Novel Textbook Outcomes following emergency laparotomy: Delphi exercise

David N Naumann; Aneel Bhangu; Adam Brooks; Matthew Martin; Bryan A Cotton; Mansoor Khan; Mark J Midwinter; Lyndsay Pearce; Douglas M Bowley; John B Holcomb; Ewen A Griffiths; BEACON Collaborative

doi:10.1093/bjsopen/zrad145

Novel Textbook Outcomes following emergency laparotomy: Delphi exercise

BJS Open. 2024 Jan 3;8(1):zrad145. doi: 10.1093/bjsopen/zrad145.

Authors

Collaborators

BEACON Collaborative:
Adam Abu-Abeid, Adam Brooks, Adam Peckham-Cooper, Adam R Dyas, Ademola Adeyeye, Agron Dogjani, Alasdair C Y Ball, Albert M Wolthuis, Alejandro Quiroga-Garza, Aleksandar R Karamarkovic, Alessio Giordano, Alexander Fuchs, Alexander Julianov, Alexander W Phillips, Alexander Zimmermann, Alexandros Charalabopoulos, Alexei A Birkun, Alexis Rafael Narvaez-Rojas, Ali Guner, Amelia L Davis, Andras Vereczkei, Andrea Balla, Andrea Celotti, Andrea Romanzi, Andrea Trombetta, Andrew D Beggs, Andrew G Robertson, Andrew Petrosoniak, Andrew R Davies, Ángel Becerra-Bolaños, Anthony Loria, Antonio Brillantino, Antonios Athanasiou, Arda Isik, Argyrios Ioannidis, Ariel P Santos, Arin K Saha, Arturo Vilches-Moraga, Asad J Choudhry, Asuka Tsuchiya, B Mark Smithers, Bas P L Wijnhoven, B D Keeler, Belinda De Simone, Rodica Birla, Biswadev Mitra, Boyko Chavdarov Atanasov, Brian Badgwell, Brodie Nolan, Bryan A Cotton, Byung Hee Kang, Caoimhe C Duffy, Carlos A Ordoñez, Carlos Augusto Gomes, Carmen L Mueller, Caroline E Reinke, Carter C Lebares, Catherine J Hunter, Celia Villodre, Cem E Guldogan, Charalampos Seretis, Charles A Adams, Charles H C Pilgrim, Chris Varghese, Christian Owoo, Christian S Meyhoff, Christina A Fleming, Christina M Stuart, Christopher A Lewis-Lloyd, Christopher J McLaughlin, Claire L Stevens, Colin A Graham, Conor Magee, David I Saunders, D Dante Yeh, Daniel L Chan, Daniel M Felsenreich, Daniel N Holena, Dauda Bawa, David J Bowrey, David N Naumann, David S Liu, David S Y Chan, Deb Sanjay Nag, Diane N Haddad, Diletta Corallino, Dimitrios Damaskos, Dimitrios Moris, Dimitrios Schizas, Dimitris P Korkolis, Dinesh Kumar Bagaria, Dmitry Mikhailovich Adamovich, Douglas A Colquhoun, Douglas M Bowley, Dinesh Singhal, Manjunath Siddaiah-Subramanya, Rohit Kapoor, Duncan Wyncoll, Duong Van Hai, Ewoud Ter Avest, Edoardo Maria Muttillo, Edoardo Picetti, Edward Kelly, Efstratia Baili, Eleonora Pinto, Elif Colak, Elijah Dixon, Elisa Reitano, Emiko Sultana, Emily C Mills, Eric J Ley, Erik Osterman, Evan G Pivalizza, Evripidis Tokidis, Ewen A Griffiths, Anne-Cécile Ezanno, Fausto Catena, Federica Pederiva, Federico Coccolini, Felix Nickel, Ferdinando Agresta, Fernando Navarro Tovar, Fikri M Abu-Zidan, Filip Brzeszczyński, Michael El Boghdady, Flavio Roberto Takeda, Francesco Fleres, Francesca Pecchini, Francesco Maria Carrano, Francesco Pata, Francesk Mulita, Fredrik Klevebro, Gabriel Rodrigues, Gaetano Gallo, Gaetano Poillucci, Gary Alan Bass, Geeta Aggarwal, Gennaro Perrone, Geoffrey Roberts, Georgios Koukoulis, Georgios Zacharis, Gian Luca Baiocchi, Gianluca Pellino, Giorgio Lisi, Giovanni Dapri, Giuseppe Brisinda, Goran Augustin, Grigorios Christodoulidis, Guglielmo Imbriaco, Guillaume Ducarme, H Kemal Rasa, Peter W Hamer, Hans Lederhuber, Haralds Plaudis, Hayaki Uchino, Hazem Beji, Henry J M Ferguson, Hugo M L Cohen, Iain Wilson, Igor A Kryvoruchko, Ilari Kuitunen, Ilaria Benzoni, Ilenia Merlini, Ilze Ose, Imtiaz Wani, Ines Gockel, Ionut Negoi, Irena Gribovskaja-Rupp, Ivan Tomasi, Iyiade Olatunde Olaoye, J Cleo Kenington, J Scott Roth, Jacob Rosenberg, Jacopo Viganò, James Matthew Lloyd Williamson, Jan J De Waele, Jason E Smith, Jeffry Nahmias, Jennifer L Stevens, Jennifer Rickard, Jin Jiun Mah, Job F Waalwijk, Jonathan B Yuval, Joonas H Kauppila, Joseph Cuschieri, Joshua B Brown, Juan Gomez Rivas, Juliet Emamaullee, K Lasithiotakis, Katherine McKenzie, Kazuhide Matsushima, A I Koivusalo, L Max Almond, Lars Konge, Lars N Jorgensen, Laurent Genser, Lena M Napolitano, Leo R Brown, Lewis J Kaplan, Luca Degrate, Luigi Bonavina, Lynne Moore, Mahir Gachabayov, Mamun David Dornseifer, Manjunath Siddaiah-Subramanya, Mansour Abdulshafea, Marcelo A F Ribeiro Junior, Marcello Migliore, Marco Ceresoli, Marco Clementi, Marco Scarpa, Maria Olausson, Mariana R F Sousa, Mario Giuffrida, Mario D'Oria, Mario Pacilli, Martin Czerny, Martin Reichert, Martin Rutegård, Maryam Bahreini, Matthew J Lee, Matthew J Martin, Matti Tolonen, Matyas Fehervari, Maurizio Rho, Mauro Podda, Maxime Léger, Maximos Frountzas, Meer M Chisthi, Meghan R Lewis, Mélanie Bérubé, Melissa Oliveira-Cunha, Max E R Marsden, Mesut Tez, Micaela Piccoli, Michael F Bath, Michael Flanagan, Michael Gottlieb, Michael L Pearl, Michael P Achiam, Michael Swart, Mika Ukkonen, Miklosh Bala, Mohamed Ebrahim, Mohammed N AlAli, Monica Ortenzi, Montassar Ghalleb, Morten Hylander Møller, Muhammad R Iqbal, Muhammed A Ali, Munir Tarazi, Nicholas J Newton, Nader M Hanna, Nadia A Henriksen, Natalie S Blencowe, Neil Merrett, Neil T Welch, Nicola Colucci, Nicola de'Angelis, Nicola Latronico, Nicole L Werner, Niels D Martin, Nikolaos Machairas, Nikolay Bugaev, Ning Qi Pang, Obinna Obinwa, Onigbinde Oluwanisola Akanji, Panagiotis Kapsampelis, Paola De Nardi, Paolo Vincenzi, Patricio Lamoza Kohan, Philip H Pucher, Philip J J Herrod, Philip W Y Chiu, Pierluigi Marzuillo, Pierpaolo Sileri, Pietro Fransvea, Pradeep H Navsaria, Predescu Dragos Valentin, Roel Bakx, Rachel L Choron, Rahul Gupta, Rao R Ivatury, Raquel Diaz, Rebecca Anne Bradley, Reitano Elisa, René M Palacios Huatuco, Reza Shahriarirad, Rishi Rattan, Riyad Karmy-Jones, Robert G Sawyer, Robert J S Coelen, Roberto Cirocchi, Rondi B Gelbard, Roxanna Zakeri, Rui Farinha, Rutger M Schols, Ryan P Dumas, Salomone Di Saverio, Samik Kumar Bandyopadhyay, Samir Delibegovic, Sean Stevens, Sergio M Navarro, Shamita Chatterjee, Stamatios Petousis, Stavros Gourgiotis, Stephanie M Streit, Suman Baral, Sunaina T Karna, Susan Moug, Susan Yoong, Suzanne S Gisbertz, Tareq Kheirbek, Teoh Yuen-Chun Jeremy, Therese M Duane, Thomas Korgaard Jensen, Tim Bright, Timothy Craig Hardcastle, Triantafyllou Tania, Vahagn C Nikolian, Valentina Bianchi, Victor Kong, Vincenzo Trapani, Vishal G Shelat, Vishnu R Mani, Vladimir M Khokha, Wah Yang, Waleed Al-Khyatt, Yick Ho Lam, Yu Kijima, Yunfeng Cui, Zane B Perkins, Zaza Demetrashvili, Zi Qin Ng

Affiliations

¹ Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
² NIHR Global Health Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham, Birmingham, UK.
³ East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham, UK.
⁴ Division of Trauma and Acute Care Surgery, Department of Surgery, Los Angeles County & USC Medical Center, Los Angeles, California, USA.
⁵ The Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁶ Department of General Surgery, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
⁷ School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia.
⁸ Department of General Surgery, Salford Royal NHS Foundation Trust, Salford, UK.
⁹ Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.

PMID: 38949628
DOI: 10.1093/bjsopen/zrad145

Abstract

Background: Textbook outcomes are composite outcome measures that reflect the ideal overall experience for patients. There are many of these in the elective surgery literature but no textbook outcomes have been proposed for patients following emergency laparotomy. The aim was to achieve international consensus amongst experts and patients for the best Textbook Outcomes for non-trauma and trauma emergency laparotomy.

Methods: A modified Delphi exercise was undertaken with three planned rounds to achieve consensus regarding the best Textbook Outcomes based on the category, number and importance (Likert scale of 1-5) of individual outcome measures. There were separate questions for non-trauma and trauma. A patient engagement exercise was undertaken after round 2 to inform the final round.

Results: A total of 337 participants from 53 countries participated in all three rounds of the exercise. The final Textbook Outcomes were divided into 'early' and 'longer-term'. For non-trauma patients the proposed early Textbook Outcome was 'Discharged from hospital without serious postoperative complications (Clavien-Dindo ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation or death). For trauma patients it was 'Discharged from hospital without unexpected transfusion after haemostasis, and no serious postoperative complications (adapted Clavien-Dindo for trauma ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation on or death)'. The longer-term Textbook Outcome for both non-trauma and trauma was 'Achieved the early Textbook Outcome, and restoration of baseline quality of life at 1 year'.

Conclusion: Early and longer-term Textbook Outcomes have been agreed by an international consensus of experts for non-trauma and trauma emergency laparotomy. These now require clinical validation with patient data.

MeSH terms

Consensus
Delphi Technique*
Emergencies
Humans
Laparotomy* / adverse effects
Outcome Assessment, Health Care
Postoperative Complications / etiology

Grants and funding

Royal College of Surgeons of England