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; Adam Abu-Abeid; 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; Aly Fayed; 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; BEACON Collaborative; Rutger Schols

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, Adam Abu-Abeid, Adam Peckham-Cooper, Adam R. Dyas, Ademola Adeyeye, Agron Dogjani, Alasdair C.Y. Ball, Albert M. Wolthuis, Alejandro Quiroga-Garza, Aleksandar R. KaramarkovicAlessio Giordano, Alexander Fuchs, Alexander Julianov, Alexander W. Phillips, Alexander Zimmermann, Alexandros Charalabopoulos, Alexei A. Birkun, Alexis Rafael Narvaez-Rojas, Ali Guner, Aly Fayed, 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, BEACON Collaborative, Rutger Schols

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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
Number of pages	9
Journal	BJS Open
Volume	8
Issue number	1
DOIs	https://doi.org/10.1093/bjsopen/zrad145
Publication status	Published - 1 Feb 2024

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10.1093/bjsopen/zrad145Licence: CC BY

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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., Abu-Abeid, A., Peckham-Cooper, A., Dyas, A. R., Adeyeye, A., Dogjani, A., Ball, A. C. Y., Wolthuis, A. M., Quiroga-Garza, A., ... Schols, R. (2024). Novel Textbook Outcomes following emergency laparotomy: Delphi exercise. BJS Open, 8(1), Article zrad145. https://doi.org/10.1093/bjsopen/zrad145

@article{749bf46e5b684951a8f4aa7e500e06f1,

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 {\textquoteleft}early{\textquoteright} and {\textquoteleft}longer-term{\textquoteright}. For non-trauma patients the proposed early Textbook Outcome was {\textquoteleft}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 {\textquoteleft}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){\textquoteright}. The longer-term Textbook Outcome for both non-trauma and trauma was {\textquoteleft}Achieved the early Textbook Outcome, and restoration of baseline quality of life at 1 year{\textquoteright}. 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 Adam Abu-Abeid and Adam Peckham-Cooper and Dyas, {Adam R.} and Ademola Adeyeye and Agron Dogjani and Ball, {Alasdair C.Y.} and Wolthuis, {Albert M.} and Alejandro Quiroga-Garza and Karamarkovic, {Aleksandar R.} and Alessio Giordano and Alexander Fuchs and Alexander Julianov and Phillips, {Alexander W.} and Alexander Zimmermann and Alexandros Charalabopoulos and Birkun, {Alexei A.} and Narvaez-Rojas, {Alexis Rafael} and Ali Guner and Aly Fayed and Davis, {Amelia L.} and Andras Vereczkei and Andrea Balla and Andrea Celotti and Andrea Romanzi and Andrea Trombetta and Beggs, {Andrew D.} and Robertson, {Andrew G.} and Andrew Petrosoniak and Davies, {Andrew R.} and {\'A}ngel Becerra-Bola{\~n}os and Anthony Loria and Antonio Brillantino and Antonios Athanasiou and Arda Isik and Argyrios Ioannidis and Santos, {Ariel P.} and Saha, {Arin K.} and Arturo Vilches-Moraga and Choudhry, {Asad J.} and {BEACON Collaborative} and Rutger Schols",

note = "Funding Information: J.B.H. is on the board of directors of Decisio Health, CCJ Medical Devices, QinFlow, Hemostatics, Zibrio and Oxyband. He receives research grant support from the DoD, DARPA, NIH and CSL focused on haemorrhage control and resuscitation. He consults with BARDA, WFIRM, and Aspen Medical, is the co-inventor of the Junctional Emergency Tourniquet Tool and receives royalties from UT Health. All remaining authors declare no other conflicts of interest. Funding Information: The present study was funded by the Royal College of Surgeons of England as a Pump Primer Grant to the lead author. Publisher Copyright: {\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 Inc.",

number = "1",

}

Naumann, DN, Bhangu, A, Brooks, A, Martin, M, Cotton, BA, Khan, M, Midwinter, MJ, Pearce, L, Bowley, DM, Holcomb, JB, Griffiths, EA, Abu-Abeid, A, Peckham-Cooper, A, Dyas, AR, Adeyeye, A, Dogjani, A, Ball, ACY, Wolthuis, AM, Quiroga-Garza, A, Karamarkovic, AR, Giordano, A, Fuchs, A, Julianov, A, Phillips, AW, Zimmermann, A, Charalabopoulos, A, Birkun, AA, Narvaez-Rojas, AR, Guner, A, Fayed, A, Davis, AL, Vereczkei, A, Balla, A, Celotti, A, Romanzi, A, Trombetta, A, Beggs, AD, Robertson, AG, Petrosoniak, A, Davies, AR, Becerra-Bolaños, Á, Loria, A, Brillantino, A, Athanasiou, A, Isik, A, Ioannidis, A, Santos, AP, Saha, AK, Vilches-Moraga, A, Choudhry, AJ, BEACON Collaborative & Schols, R 2024, 'Novel Textbook Outcomes following emergency laparotomy: Delphi exercise', BJS Open, vol. 8, no. 1, zrad145. https://doi.org/10.1093/bjsopen/zrad145

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 - 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 - Vilches-Moraga, Arturo

AU - Choudhry, Asad J.

AU - BEACON Collaborative

AU - Schols, Rutger

N1 - Funding Information: J.B.H. is on the board of directors of Decisio Health, CCJ Medical Devices, QinFlow, Hemostatics, Zibrio and Oxyband. He receives research grant support from the DoD, DARPA, NIH and CSL focused on haemorrhage control and resuscitation. He consults with BARDA, WFIRM, and Aspen Medical, is the co-inventor of the Junctional Emergency Tourniquet Tool and receives royalties from UT Health. All remaining authors declare no other conflicts of interest. Funding Information: The present study was funded by the Royal College of Surgeons of England as a Pump Primer Grant to the lead author. 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.

U2 - 10.1093/bjsopen/zrad145

DO - 10.1093/bjsopen/zrad145

M3 - Article

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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