ Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
² Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
³ Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
⁴ University of Newcastle, Newcastle, UK
⁵ University of Huddersfield, Huddersfield, UK
⁶ Monash Nursing and Midwifery, Monash University, Australia
⁷ Cabrini Research, Cabrini Health, Australia
⁸ Avondale University, Australia
⁹ Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA US_SRG_WOUN_420237