Background: Major surgery is a term frequently used but poorly defined. The aim of the present study was to reach a consensus in the definition of major surgery within a panel of expert surgeons from the European Surgical Association (ESA). Methods: A 3-round Delphi process was performed. All ESA members were invited to participate in the expert panel. In round 1, experts were inquired by open- and closed-ended questions on potential criteria to define major surgery. Results were analyzed and presented back anonymously to the panel within next rounds. Closed-ended questions in round 2 and 3 were either binary or statements to be rated on a Likert scale ranging from 1 (strong disagreement) to 5 (strong agreement). Participants were sent 3 reminders at 2-week intervals for each round. 70% of agreement was considered to indicate consensus. Results: Out of 305 ESA members, 67 (22%) answered all the 3 rounds. Significant comorbidities were the only preoperative factor retained to define major surgery (78%). Vascular clampage or organ ischemia (92%), high intraoperative blood loss (90%), high noradrenalin requirements (77%), long operative time (73%) and perioperative blood transfusion (70%) were procedure-related factors that reached consensus. Regarding postoperative factors, systemic inflammatory response (76%) and the need for intensive or intermediate care (88%) reached consensus. Consequences of major surgery were high morbidity (>30% overall) and mortality (>2%). Conclusion: ESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences and consecutive clinical outcomes.
Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members / Martin D.; Mantziari S.; Demartines N.; Hubner M.; Bismuth H.; Sarr M.G.; Strasberg S.M.; Wexner S.D.; Adham M.; Altomare D.F.; Andersson R.; Bechstein W.; Biondo S.; Bockhorn M.; Bonavina L.; Rituerto D.C.; Clavien P.-A.; De Manzini N.; Decker G.; Dejong C.H.; Dervenis C.; Farges O.; Figueras J.; Fingerhut A.L.; Friess H.; Glehen O.; Gnant M.; Gutschow C.; Hahnloser D.; Hamberger B.; Hamming J.F.; Holscher A.H.; Izbicki J.R.; Jonas S.; Karamarkovic A.; Kehlet H.; Leppaniemi A.K.; Lerut J.; Line P.-D.; Lodge J.P.A.; Meakins J.L.; Montorsi M.; Nafteux P.; Naredi P.; Olah A.; Panis Y.; Pardo F.; Parks R.W.; Pedrazzoli S.; Pessaux P.; Marques H.P.; Poggioli G.; Popescu I.; Puolakkainen P.A.; Ramia Angel J.M.; Rasanen J.; Reynolds J.V.; Rosati R.; Saeger H.-D.; Schneeberger S.; Schneider P.M.; Soreide K.; Stippel D.; Toso C.; Tuech J.-J.; Tukiainen E.J.; Van Hillegersberg R.; Wijnhoven B.; Winter D.C.; Zaninotto G.. - In: WORLD JOURNAL OF SURGERY. - ISSN 0364-2313. - ELETTRONICO. - 44:7(2020), pp. 2211-2219. [10.1007/s00268-020-05476-4]
Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members
Poggioli G.;
2020
Abstract
Background: Major surgery is a term frequently used but poorly defined. The aim of the present study was to reach a consensus in the definition of major surgery within a panel of expert surgeons from the European Surgical Association (ESA). Methods: A 3-round Delphi process was performed. All ESA members were invited to participate in the expert panel. In round 1, experts were inquired by open- and closed-ended questions on potential criteria to define major surgery. Results were analyzed and presented back anonymously to the panel within next rounds. Closed-ended questions in round 2 and 3 were either binary or statements to be rated on a Likert scale ranging from 1 (strong disagreement) to 5 (strong agreement). Participants were sent 3 reminders at 2-week intervals for each round. 70% of agreement was considered to indicate consensus. Results: Out of 305 ESA members, 67 (22%) answered all the 3 rounds. Significant comorbidities were the only preoperative factor retained to define major surgery (78%). Vascular clampage or organ ischemia (92%), high intraoperative blood loss (90%), high noradrenalin requirements (77%), long operative time (73%) and perioperative blood transfusion (70%) were procedure-related factors that reached consensus. Regarding postoperative factors, systemic inflammatory response (76%) and the need for intensive or intermediate care (88%) reached consensus. Consequences of major surgery were high morbidity (>30% overall) and mortality (>2%). Conclusion: ESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences and consecutive clinical outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
