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; Christian Sylvest Meyhoff; Jacob Rosenberg; Lars Konge; Lars Nannestad Jørgensen; Michael Patrick Achiam; Mohamed Ebrahim; Morten Hylander Møller; Nadia Henriksen; Thomas Korgaard Jensen

doi:10.1093/bjsopen/zrad145

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 , Christian Sylvest Meyhoff (Member of study group), Jacob Rosenberg (Member of study group), Lars Konge (Member of study group), Lars Nannestad Jørgensen (Member of study group), Michael Patrick Achiam (Member of study group), Mohamed Ebrahim (Member of study group), Morten Hylander Møller (Member of study group), Nadia Henriksen (Member of study group)Thomas Korgaard Jensen (Member of study group)

^*Corresponding author for this work

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.

Original language	English
Article number	zrad145
Journal	BJS open
Volume	8
Issue number	1
ISSN	2474-9842
DOIs	https://doi.org/10.1093/bjsopen/zrad145
Publication status	Published - 1 Feb 2024

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10.1093/bjsopen/zrad145

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Naumann, D. N., Bhangu, A., Brooks, A., Martin, M., Cotton, B. A., Khan, M., Midwinter, M. J., Pearce, L., Bowley, D. M., Holcomb, J. B., Griffiths, E. A., BEACON Collaborative , Meyhoff, C. S., Rosenberg, J., Konge, L., Jørgensen, L. N., Achiam, M. P., Ebrahim, M., Møller, M. H., ... Jensen, T. K. (2024). Novel Textbook Outcomes following emergency laparotomy: Delphi exercise. BJS open, 8(1), Article zrad145. https://doi.org/10.1093/bjsopen/zrad145

Naumann, DN, Bhangu, A, Brooks, A, Martin, M, Cotton, BA, Khan, M, Midwinter, MJ, Pearce, L, Bowley, DM, Holcomb, JB, Griffiths, EA, BEACON Collaborative , Meyhoff, CS , Rosenberg, J , Konge, L , Jørgensen, LN , Achiam, MP , Ebrahim, M , Møller, MH , Henriksen, N & Jensen, TK 2024, 'Novel Textbook Outcomes following emergency laparotomy: Delphi exercise', BJS open, vol. 8, no. 1, zrad145. https://doi.org/10.1093/bjsopen/zrad145

@article{6f954eca54384e60ae15750fce0fce71,

title = "Novel Textbook Outcomes following emergency laparotomy: Delphi exercise",

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.",

author = "Naumann, {David N} and Aneel Bhangu and Adam Brooks and Matthew Martin and Cotton, {Bryan A} and Mansoor Khan and Midwinter, {Mark J} and Lyndsay Pearce and Bowley, {Douglas M} and Holcomb, {John B} and Griffiths, {Ewen A} and {BEACON Collaborative} and Meyhoff, {Christian Sylvest} and Jacob Rosenberg and Lars Konge and J{\o}rgensen, {Lars Nannestad} and Achiam, {Michael Patrick} and Mohamed Ebrahim and M{\o}ller, {Morten Hylander} and Nadia Henriksen and Jensen, {Thomas Korgaard}",

note = "{\textcopyright} The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.",

year = "2024",

month = feb,

day = "1",

doi = "10.1093/bjsopen/zrad145",

language = "English",

volume = "8",

journal = "BJS open",

issn = "2474-9842",

publisher = "John Wiley & Sons Ltd.",

number = "1",

}

TY - JOUR

T1 - Novel Textbook Outcomes following emergency laparotomy

T2 - Delphi exercise

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 - BEACON Collaborative

A2 - Meyhoff, Christian Sylvest

A2 - Rosenberg, Jacob

A2 - Konge, Lars

A2 - Jørgensen, Lars Nannestad

A2 - Achiam, Michael Patrick

A2 - Ebrahim, Mohamed

A2 - Møller, Morten Hylander

A2 - Henriksen, Nadia

A2 - Jensen, Thomas Korgaard

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.

UR - http://www.scopus.com/inward/record.url?scp=85183736629&partnerID=8YFLogxK

U2 - 10.1093/bjsopen/zrad145

DO - 10.1093/bjsopen/zrad145

M3 - Journal article

C2 - 38284399

SN - 2474-9842

VL - 8

JO - BJS open

JF - BJS open

IS - 1

M1 - zrad145

ER -

Novel Textbook Outcomes following emergency laparotomy: Delphi exercise

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