As surgical volumes rise and care pathways grow more complex across Asia Pacific, the limitations of how post operative outcomes are measured are becoming increasingly clear. In this in depth interview for BioPharma APAC, leading voices from surgery, infection control and medical technology reflect on a critical gap in global healthcare the lack of a consistent, practical framework to describe and compare surgical outcomes.

Featuring perspectives from Dr Giles Bond-Smith, Prof Keita Morikane and Iain Hamilton, the discussion examines why fragmented definitions continue to undermine surveillance and quality improvement, particularly in Southeast Asia. The conversation also explores how clinician led frameworks such as the DISH Classification could enable more objective reporting, support prevention strategies and allow APAC to play a defining role in shaping global standards for surgical care.

Why is establishing a unified classification for surgical outcomes so critical at this moment, and what gaps in global surgical care does it directly address?

Dr Giles Bond-Smith: Surgical teams have been working without a common language for wound complications. A systematic review found 41 different definitions of SSI across nearly 100 studies, which tells you just how fragmented the field has become. Without consistent definitions, it’s extremely difficult to compare outcomes, evaluate evidence, or drive quality improvement across hospitals.

The problem we have is that we could not come up with a reliable and usable definition of what a surgical site infection meant that was reproducible and academically reviewable. That’s why a unified classification for surgical outcomes matters. The DISH (Dehiscence, Infection/Inflammation, Seroma, Hematoma) Classification gives us a shared framework that finally captures the full spectrum of wound outcomes — not just infections, but also inflammation, dehiscence, seromas, and hematomas, which significantly influence recovery but are often inconsistently recorded. By reframing ‘wound complications’ as ‘surgical outcomes’, it reduces the negative connotation associated with a complication and encourages more frequent and objective reporting. This structure enables all members of the surgical team to describe surgical outcomes in the same way, allowing us to measure postoperative outcomes more accurately and learn from each other.

Southeast Asia’s SSI burden is significantly higher than Western regions. From your perspective, what underlying clinical, infrastructural or reporting challenges make standardized outcome tracking so difficult today?

Prof Keita Morikane: The SSI burden in Southeast Asia — around 7.8%, compared with 0.9–2.8% in many Western health systems — reflects a complex mix of clinical and structural barriers. In fact, the reported incidence of SSI varies widely across APAC — cumulative incidences of 2.8% in Australia (2002–2013), 2.0–9.7% in the Republic of Korea, 4% in China (2000–2017), 7.8% in Southeast Asia and Singapore (pooled; 2000–2012), and 4.5% in Japan (2024). These variations underscore how challenging consistent monitoring is across APAC.

Rather than general infrastructure limitations, the more clearly documented issue is surveillance inconsistency. There are not many SSI surveillance systems in APAC countries. Hospitals across the region rely on different reporting systems, data-collection practices and levels of follow-up, with limited personnel or systems devoted to collecting surveillance data. These make it difficult to measure outcomes reliably or compare institutions.

A unified framework to classify these outcomes is therefore essential. By aligning how complications are recognized and reported, we can begin to build a clearer, more comparable regional picture of surgical outcomes in APAC and beyond.

How does the proposed DISH Classification improve upon current practices? Could you explain how it captures nuances across SSIs, dehiscence, seromas and hematomas in a way clinicians can use consistently?

Dr Giles Bond-Smith: At present, wound complications are recorded through a patchwork of guidelines, local definitions, and subjective descriptors. The DISH Classification replaces that variability with clear, structured criteria for reporting each complication type.

By providing a shared, objective language for all surgical outcomes — not only infections but also issues like wound reopening, fluid collections, and bleeding — the system finally allows us to describe complications in a way that is consistent, comparable, and clinically meaningful. This removes much of the ambiguity that currently exists and aligns documentation with how decisions are made at the bedside. With that consistency, we can generate more reliable datasets, compare outcomes across teams and institutions, and evaluate quality-improvement efforts with far greater accuracy.

Prof Keita Morikane: From a surveillance perspective, the DISH Classification adds value by ensuring that all wound outcomes are captured in a consistent, structured way. This is particularly important for APAC because the region sees a wide spectrum of practice environments, and the types of complications that occur — such as seromas, hematomas, or early wound breakdown — may be documented very differently across hospitals, if at all. Without a common system, these events are difficult to compare or track over time.

In APAC, where reporting systems and follow-up practices differ significantly, having a standard framework creates a shared vocabulary that clinicians can use regardless of country or resource level. This means we can more clearly see patterns of early complications, identify where preventive practices may need strengthening, and build a more accurate regional picture of post-operative outcomes. Better visibility leads to better prevention — and that is where a unified classification can make a meaningful difference for APAC.

APAC is a diverse region with varying resource levels and clinical environments. How are insights from APAC clinicians shaping the system to ensure it is globally robust yet locally practical?

Dr Giles Bond-Smith: APAC clinicians have made it clear that the classification must be workable in very different surgical environments — from high-volume referral centers to hospitals where digital systems are still developing. Their feedback has helped refine the definitions so they remain clinically intuitive and easy to apply at the point of care, even when time and resources are limited. For me, that is essential: if a system functions reliably across APAC’s varied surgical workflows and caseloads, it is far more likely to stand up as a truly global standard. The region’s diversity is proving invaluable in stress-testing the framework.

Prof Keita Morikane: From a surveillance and implementation perspective, APAC input is helping ensure the classification is practical to document and consistently reproducible, regardless of national infrastructure. Clinicians across the region have highlighted where descriptors must be clearer for paper-based systems, where follow-up practices differ, and how terminology needs to work across languages. This helps shape a framework that health systems with varying reporting capacity can actually adopt. In that sense, APAC’s diversity is not just a test of usability — it directly informs how the system can be scaled and embedded in real-world monitoring across countries.

What did the APAC Surgical Outcomes Symposium in Bangkok aim to validate specifically? Are there early indications of pilot sites, adoption interest or implementation barriers that global teams should be aware of?

Dr Giles Bond-Smith: The APAC Surgical Outcomes Symposium is a key opportunity to test whether clinicians across APAC interpret and apply the definitions in a consistent and clinically meaningful way. Through Delphi Panel review and case-based discussions, we can see where descriptors may need refinement and where additional clarity would improve usability. Because the region represents such diverse surgical settings, confirming that the classifications hold up across different workflows is an essential step before global finalization.

Prof Keita Morikane: From a surveillance standpoint, the meeting helps us understand the practical considerations that influence whether hospitals can adopt the system reliably — such as documentation workflows, staff training needs, and alignment with existing reporting structures. Early discussions across the region show strong interest in the framework, but also highlight that facilities vary in their readiness to implement a new classification. Capturing these differences now will help shape a realistic, phased adoption plan. Also, even though the definitions were developed through intense discussions as well as the sophisticated Delphi method, Symposium participants faced challenges in applying the definitions to various clinical case scenarios. A unified definition is of utmost importance and should be upheld, but the APAC region would require practical guidelines including language translation in order to accurately apply definitions and scoring.

Iain Hamilton: For us, the Symposium is about understanding what healthcare professionals and hospitals need to move from interest to implementation. We’re seeing real momentum — clinicians are eager for a system that allows them to measure outcomes consistently and see the full picture of healing, not just infection. The Bangkok event allows us to work directly with APAC partners to identify the support required, whether that’s structured training, workflow integration, or digital tools.

This meeting is also part of a broader global effort, where insights from APAC will help shape the tools for implementing the DISH Classification framework. It’s an important moment for the region to influence standards that will eventually be adopted worldwide.

Industry partnerships are increasingly important in surgical quality improvement. How do you foresee organizations like Johnson & Johnson MedTech supporting rollout, clinician training and long-term adoption once the framework is finalized?

Dr Giles Bond-Smith: Industry involvement is essential for taking a classification from theory to daily practice. Surgeons need practical support — training, clear materials, and implementation guidance — so the system becomes easy to use rather than an added burden. When partners help coordinate education and dissemination, it accelerates consistent adoption across hospitals and specialties.

Prof Keita Morikane: Long-term surveillance depends on consistent, repeatable processes. Industry partners can play a meaningful role by providing tools and resources that help hospitals apply the classification accurately, regardless of their baseline reporting capacity. Support for education, workflow integration, and documentation approaches can make the transition smoother and help ensure the system is used reliably over time.

Iain Hamilton: At Johnson & Johnson MedTech, our role is to enable the system to take root and deliver its intended impact. That starts with training — through the Johnson & Johnson Institute, we can support clinicians across APAC in understanding and applying the definitions consistently. We are also investing in digital solutions through our Polyphonic™ digital ecosystem to help connect data for modern surgical care. By linking wound outcomes through digital tools and patient monitoring, we can help hospitals move from simply counting infections to understanding surgical outcomes holistically.

Our commitment is to help integrate the DISH Classification framework into existing workflows, support early adopters, and build the foundation for long-term, data-driven surgical quality improvement to reduce wound complications. This is part of how we see APAC contributing to — and shaping — the standards that will guide surgical care globally.