Novel Textbook Outcomes following emergency laparotomy: Delphi exercise

Area of Science:

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

Background:

• Textbook outcomes define ideal patient experiences but are lacking for emergency laparotomy.
• Emergency laparotomy is a high-risk procedure with significant patient morbidity and mortality.
• Establishing consensus on desired outcomes is crucial for improving care quality.

Purpose of the Study:

• To achieve international consensus on textbook outcomes for emergency laparotomy.
• To define ideal early and longer-term outcomes for both non-trauma and trauma patients.
• To involve both expert clinicians and patients in outcome definition.

Main Methods:

• A modified Delphi exercise involving 337 participants from 53 countries across three rounds.
• Separate outcome measures were considered for non-trauma and trauma emergency laparotomy.
• A patient engagement exercise informed the final round of expert consensus.

Main Results:

• Agreed early textbook outcome for non-trauma: discharge without serious complications (Clavien-Dindo ≥ grade III).
• Agreed early textbook outcome for trauma: discharge without unexpected transfusion or serious complications (adapted Clavien-Dindo ≥ grade III).
• Agreed longer-term outcome for both: achieving early outcome and baseline quality of life restoration at 1 year.

Conclusions:

• International consensus reached on early and longer-term textbook outcomes for emergency laparotomy.
• Defined outcomes provide a benchmark for ideal patient recovery after emergency laparotomy.
• Clinical validation of these agreed-upon outcomes using patient data is the next critical step.