Boezaart Grading Scale Scoring
The Boezaart grading scale scores the quality of the surgical field during endoscopic procedures from 0 to 5, with lower scores indicating a cleaner surgical field and scores ≤2 defining an acceptable operative field. 1
Scoring System
The Boezaart grading system uses the following scale:
- Score 0: No bleeding - ideal surgical field
- Score 1: Slight bleeding - minimal suction required
- Score 2: Slight bleeding - occasional suction required
- Score 3: Moderate bleeding - frequent suction required
- Score 4: Moderate bleeding - bleeding threatens surgical field
- Score 5: Severe bleeding - continuous suction required, surgical field severely compromised
Clinical Application
A clean or acceptable surgical field is operationally defined as a Boezaart score ≤2, which allows the surgeon to proceed without significant impediment from bleeding. 1
Interpretation in Practice:
- Scores 0-2: Acceptable surgical field quality - surgery can proceed efficiently 1, 4
- Scores 3-5: Poor surgical field quality - increased operative time, impaired visualization, and potentially compromised surgical outcomes 2, 3, 5
Clinical Significance
The Boezaart scale directly correlates with:
- Operative duration: Higher scores (worse fields) significantly prolong surgery time 3, 4
- Blood loss volume: Scores correlate with measurable intraoperative bleeding 2, 3, 4
- Surgeon satisfaction: Lower Boezaart scores associate with higher surgeon satisfaction ratings 2
Common Pitfall:
The scale is subjective and assessed by the operating surgeon in real-time during the procedure. It requires periodic assessment throughout surgery rather than a single end-of-case measurement, as surgical field quality can vary during different phases of the operation. 1, 5