Novel Textbook Outcomes following emergency laparotomy: Delphi exercise

Area of Science:

• Surgical Outcomes Research
• Patient-Centered Care
• Global Health

Background:

• Textbook outcomes are ideal patient experience measures, widely used in elective surgery.
• No established textbook outcomes exist for emergency laparotomy patients.
• This study aimed to establish consensus on textbook outcomes for emergency laparotomy.

Purpose of the Study:

• To achieve international consensus on textbook outcomes for non-trauma and trauma emergency laparotomy.
• To define both early and longer-term outcomes.
• To incorporate patient perspectives into outcome definitions.

Main Methods:

• A modified Delphi exercise involving three rounds was conducted.
• Consensus was sought on the category, number, and importance of outcome measures.
• A patient engagement exercise informed the final round of expert consensus.

Main Results:

• 337 participants from 53 countries contributed to the consensus.
• Early non-trauma outcome: Discharge without serious complications (Clavien-Dindo ≥ grade III).
• Early trauma outcome: Discharge without unexpected transfusion or serious complications (adapted Clavien-Dindo ≥ grade III).
• Longer-term outcome for both: Achieving early outcome and baseline quality of life at 1 year.

Conclusions:

• International consensus was reached on early and longer-term textbook outcomes for emergency laparotomy.
• Defined outcomes apply to both non-trauma and trauma patient groups.
• Clinical validation of these proposed outcomes using patient data is the next step.