TY - JOUR
T1 - Novel Textbook Outcomes following emergency laparotomy
T2 - Delphi exercise
AU - BEACON Collaborative
AU - Naumann, David N.
AU - Bhangu, Aneel
AU - Brooks, Adam
AU - Martin, Matthew
AU - Cotton, Bryan A.
AU - Khan, Mansoor
AU - Midwinter, Mark J.
AU - Pearce, Lyndsay
AU - Bowley, Douglas M.
AU - Holcomb, John B.
AU - Griffiths, Ewen A.
AU - Abu-Abeid, Adam
AU - Peckham-Cooper, Adam
AU - Dyas, Adam R.
AU - Adeyeye, Ademola
AU - Dogjani, Agron
AU - Ball, Alasdair C.Y.
AU - Wolthuis, Albert M.
AU - Quiroga-Garza, Alejandro
AU - Karamarkovic, Aleksandar R.
AU - Giordano, Alessio
AU - Fuchs, Alexander
AU - Julianov, Alexander
AU - Phillips, Alexander W.
AU - Zimmermann, Alexander
AU - Charalabopoulos, Alexandros
AU - Birkun, Alexei A.
AU - Narvaez-Rojas, Alexis Rafael
AU - Guner, Ali
AU - Fayed, Aly
AU - Davis, Amelia L.
AU - Vereczkei, Andras
AU - Balla, Andrea
AU - Celotti, Andrea
AU - Romanzi, Andrea
AU - Trombetta, Andrea
AU - Beggs, Andrew D.
AU - Robertson, Andrew G.
AU - Petrosoniak, Andrew
AU - Davies, Andrew R.
AU - Becerra-Bolaños, Ángel
AU - Loria, Anthony
AU - Brillantino, Antonio
AU - Athanasiou, Antonios
AU - Isik, Arda
AU - Ioannidis, Argyrios
AU - Santos, Ariel P.
AU - Saha, Arin K.
AU - Chan, David S.Y.
AU - Smith, Jason E.
N1 - Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - 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.
AB - 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.
KW - Humans
KW - Laparotomy/adverse effects
KW - Quality of Life
KW - Outcome Assessment, Health Care
KW - Sepsis
KW - Postoperative Complications
UR - https://www.scopus.com/pages/publications/85183736629
UR - https://pearl.plymouth.ac.uk/pms-research/1229/
U2 - 10.1093/bjsopen/zrad145
DO - 10.1093/bjsopen/zrad145
M3 - Article
C2 - 38284399
AN - SCOPUS:85183736629
SN - 2474-9842
VL - 8
JO - BJS Open
JF - BJS Open
IS - 1
M1 - zrad145
ER -