Inter-rater reliability of the PIPES tool: Validation of a surgical capacity index for use in resource-limited settings

Abraham Markin, Roxana Barbero, Jeffrey J. Leow, Reinou S. Groen, Greg Perlman, Elizabeth B. Habermann, Keith N. Apelgren, Adam L. Kushner, Benedict C. Nwomeh

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Introduction: In response to the need for simple, rapid means of quantifying surgical capacity in low resource settings, Surgeons OverSeas (SOS) developed the personnel, infrastructure, procedures, equipment and supplies (PIPES) tool. The present investigation assessed the inter-rater reliability of the PIPES tool. Methods: As part of a government assessment of surgical services in Santa Cruz, Bolivia, the PIPES tool was translated into Spanish and applied in interviews with physicians at 31 public hospitals. An additional interview was conducted with nurses at a convenience sample of 25 of these hospitals. Physician and nurse responses were then compared to generate an estimate of reliability. For dichotomous survey items, inter-rater reliability between physicians and nurses was assessed using the Cohen's kappa statistic and percent agreement. The Pearson correlation coefficient was used to assess agreement for continuous items. Results: Cohen's kappa was 0.46 for infrastructure, 0.43 for procedures, 0.26 for equipment, and 0 for supplies sections. The median correlation coefficient was 0.91 for continuous items. Correlation was 0.79 for the PIPES index, and ranged from 0.32 to 0.98 for continuous response items. Conclusions: Reliability of the PIPES tool was moderate for the infrastructure and procedures sections, fair for the equipment section, and poor for supplies section when comparing surgeons' responses to nurses' responses - an extremely rigorous test of reliability. These results indicate that the PIPES tool is an effective measure of surgical capacity but that the equipment and supplies sections may need to be revised.

Original languageEnglish (US)
Pages (from-to)2195-2199
Number of pages5
JournalWorld Journal of Surgery
Issue number9
StatePublished - Sep 2014

ASJC Scopus subject areas

  • Surgery


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